Previous reports have shown that around 1,585 mental health patients die by suicide in the UK each year. However, there is little evidence for how services reduce suicide. This investigation examined 17 key recommendations and service changes in mental health care, chosen because of their inclusion in a previous study or because they were in areas of policy or clinical priority.

This report summarizes key findings and puts forward the following key messages to mental health services.

1) provide specialist community services such as crisis resolution/home treatment, assertive outreach and services for patients with dual diagnosis

2) implement NICE guidance on depression

3) share information with criminal justice agencies

4) ensure physical safety, and reduce absconding on in-patient wards

5) create a learning culture based on multi- disciplinary review.

Published By: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

Publication Date: November 2013

View Patient Suicide: The Impact of Service Change

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