Improving care, reducing harm
Suicide and self-harm are the most serious consequences of mental illness. Over 4,000 people take their lives every year in England making suicide the leading cause of premature death. As suicide occurs predominantly in young people, with over 50% of suicides occurring in the under 45s, it is a major contributor to potential years of life lost.
Joining up the dots
Almost half of those who die from suicide have been in contact with health services within a month of their death.
There are an estimated 200,000 hospital presentations for self-harm per year in England making it one of the commonest reasons for emergency admission. Over 30% of suicides have previously been in contact with health services following self-harm and over 20% of people who self-harm repeat their action within 12 months.
Whilst previous self-harm is one of the strongest risk factors for suicide, unemployment and easy access to high lethality suicide methods are the most potent influences on suicide rates. Based on this knowledge, and with these areas as the focus, researchers funded by the NIHR Programme Grant for Applied Research (PGfAR) programme collected evidence to inform the National Suicide Prevention Strategy. As well as a reduction in suicide rates, the team were looking to use their findings to improve the care of people who self-harm in England, addressing the variation across hospitals.
Research plans were developed with help from clinicians, policy makers, service users and Samaritans and a variety of methods were used to collect evidence including interviews, systematic reviews of existing research for assessing risk in people who self harm and the analysis of suicide data.
Informing best practice
The team identified patterns in access to medications and suicide levels, such as a reduction in pack sizes of paracetamol being followed by a 43% reduction of deaths over the next 11 years. They found that the withdrawal of co-proxamol from use in the UK resulted in approximately 600 fewer deaths than predicted between 2005 and 2010, based on previous trends.
Beyond this the research programme has made significant additions to the evidence base relating to suicide and self-harm prevention in the UK. This is informing the approach taken by UK professional and voluntary bodies to minimise the impact of the economic crisis on suicide. It also provides guidance for clinicians on how best to assess and manage patients who self-harm along with guidance for parents whose children self-harm.
Furthermore, findings from this study provide evidence to inform prescribing advice for medicines associated with high risk when taken in overdose, benefitting both regulatory bodies and clinicians.
This NIHR research is a collaboration between the universities of Bristol, Oxford and Manchester, with the Avon and Wiltshire Mental Health Partnership NHS Trust, Manchester Mental Health & Social Care Trust and Oxford Health NHS Foundation Trust. Over 15 collaborating researchers, service users and voluntary sector representatives are part of the research group.
Full publication available in the NIHR Journals Library: A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England.
If you’ve got a solution that could address unmet clinical need in mental health through medical technology you may be interested in applying for the 2018 NIHR Invention for Innovation (i4i) Challenge Award, open until 4 April.