Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006: a cross-sectional and before-and-after observational study

详细信息	查看全文 | 推荐本文 |

• 作者：David While ; PhD^a ; Harriet Bickley ; BA^a ; Alison Roscoe ; MSc^a ; Kirsten Windfuhr ; PhD^a ; Shaiyan Rahman ; MRCPsych^a ; Prof Jenny Shaw ; FRCPsych^a ; Prof Louis Appleby ; FRCPsych^a ; Prof Navneet Kapur ; FRCPsych^a ; ^{nav.kapur@manchester.ac.uk}
• 刊名：The Lancet
• 出版年：2012
• 期刊代码：182_01406736
• 类别：med
• 出版时间：17-23 March, 2012
• 卷：379
• 期：9820
• 页码：1005-1012
• 文件大小：247 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences

Summary

Background

Research investigating which aspects of mental health service provision are most effective in prevention of suicide is scarce. We aimed to examine the uptake of key mental health service recommendations over time and to investigate the association between their implementation and suicide rates.

Methods

We did a descriptive, cross-sectional, and before-and-after analysis of national suicide data in England and Wales. We collected data for individuals who died by suicide between 1997 and 2006 who were in contact with mental health services in the 12 months before death. Data were obtained as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. When denominator data were missing, we used information from the Mental Health Minimum Data Set. We compared suicide rates for services implementing most of the recommendations with those implementing fewer recommendations and examined rates before and after implementation. We stratified results for level of socioeconomic deprivation and size of service provider.

Findings

The average number of recommendations implemented increased from 0路3 per service in 1998 to 7路2 in 2006. Implementation of recommendations was associated with lower suicide rates in both cross-sectional and before-and-after analyses. The provision of 24 h crisis care was associated with the biggest fall in suicide rates: from 11路44 per 10鈥?00 patient contacts per year (95%CI 11路12-11路77) before to 9路32 (8路99-9路67) after (p<0路0001). Local policies on patients with dual diagnosis (10路55; 10路23-10路89 before vs 9路61; 9路18-10路05 after, p=0路0007) and multidisciplinary review after suicide (11路59; 11路31-11路88 before vs 10路48; 10路13-10路84 after, p<0路0001) were also associated with falling rates. Services that did not implement recommendations had little reduction in suicide. The biggest falls in suicide seemed to be in services with the most deprived catchment areas (incidence rate ratio 0路90; 95%CI 0路88-0路92) and the most patients (0路86; 0路84-0路88).

Interpretation

Our findings suggest that aspects of provision of mental health services can affect suicide rates in clinical populations. Investigation of the relation between new initiatives and suicide could help to inform future suicide prevention efforts and improve safety for patients receiving mental health care.

Funding

National Patient Safety Agency, UK.