Briefing - Suicide and severe mental illness

On average, two people with mental health problems commit suicide every day (Department of Health). Around 10 per cent of people diagnosed with schizophrenia will die an unnatural death, usually suicide, compared to a suicide incidence in the general population of 1 per cent.

• One suicide occurs every 88 minutes (1)
• A specified target in the Government’s White Paper, Our Healthier Nation is a reduction in suicides by at least 20% by 2010 from a 1999 baseline (2)
• 5,000 people kill themselves in the UK every year. 1,200 of these people have been in touch with mental health services in the past 12 months. Many of these are likely to be people with schizophrenia and under the age of 35 (3) 
• The suicide rate for patients with schizophrenia is 20-50 times greater than the suicide rate of the general population (4)
• Suicide is a leading cause of premature death in patients with schizophrenia (5) and the leading cause of suicide in patients with schizophrenia under the age of 35 (6) 
• Almost 50% of people with schizophrenia will attempt suicide in their lifetime (7)
• 10-13% of people with schizophrenia will take their own lives (5)
• One in 100 young women aged 15-19 will attempt suicide 
• Schizophrenia affects about 488,000 people in the UK (8,9) 
• Schizophrenia affects about 420,000 people in England and Wales
  alone (8,9) 
• Schizophrenia affects about 51,000 people in Scotland alone (8,9)
• Schizophrenia affects about 17,000 people in Northern Ireland alone (8,9)

Schizophrenia is a chronic and disabling illness that is distressing not only for people who have the disease, but also for their families and friends. It is sometimes (wrongly) described as split personality. In fact, schizophrenia causes a disintegration of personality, characterised by disturbances in thinking, mood, sense of self and relationship to the external world and behaviour

Well known symptoms include hallucinations and delusions, often referred to as ‘positive’ symptoms. These can be extremely frightening for people experiencing them – and sometimes sufferers will attempt to harm or kill themselves in order to escape, or as a result of their symptoms

Less well-known, but equally disabling are so-called ‘negative’ symptoms. These include self-neglect, apathy, a lack of self-care, feelings of depression and hopelessness. Negative symptoms adversely affect people’s quality of life, and are another reason why people with schizophrenia can experience suicidal thoughts and feelings.

However people with schizophrenia are not often driven to take their own lives by "voices" or by delusions, such as flying from a high building. People with a severe mental illness are likely to commit suicide for similar reasons to everyone else - the collapse of personal relationships, the loss of a job or home and so on - all factors likely to be created by the mental illness itself. The Office for National Statistics says that suicide rates are linked to poverty levels. Local authorities in which suicide rates are significantly high are characterised by high levels of deprivation. Local authorities with significantly low suicide rates tend to be those with low levels of deprivation. There is also a positive relationship between schizophrenia and poverty.

Suicides are not inevitable and can be prevented. In the community, proper support, financial security, safe accommodation and useful occupation in day centres and sheltered work settings for those without paid employment can all help. In a hospital setting, where many suicides take place, staff need to be fully trained in Risk Assessment And The Skills Of Prevention.

A study undertaken by the Centre for Suicide Prevention at the University of Manchester, as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, has found that one-third of in-patients suicides are preventable.

Suicide prevention is a health service priority. Previous research has identified psychiatric in-patients as a high-risk group for suicide. Such suicides occur in close proximity to mental health care, and therefore could be most amenable to prevention by psychiatric services.

The researchers carried out a national clinical survey based on a six-year (1996-2002) sample of suicides. Detailed information was collected on those who had been in contact with mental health services in the 12 months before death.

It was found that there were 32,524 suicides over the period studied and, of these, 8,253 (25%) were confirmed to have been in contact with mental health services in the previous year.

Completed questionnaires were received on 8,066 cases, a response rate of 98%. A total of 1,241 individuals (15% of the sample) died during an episode of in-patient care. 83% of the sample had either schizophrenia or a major affective disorder.

Around a third of in-patient suicides occurred on the ward itself, the majority by hanging, and using a belt as a ligature. In suicides that occurred off the ward, the majority (60%) of patients who completed suicide had been on agreed leave or had left with staff agreement.

One third of in-patient suicides were seen as preventable by mental health professionals. Suicides under observation were more often seen as preventable.

These results have been translated into policy by the requirement for all likely ligature points to be removed from psychiatric in-patient wards. Regular risk assessment and closer supervision are required, particularly in the first week after admission. In-patient services should review current practices with regard to non-routine observations and, where necessary, closely observe exits on open wards.