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Suicide and Deliberate Self Harm Dr David Whitty Consultant Psychiatrist Poole CMHT Suicide Statistics 1 million people worldwide in 2000 (WHO) 16 per 100 000 worldwide 10 per 100 000 in England and Wales On average, 4,500/year in England (DoH) Most common methods Men: hanging Women: overdose The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness October 2016 Methods of suicide The commonest suicide method used by patients is hanging, a method that is hard to prevent outside institutional settings, with self-poisoning the second most common. The type of drug most often taken in fatal overdose in all UK countries is opiates, including both prescribed and illicit drugs, although the number of opiate deaths fell in 2014. Jumping from a height or in front of a train is the third most common method. Opiate analgesics should be subject to safer prescribing in primary care and accident and emergency departments, i.e. reduced use, short-term supplies. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness October 2016 The clinical and social characteristics of patients who die by suicide show a number of changes over the last 20 years. Certain risk factors have become more common as antecedents of suicide - these are the factors that services have to address to reduce risk. They include: isolation economic adversity alcohol and drug misuse recent self-harm The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness October 2016 Substance Misuse Over half the patients who died by suicide had a history of alcohol or drug misuse. There were national differences, with alcohol misuse a more common antecedent of suicide in Scotland and Northern Ireland, drug misuse more common in Scotland. However, a much smaller group was in contact with specialist substance misuse services. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness October 2016 There is evidence that economic factors are becoming more common as antecedents in patient suicides. Unemployment and homelessness have increased and 13% of patients who died by suicide had experienced serious financial difficulties in the previous 3 months. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness October 2016 Key elements of safer care in the wider health system: Psychosocial assessment of self-harm patients Safer prescribing of opiate and antidepressants Diagnosis and treatment of mental health problems especially depression in primary care Additional measures for men with mental ill-health, including services online and in non-clinical settings Suicide risk factors Men (3:1) Unemployed Living alone Middle aged/Elderly After discharge from hospital Previous DSH (1% suicide in next year) Increased risk of suicide Mood disorder Schizophrenia Alcohol and drug dependence Personality disorder Physical ill-health: epilepsy, chronic medical conditions Deliberate Self Harm 3 per 1000 in Britain Commoner in younger people More common among females (but gap closing) Consequences of DSH Following an act of self-harm the rate of suicide increases to between 50 and 100 times the rate of suicide in the general population (Hawton et al., 2003b; Owens et al., 2002). Men who self-harm are more than twice as likely to die by suicide as women and the risk increases greatly with age for both genders (Hawton et al., 2003b). It has been estimated that one-quarter of all people who die by suicide would have attended a general hospital following an act of self-harm in the previous year (Owens & House,1994). There is no good evidence to support the widely voiced opinion that people who harm themselves repeatedly, particularly by cutting, are less likely to die by suicide. Spectrum of Suicidality Passive SI Active SI Intent Plan How to ask about suicide Have things got so bad that you don’t want to go on? Have you thought what you might do? Have you taken any steps to put such a plan in place? How close do you think you are to trying to kill yourself? Roll play exercise Groups of 2 or 3 1 patient, 1 interviewer (1 observer)
