dr kirsten windfuhr senior research fellow & senior project manager national confidential...
TRANSCRIPT
Dr Kirsten WindfuhrSenior Research Fellow & Senior Project Manager
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH)
Centre for Mental Health and Risk
February 4 2015Cheshire & Merseyside Suicide Reduction Summit
Improving services, reducing suicide
What are the causes of suicide?
Suicidal
Behaviour
Biological factors•Genes•Neurodevelopment
Clinical factors•Mental illness•Physical illness•Previous suicidal behaviour•Drugs and alcohol•Treatment
Psychological factors•Problem solving•Hopelessness•Impulsivity•Aggression
Environmental factors•Early life experience•Life events•Socio-economic conditions•Societal attitudes•Availability of methods(Adapted from Gunnell and Lewis 2005)
UK England Wales Scotland N. Ireland
Generalpopulation 100,329 78,170 5,475 13,235 3,449
NCISH
In contactwith MHservices
26,216
(26%)
20,300
(26%)
1,260
(23%)
3,705
(28%)
951
(28%)
Suicide in the UK; 1996/7-2012
UK_SUICIDE © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.Not to be reproduced in whole or part without the permission of the copyright holder.
Source: Public Health England; Health Profileshttp://www.phoutcomes.info/profile/health-profiles/data#gid/1938132696/pat/6/ati/102/page/4/par/E12000002/are/E08000003
“GPs can make a big difference to overall suicide rates.” (DH, 2014)
“Primary care services have a crucial role in addressing mental health problems and assessing suicide risk.”
“The RCGP/RCPsych have issued a helpful factsheet on managing suicide risk in primary care.”
“Research is essential to inform effective suicide prevention.”
Why are GPs central to reducing suicide?
1. Majority of people present to their GP prior to losing their life to suicide
1: GP contact prior to suicide
GP contact: month prior to suicide
GP contact: year prior to suicide
Luoma et al., 2002 Am J Psychiatry
Why are GPs central to reducing suicide?
1. Majority of people present to their GP prior to losing their life to suicide
2. A substantial proportion of people with mental illness are managed in primary care
Why are GPs central to reducing suicide?
1. Majority of people present to their GP prior to losing their life to suicide
2. A substantial proportion of people with mental illness are managed in primary care
3. Suicide risk is greater in the context of mental illness
3: Suicide risk and mental illness
Year prior to suicide: mental health patient suicide deaths
Pearson et al., 2009, BJGP
Proportion of suicide deaths who had a mental illness prior to death
Cavanagh et al., 2003, Psych Med
• Study of attendance and clinical factors
• 10 years
• Case control study in primary care
• Clinical Practice Research Datalink (CPRD)
Patients who died by suicide: consultation, diagnosis, treatment, and referral
Face-to-face GP consultation within 12months of suicide [number= 1,504 (63%)]
Clin
ical ti
me lin
e
2,384 patients who died by suicide
Number of consultations in the 12 months prior to suicide
880246
184183
128114
779181
664646
253020
48403445
0 200 400 600 800 1000
0123456789
1011121314
15-1617-1920-24
>24
Number of suicides
1,504
Suicide risk in primary care
• Attendance – frequent attendance– increasing attendance– non-attendance
Patients who died by suicide: consultation, diagnosis, treatment, and referral
Face-to-face GP consultation within 12 months of suicidenumber= 1,504 (63%)
Mental health diagnosis (any time)[number= 1,497 (63%)]
Clin
ical ti
me lin
e
2,384 patients who died by suicide
Diagnosis• Mental health diagnosis (at any time)
– 63% (v. 28% of living patients)– mainly depression
• Of patients with no diagnosis (37%)– male– 35-44
Suicide risk in primary care
• Attendance – frequent attendance– increasing attendance– non-attendance
• Diagnosis– under-recognition
Patients who died by suicide: consultation, diagnosis, treatment, and referral
Face-to-face GP consultation within 12 months of suicidenumber= 1,504 (63%)
Mental health diagnosis (any time)number= 1,497 (63%)
Psychotropic drug treatment within 12 months of suicide [number= 1,148 (48%)]C
lin
ical ti
me lin
e
2,384 patients who died by suicide
Managing mental illness: suicide risk and multiple drug prescriptions
0
10
20
30
40
50
60
70
80
90
0 1 2 3 4 5 ormore
Risk
Number of drug groups
• 5x more likely to have psychotropic drugs prescribed
• 31% prescribed 2+
• elevated risk with 4 or 5
Drug treatment
• Multiple drug types
– Illness severity
– Inherent risks with complex prescribing
• Risk
Suicide risk in primary care
• Attendance – frequent attendance– increasing attendance– non-attendance
• Diagnosis– under-recognition
• Drug prescriptions– multiple drug types
Key messages for services• Markers of risk include
– frequent attendance – increasing attendance– non-attendance– multiple drug prescriptions
• Markers could form basis of ‘flag’ alert in primary care records– further assessment, engagement
• Collaborative working with third sector, on-line support