Friday, April 23, 1999 Published at 02:17 GMT 03:17 UK
Suicide risk of 'recovering' patients
Some mentally ill people who commit suicide may seem to be getting better
People with mental health problems may remain at high risk of committing suicide for some time after they appear to be well, according to a study.
It found a strong link between suicide and reducing supervision and treatment for people with a history of psychiatric inpatient care.
The researchers, led by Professor Louis Appleby of the School of Psychiatry and Behavioural Sciences at the University Hospital of South Manchester, say their findings suggest aftercare should continue for up to a year after a person at medium or high risk of suicide is deemed well.
The study, published in The Lancet, looked at suicides in the Greater Manchester area over a 30-month period.
Risk factors for suicide were assessed by two psychiatrists, based on case notes.
The researchers found that a third of the patients had a history of psychiatric inpatient admission.
Some 12% had been inpatients more than five years before their suicide and 5% were in-patients at the time they took their life.
The researchers studied 149 patients who committed suicide up to five years after admission to inpatient care.
Of these 95% committed suicide within a year of discharge.
Some 40% of people had a major affective disorder like depression, 24% were alcoholics, 23% wer schizophrenic, 5% had a personality disorder and 5% were dependent on drugs.
The most common risk factors for suicide was a history of self-harm, usually overdose.
The Samaritans says people who have attempted suicide are 100 times more likely to try to take their lives than average.
People dependent on drugs and alcohol are four times more likely to attempt suicide than average.
Suicides were likely to be assessed as falling into a moderate or high risk category, but there was no big difference between the two groups.
The researchers found that patients who took their lives were significantly more likely to have had their care reduced at their final appointment with a health worker because they were deemed to be improving or doing well.
This included a reduction in supervision and a cut in drug dosage. Most reductions were initiated by the patient.
Only around a third had an identifiable key worker - a key factor in the Care Programme Approach introduced in 1991 for vulnerable patients.
The researchers admit that it is difficult for psychiatrists to identify those most likely to commit suicide and call for a more precise definition of high risk.
And they say it would be too expensive to maintain care for all at risk mentally ill patients deemed to have improved.
They suggest instead that care should not be reduced for up to a year after a person at high risk of suicide is thought to have improved since this is the period when they are most in danger.
Judi Clements of mental health charity Mind said the study was "very timely" since the government is preparing to launch its national service framework on mental health.
She said it showed the need for continuing aftercare and support in other areas such as housing to prevent regression.
She said it was "appalling" that eight years after the implementation of care plans as a statutory right, very few mentally ill people discharged from hospital had them.
She hoped the national service frameworks would tighten up discharge planning and she called for resources to be more evenly spread between hospital care and community care.