Suicide in high security hospital patients
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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.
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.
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.
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.
KeywordsSuicide Forensic psychiatry Unnatural death Violence
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
- 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.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
- 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
- 16.Hawton K (1994) Suicide. In: Paykel E, Jenkins R (eds) Prevention in psychiatry. Gaskell, LondonGoogle Scholar
- 35.Robertson G (1987) Mentally abnormal offenders: manner of death. Br Med J 145:469–472Google Scholar
- 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.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
- 41.Stone M (1990) The fate of borderline patients. Guillford Press, LondonGoogle Scholar
- 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
- 44.West D (1967) Murder followed by suicide. Harvard University Press, Cambridge, MAGoogle Scholar
- 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.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