Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 46, Issue 8, pp 723–731 | Cite as

Suicide in high security hospital patients

  • Roland M. JonesEmail author
  • Heidi Hales
  • Martin Butwell
  • Mike Ferriter
  • Pamela J. Taylor
Original Paper

Abstract

Purpose

People with mental disorder and people who are violent are separately recognised as being at high risk of suicide. People detained in high security hospitals are recognised for their violence to others, but perhaps less so for their suicide potential. We aimed to investigate suicide rates among such patients during and after their high security hospital residency, and to establish risk factors for suicide.

Methods

We extracted data from the Special Hospitals’ Case Register on each person resident at any time between 1 January 1972 and 31 December 2000. Suicide rates were calculated for the whole period. We compared rates to the general population using standardised mortality ratios (SMRs). We used poisson regression to estimate the effects of gender, legal category of detention, offending history and length of admission on the suicide rate.

Results

Of the 5,955 individuals, 218 completed suicide. The suicide rate was nearly 7 times higher among resident men (SMR 662, 95% CI 478–845) and over 40 times higher in resident women (SMR 4,012, 95% CI 2,526–5,498) than in the general population; it was 23 times higher (SMR 2,325, 95% CI 1,901–2,751) and 45 times higher (SMR 4,486, 95% CI 2,727–6,245) among post-discharge men and women, respectively. The suicide rate was significantly higher among women than men inside high security but not after discharge.

Conclusions

The suicide rate among high security hospital patients was significantly higher than in the general population. Women were especially at risk while resident, whereas for men, the risk was higher after discharge.

Keywords

Suicide Forensic psychiatry Unnatural death Violence 

Notes

Acknowledgments

Many thanks to Robert Cawley, Winifred Höping and Morven Leese for all of their help in the planning and earlier phases of the study. Many thanks to all those in the Special Hospital Case Register Department who have helped collect and input the data, and of course to the patients themselves who gave so generously of their time in the interview process and consented to the longer term follow-up.

Conflict of interest statement

None.

References

  1. 1.
    Alaraisanen A, Miettunen J, Rasanen P, Fenton W, Koivumaa-Honkanen HT, Isohanni M (2009) Suicide rate in schizophrenia in the Northern Finland 1966 Birth Cohort. Soc Psych Psych Epid 44:1107–1110CrossRefGoogle Scholar
  2. 2.
    Appleby L, Shaw J, Amos T, McDonnell R, Harris C, McCann K, Kiernan K, Davies S, Bickley H, Parsons R (1999) Suicide within 12 months of contact with mental health services: national clinical survey. Br Med J 318:1235–1239Google Scholar
  3. 3.
    Appleby L, Shaw J, Kapur N (2006) Avoidable deaths. Five year report of the national confidential inquiry into suicide and homicide by people with mental illness. In: Report for the national patient safety agency, Department of healthGoogle Scholar
  4. 4.
    Baraclough B, Bunch J, Nelson B, Sainsbury P (1974) A hundred cases of suicide: clinical aspects. Br J Psychiatry 125:355–373CrossRefGoogle Scholar
  5. 5.
    Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD (2007) Release from prison—a high risk of death for former inmates. N Engl J Med 356:157–165PubMedCrossRefGoogle Scholar
  6. 6.
    Bjork T, Lindqvist P (2005) Mortality among mentally disordered offenders: a community based follow-up study. Crim Behav Ment Health 15:93–96PubMedCrossRefGoogle Scholar
  7. 7.
    Burtch BE (1979) Prisoner suicides reconsidered. Int J Law Psychiatry 2:407–413PubMedCrossRefGoogle Scholar
  8. 8.
    Corcoran E, Walsh D (2000) Suicide in psychiatric hospital in-patients in Ireland. Br J Psychiatry 177:181PubMedCrossRefGoogle Scholar
  9. 9.
    Davies S, Clarke M, Hollin C, Duggan C (2007) Long-term outcomes after discharge from medium secure care: a cause for concern. Br J Psychiatry 191:70–74PubMedCrossRefGoogle Scholar
  10. 10.
    DuRand CJ, Burtka GJ, Federman EJ, Haycox JA, Smith JW (1995) A quarter century of suicide in a major urban jail: implications for community psychiatry. Am J Psychiatry 152:1077–1080PubMedGoogle Scholar
  11. 11.
    Fazel S, Benning R, Danesh J (2005) Suicides in male prisoners in England and Wales, 1978–2003. Lancet 366:1301–1302PubMedCrossRefGoogle Scholar
  12. 12.
    Foster T, Gillespie K, McClelland R, Patterson C (1999) Risk factors for suicide independent of DSM-III-R axis I disorder. Case-control psychological autopsy study in Northern Ireland. Br J Psychiatry 175:175–179PubMedCrossRefGoogle Scholar
  13. 13.
    Fruehwald S, Matschnig T, Koenig F, Bauer P, Frottier P (2004) Suicide in custody: case-control study. Br J Psychiatry 185:494–498PubMedCrossRefGoogle Scholar
  14. 14.
    Geddes JR, Juszczak E (1995) Period trends in rate of suicide in first 28 days after discharge from psychiatric hospital in Scotland, 1968–92. Br Med J 311:357–360Google Scholar
  15. 15.
    Gordon H (2002) Suicide in secure psychiatric facilities. Adv Psychiatr Treat 8:408–417CrossRefGoogle Scholar
  16. 16.
    Hawton K (1994) Suicide. In: Paykel E, Jenkins R (eds) Prevention in psychiatry. Gaskell, LondonGoogle Scholar
  17. 17.
    Haycock J (1993) Comparative suicide rates in different types of involuntary confinement. Med Sci Law 33:128–136PubMedGoogle Scholar
  18. 18.
    Haycock J (1993) Double jeopardy: suicide rates in forensic hospitals. Suicide Life Threat Behav 23:130–138PubMedGoogle Scholar
  19. 19.
    Hiroeh U, Appleby L, Mortensen PB, Dunn G (2001) Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. Lancet 358:2110–2112PubMedCrossRefGoogle Scholar
  20. 20.
    Jenkins R, Bhugra D, Meltzer H, Singleton N, Bebbington P, Brugha T, Coid J, Farrell M, Lewis G, Paton J (2005) Psychiatric and social aspects of suicidal behaviour in prisons. Psychol Med 35:257–269PubMedCrossRefGoogle Scholar
  21. 21.
    Kapur N, Hunt IM, Webb R, Bickley H, Windfuhr K, Shaw J, Appleby L (2006) Suicide in psychiatric in-patients in England, 1997 to 2003. Psychol Med 36:1485–1492PubMedCrossRefGoogle Scholar
  22. 22.
    Lawlor D, Kosky R (1992) Serious suicide attempts among adolescents in custody. Aust N Z J Psychiatry 26:474–478PubMedCrossRefGoogle Scholar
  23. 23.
    Lesage A, Boyer R, Grunberg F, Vanier C, Morissette R, Menard-Buteau C, Loyer M (1994) Suicide and mental disorder: a case-control study of young men. Am J Psychiatry 151:1063–1068PubMedGoogle Scholar
  24. 24.
    Lieberman DZ, Resnik HL, Holder-Perkins V (2004) Environmental risk factors in hospital suicide. Suicide Life Threat Behav 34:448–453PubMedCrossRefGoogle Scholar
  25. 25.
    Lindqvist P, Leifman A, Eriksson A (2007) Mortality among homicide offenders: a retrospective population-based long-term follow-up. Crim Behav Ment Health 17:107–112PubMedCrossRefGoogle Scholar
  26. 26.
    Meehan J, Kapur N, Hunt IM, Turnbull P, Robinson J, Bickley H, Parsons R, Flynn S, Burns J, Amos T, Shaw J, Appleby L (2006) Suicide in mental health in-patients and within 3 months of discharge. National clinical survey. Br J Psychiatry 188:129–134PubMedCrossRefGoogle Scholar
  27. 27.
    Nock M, Marzuk P (2000) Suicide and violence. In: Hawton K, van Heeringen K (eds) The international handbook of suicide and attempted suicide. Wiley, Chichester, pp 437–456CrossRefGoogle Scholar
  28. 28.
    Perez-Carceles MD, Inigo C, Luna A, Osuna E (2001) Mortality in maximum security psychiatric hospital patients. Forensic Sci Int 119:279–283PubMedCrossRefGoogle Scholar
  29. 29.
    Powell J, Geddes J, Deeks J, Goldacre M, Hawton K (2000) Suicide in psychiatric hospital in-patients. Risk factors and their predictive power. Br J Psychiatry 176:266–272PubMedCrossRefGoogle Scholar
  30. 30.
    Pratt D, Piper M, Appleby L, Webb R, Shaw J (2006) Suicide in recently released prisoners: a population-based cohort study. Lancet 368:119–123PubMedCrossRefGoogle Scholar
  31. 31.
    Putkonen H, Komulainen E, Virkkunen M, Lonnqvist J (2001) Female homicide offenders have greatly increased mortality from unnatural deaths. Forensic Sci Int 119:221–224PubMedCrossRefGoogle Scholar
  32. 32.
    Qin P, Nordentoft M (2005) Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry 62:427–432PubMedCrossRefGoogle Scholar
  33. 33.
    Ramsay L, Gray C, White T (2001) A review of suicide within the State Hospital, Carstairs 1972–1996. Med Sci Law 41:97–101PubMedGoogle Scholar
  34. 34.
    Robertson G (1987) Mentally abnormal offenders—manner of death. Br Med J 295:632–634CrossRefGoogle Scholar
  35. 35.
    Robertson G (1987) Mentally abnormal offenders: manner of death. Br Med J 145:469–472Google Scholar
  36. 36.
    Salize H, Dreßing H (2005) Placement and treatment of mentally disordered offenders. Legislation and practice in EU member states. University of Mannhein, Mannheim, GermanyGoogle Scholar
  37. 37.
    Shaw J, Appleby L, Amos T, McDonnell R, Harris C, McCann K, Kiernan K, Davies S, Bickley H, Parsons R (1999) Mental disorder and clinical care in people convicted of homicide: national clinical survey. Br Med J 318:1240Google Scholar
  38. 38.
    Shaw J, Baker D, Hunt IM, Moloney A, Appleby L (2004) Suicide by prisoners. National clinical survey. Br J Psychiatry 184:263–267PubMedCrossRefGoogle Scholar
  39. 39.
    Shaw S, Sims A (1984) A survey of unexpected deaths among psychiatric in-patients and ex-patients. Br J Psychiatry 145:473–476PubMedCrossRefGoogle Scholar
  40. 40.
    Steels M, Roney G, Larkin E, Jones P, Croudace T, Duggan C (1998) Discharged from special hospital under restrictions: a comparison of the fates of psychopaths and the mentally ill. Crim Behav Ment Health 8:39–55CrossRefGoogle Scholar
  41. 41.
    Stone M (1990) The fate of borderline patients. Guillford Press, LondonGoogle Scholar
  42. 42.
    Taylor P, Dunn E, Felthous AR, Gagné P, Harding T, Kramp P, Lindqvist P, Ogloff JP, Nedopil N, Skipworth J, Thomson L, Yoshikawa K (2010) Forensic psychiatry and its interfaces outside the UK: comparisons across five continents. In: Gunn J, Taylor PJ (eds) Forensic psychiatry. Clinical legal and ethical issues. Hodder, LondonGoogle Scholar
  43. 43.
    Tidemalm D, Elofsson S, Stefansson CG, Waern M, Runeson B (2005) Predictors of suicide in a community-based cohort of individuals with severe mental disorder. Soc Psych Psych Epid 40:595–600CrossRefGoogle Scholar
  44. 44.
    West D (1967) Murder followed by suicide. Harvard University Press, Cambridge, MAGoogle Scholar
  45. 45.
    WHO (2007) Suicide rates per 100,000 by country, year and sex. http://www.who.int/mental_health/prevention/suicide_rates/en/index.html
  46. 46.
    Yen S, Shea MT, Pagano M, Sanislow CA, Grilo CM, McGlashan TH, Skodol AE, Bender DS, Zanarini MC, Gunderson JG, Morey LC (2003) Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study. J Abnorm Psychol 112:375–381PubMedCrossRefGoogle Scholar
  47. 47.
    Zilber N, Shufman N, Larner Y (1989) Mortality among psychiatric patients—the groups at risk. Acta Psychiatr Scand 79:248–256PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Roland M. Jones
    • 1
    • 2
    Email author
  • Heidi Hales
    • 3
  • Martin Butwell
    • 4
  • Mike Ferriter
    • 5
  • Pamela J. Taylor
    • 1
  1. 1.Department of Psychological Medicine and NeurologyCardiff UniversityCardiffUK
  2. 2.Llanarth Court HospitalRaglanUK
  3. 3.St Andrew’s HealthcareNorthamptonUK
  4. 4.Metanoia InstituteLondonUK
  5. 5.Department of ResearchRampton HospitalWoodbeckUK

Personalised recommendations