Transcript Improving Services, Reducing Suicide.

Improving services,
reducing suicide
Dr Kirsten Windfuhr
Senior Research Fellow & Senior Project Manager
National Confidential Inquiry into Suicide and
Homicide by People with Mental Illness (NCISH)
Centre for Mental Health and Risk
February 4 2015
Cheshire & Merseyside Suicide Reduction Summit
Suicide prevention is an imperative
What are the causes of suicide?
Clinical factors
•Mental illness
•Physical illness
•Previous suicidal
behaviour
•Drugs and alcohol
•Treatment
Psychological
factors
•Problem solving
•Hopelessness
•Impulsivity
•Aggression
Suicidal
Behaviour
Biological factors
•Genes
•Neurodevelopment
(Adapted from Gunnell and Lewis 2005)
Environmental
factors
•Early life experience
•Life events
•Socio-economic
conditions
•Societal attitudes
•Availability of
methods
Suicide in the UK; 1996/7-2012
General
population
UK
England
Wales
Scotland
N. Ireland
100,329
78,170
5,475
13,235
3,449
26,216
20,300
1,260
3,705
951
(26%)
(26%)
(23%)
(28%)
(28%)
NCISH
In contact
with MH
services
UK_SUICIDE
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What are national and local trends?
Source: Public Health England; Health Profiles
http://www.phoutcomes.info/profile/health-profiles/data#gid/1938132696/pat/6/ati/102/page/4/par/E12000002/are/E08000003
Suicide prevention and primary care
“GPs can make a big difference to overall
suicide rates.” (DH, 2014)
“Primary care services have
a crucial role in addressing
mental health problems and
assessing suicide risk.”
“The RCGP/RCPsych have
issued a helpful factsheet on
managing suicide risk in
primary care.”
“Research is essential to inform
effective suicide prevention.”
Why are GPs central to reducing suicide?
1. Majority of people present to their GP prior to losing
their life to suicide
1: GP contact prior to suicide
GP contact: month prior
to suicide
Luoma et al., 2002 Am J Psychiatry
GP contact: year prior to
suicide
Why are GPs central to reducing suicide?
1. Majority of people present to their GP prior to losing
their life to suicide
2. A substantial proportion of people with mental illness
are managed in primary care
Why are GPs central to reducing suicide?
1. Majority of people present to their GP prior to losing
their life to suicide
2. A substantial proportion of people with mental illness
are managed in primary care
3. Suicide risk is greater in the context of mental illness
3: Suicide risk and mental illness
Proportion of suicide
deaths who had a mental
illness prior to death
Year prior to suicide:
mental health patient
suicide deaths
Cavanagh et al., 2003, Psych Med
Pearson et al., 2009, BJGP
•
Study of attendance
and clinical factors
•
10 years
•
Case control study
in primary care
•
Clinical Practice
Research Datalink
(CPRD)
Attendance
Patients who died by suicide:
consultation, diagnosis, treatment, and referral
Clinical time line
2,384 patients who died by suicide
Face-to-face GP consultation within 12
months of suicide [number= 1,504 (63%)]
Number of consultations in the 12 months
prior to suicide
>24
20-24
17-19
15-16
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
45
34
40
48
20
30
25
46
46
66
81
91
77
114
128
183
184
246
0
200
1,504
400
600
Number of suicides
880
800
1000
Risk and GP attendance frequency
12.3
7.8
Number of consultations in the time period
prior to suicide
Risk and GP attendance frequency
12.3
Characteristics of non-attenders:
• male
• younger
1.67
7.8
Suicide risk in primary care
•
Attendance
– frequent attendance
– increasing attendance
– non-attendance
Diagnosis
Patients who died by suicide:
consultation, diagnosis, treatment, and referral
2,384 patients who died by suicide
Clinical time line
Face-to-face GP consultation within 12 months of suicide
number= 1,504 (63%)
Mental health diagnosis (any time)
[number= 1,497 (63%)]
Diagnosis
•
Mental health diagnosis (at any time)
– 63% (v. 28% of living patients)
– mainly depression
•
Of patients with no diagnosis (37%)
– male
– 35-44
Suicide risk in primary care
•
Attendance
– frequent attendance
– increasing attendance
– non-attendance
•
Diagnosis
– under-recognition
Drug treatment
Patients who died by suicide:
consultation, diagnosis, treatment, and referral
2,384 patients who died by suicide
Clinical time line
Face-to-face GP consultation within 12 months of suicide
number= 1,504 (63%)
Mental health diagnosis (any time)
number= 1,497 (63%)
Psychotropic drug treatment within 12
months of suicide [number= 1,148 (48%)]
Managing mental illness:
suicide risk and multiple drug prescriptions
90
80
70
•
5x more likely to
have psychotropic
drugs prescribed
•
31% prescribed 2+
•
elevated risk with 4
or 5
60
Risk
50
40
30
20
10
0
0
1
2
3
Number of drug groups
4
5 or
more
Drug treatment
•
Multiple drug types
– Illness severity
– Inherent risks with complex prescribing
•
Risk
Suicide risk in primary care
•
Attendance
– frequent attendance
– increasing attendance
– non-attendance
•
Diagnosis
– under-recognition
•
Drug prescriptions
– multiple drug types
Key messages for services
• Markers of risk include
– frequent attendance
– increasing attendance
– non-attendance
– multiple drug prescriptions
• Markers could form basis of ‘flag’ alert in primary care
records
– further assessment, engagement
• Collaborative working with third sector, on-line support
National Confidential Inquiry into Suicide and
Homicide by People with Mental Illness
Website:
http://www.manchester.ac.uk/nci
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