Early Post-Discharge Suicide in Mental Health Patients: Findings From a National Clinical Survey

Abstract

Studies on suicide by recently discharged mental health patients have reported a high number of deaths in the early post-discharge period, which has led to recommendations of follow-up within 7 days (d). More recently, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) proposed a more "stringent" follow-up period of 2-3 days (d) after discharge. Patients who died within this early time-frame post-discharge were more likely to die before the follow-up appointment occurred. They more often had a primary diagnosis of a personality disorder, self-discharged, and had a higher frequency of death by jumping from a height or in front of the vehicle compared to later deaths. This study provides practical implications for post-discharge management and safety planning. Clinicians should be aware of (1) the increased risk of immediate suicide in the post-discharge period by people with a diagnosis of personality disorder, (2) immediate suicide risk in patients who initiate their own discharge, and (3) the increased risk of death by jumping from a height or in front of the vehicle in the immediate post-discharge period. Our findings support the recent recommendation from NCISH that follow-up should occur within 3 d of discharge from in-patient care.

Keywords: follow-up; mental health patients; personality disorder; post-discharge; self-discharge; suicide method.

Figure 1

Frequency of deaths by suicide in England and Wales between 1st January 1997 until 31st December 2016 by discharge day (N = 826).

Figure 2

Rates of suicide per 100,000 admissions to psychiatric in-patient care per year in England and Wales between 1st January 1997 until 31st December 2015 for 3 d and 1 week group.

Figure 3

Rates of suicide per 100,000 discharges from psychiatric in-patient care per year in England and Wales between 1st January 1997 until 31st December 2015 for 3 d and 1 week group.