Community care may increase suicide risk: Study questions early discharge of mentally ill from hospital

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THE EARLY discharge of psychiatric patients from hospitals to care in the community may lead to a higher suicide rate among those who are not properly looked after, a new study suggests.

The study found that the risk of suicide in the year after discharge is greater than was previously thought, and that the first month is the period of highest risk. Discharge itself may be a factor in causing some patients to commit suicide, according to the study, and the reduction of in-patient care means that more mentally-ill people who need hospitalisation at some time, are at risk of suicide when they come out.

The findings raise further questions about the Government's policy of early discharge of psychiatric patients at a time when community care is still in its infancy, and its provision is patchy. A number of high-profile cases this year in which former psychiatric patients have murdered or attacked other people or injured themselves, have been blamed on the failure of community care. Research by the National Schizophrenia Fellowship shows that 40 people have been killed by seriously mentally-ill people since 1991, when bed closures were stepped up, and there have been 100 suicides in the same period.

Researchers at the Department of Public Health and Primary Care at Oxford University say that male patients were 50 times more likely to commit suicide, and women 57 times more likely, in the year after discharge than people in the general population. In the month after discharge, the risk was 213 times greater for men and 134 times for women. Dr Michael Goldacre, who led the study, said it revealed a 'new and significant clustering' of cases shortly after discharge.

The report in tomorrow's issue of The Lancet says: 'The period of highest risk in our study was the first few weeks after discharge, which suggests that discharge itself may increase vulnerability to suicide.' They argue that when a patient commits suicide so soon after discharge ' . . . the appropriateness of the discharge and the adequacy of supporting services in the community may be questioned'.

The study emphasises the importance of ensuring that patients on drugs keep taking them after leaving hospital, and that there is adequate community support with day-care programmes and facilities to monitor patients for early signs of relapse.

The Oxford group studied 14,240 people over the age of 15 who had been treated in hospital for a range of disorders including schizophrenia, depression, neuroses and other psychiatric illnesses. Most were admitted to hospital for short periods only.