Supportive environment and intensive observation can prevent suicides among mental health patients

Between 1997 and 2006, 38% of out-of-clinic suicides by mental health patients were carried out by people absent without leave from the hospital. Researchers writing in the open access journal BMC Psychiatry suggest that measures to improve the ward environment or prevent patients from leaving psychiatric wards without staff agreement could avoid up to 50 suicide deaths every year.

Isabelle Hunt, from the University of Manchester, UK, worked with a team of researchers to investigate suicides in England and Wales over a ten-year period. There were 1,851 cases of suicide by current psychiatric in-patients, and 70% occurred off the ward. Four hundred and sixty-nine of these patients died after going absent without leave. Hunt said, "Compared to individuals who died when they were off the ward with staff agreement, those who absconded were more likely to be young, unemployed and homeless. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were more likely than inpatients on agreed leave to have been legally detained for treatment, be non-compliant with medication, and to die in the first week of admission".

The researchers suggest that a more supportive environment, tighter control of ward exits and more intensive observation of patients, particularly in the early days of admission, might be one way to limit the likelihood of a patient taking their own life. According to Hunt, "It is clearly a challenge to prevent patients leaving a general psychiatry open ward. Our findings can, however, inform staff of the clinical characteristics associated with absconding suicides, such as schizophrenia, substance misuse and noncompliance".