Exploring the risk to patients of dying by suicide or natural causes after discharge from inpatient mental health care

28 Feb

Rebecca Musgrove is a PhD Fellow funded by the NIHR GM PSTRC. Here, she discusses findings from her recent study which investigated suicide and other causes of death after discharge from inpatient mental health care.

Why carry out this research?

My colleagues and I wanted to do this research to provide up-to-date information on the risks of suicide and other causes of death for working age and older people recently discharged from mental health care.

We studied anonymous health records of over 100,000 people who had been recently discharged from hospital since 2001 in England and compared them to almost 2 million other people registered at GP practices.

I worked with our mental health service users and carers advisory group, called MS4MH-R, who helped me refine the plans for this study and provided important insight to help me to interpret the findings.

The study’s findings

  • Death by suicide after inpatient mental health discharge

The findings from our study showed that adults who have recently left inpatient mental health care continue to die by suicide at rates many times higher than other adults living in England. This agrees with similar findings in other countries. People admitted to hospital are very unwell and may have been admitted after a previous suicide attempt, so we know that they are likely to be at risk when they leave the relative protection of the hospital environment. The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) has been highlighting this issue and pushing for timely follow up support for many years. Planning for a safe discharge and transition and providing support are part of government policy and guidance.

This enduring risk suggests there must be a rethink on how people are supported throughout their hospital stay and once they return to living in the community. More needs to be done to ensure that the hospital environment is as therapeutic as possible. In addition, it is not enough that discharge plans and follow up visits exist. We believe changes need to happen to ensure that they provide the necessary support that each person requires.

  • Death by natural causes after inpatient mental health discharge

We found the risk of death from natural causes was higher in people leaving inpatient care than for other people of the same age and gender, living in the same area.

In working age adults this risk was the same throughout the post-discharge year, showing that it is probably not connected to their inpatient stay. Nevertheless, at this time of increased contact with health services there is an opportunity to engage with and support people to identify and manage ongoing physical health conditions.

However, we found that in older adults the highest risk of dying by natural causes was in the first three months after leaving hospital, and this was particularly concerning. Why might this be when these patients were admitted to hospital for their mental health rather than a physical health condition? 

Longer hospital stays were more common in adults aged over 65, so they may have more difficulty adjusting to life at home or in a care home. It is possible that the focus on their mental health means less attention is paid to underlying health conditions. The most common causes of death were heart disease and dementia, so it is important that these conditions are prioritised in people who need inpatient mental health care, particularly as our population ages further.

We suggest that after discharge, support for older adults should include assessment of physical health conditions, social support and that necessary adjustments are made to support day-to-day living.   

Mental health inpatient care in the NHS Long Term Plan

These findings make difficult reading, but the NHS in England recognises many of the issues raised by this study in their Long Term Plan. Their goal for inpatient care is “purposeful, patient-orientated and recovery-focused” within a therapeutic environment. They also recognise that alternatives to inpatient care may be better for some people and are investing in ‘crisis houses’ and further support in the community.

They have specifically committed to supporting older adults to avoid admission where possible, and if they need inpatient care to be able to access physical health support.

The NHS has faced immense challenges with the COVID-19 pandemic and pre-existing staffing challenges within the mental health sector, so it is essential that the goals of the long term plan remain a priority.

Mental health support

People seeking mental health support can contact their GP and ask for an emergency appointment, or call 111 after hours. For immediate mental health crises, call 999 or go to A&E. For further information about getting mental health help, visit Mind.

One Response to “Exploring the risk to patients of dying by suicide or natural causes after discharge from inpatient mental health care”

Trackbacks/Pingbacks

  1. NIHR ALERT: People discharged from inpatient mental healthcare are at increased risk of dying | GM PSTRC - August 1, 2022

    […] plain language summary and a blog by the author are […]

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