Suicide rate doubled among patients receiving care at home

Suicide deaths by patients with mental illness treated at home more than doubled in England from 2003 to 2011, according to recent study findings published in The Lancet Psychiatry.

However, suicide deaths by those with mental illness treated as inpatients decreased by more than half during the same period.

“Our findings suggest that crisis resolution home treatment settings are associated with a high suicide risk,” Isabelle M. Hunt, PhD, of the Centre for Suicide Prevention and Centre for Mental Health and Risk at the University of Manchester, said in a press release. “[Crisis resolution home treatment] has been used increasingly during the period we have studied and the number of patients dying by suicide is growing. The rate is consistently higher compared with psychiatric inpatients, suggesting that inpatient care might reduce suicide risk more effectively than crisis resolution home treatment.”

Hunt and colleagues evaluated all adults who had committed suicide while either being treated at home by crisis resolution home treatment (CRHT) teams or while as psychiatric inpatients in England between 2003 and 2011 (n=39,361). Researchers sought to determine the differences between suicide rates between the two groups as well as clinical features of the groups. During the study period, 1,057 people committed suicide as inpatients and 1,256 were receiving CRHT care.

The rate of suicide was higher among CRHT participants at 14.6 suicides per 10,000 episodes compared with 8.8 suicides per 10,000 admissions among inpatients. Among CRHT participants, there were an average of 80 suicides per year in 2003-2004 increasing to 163 per year in 2010-2011. In 2004-2005, rates of suicide among inpatients were 9.9 per 10,000 admissions decreasing to 6.3 per 10,000 admissions in 2010-2011.

Seventy-seven percent of inpatients had a history of self-harm compared with 70% of CRHT participants. Inpatients were also more likely to have a history of violence (P<.0001) and drug misuse (P<.0001) compared with CRHT participants. However, CRHT participants were more likely to have been ill for less than a year (P<.0001) and have experienced a recent adverse life event (P<.0001) compared with inpatients.

“The safety of individuals cared for by CRHT teams should be a priority for mental health services,” study researcher Nav Kapur, FRCPsych, said in the release. “For certain groups of high-risk patients including those who live alone or who have recently been discharged from (the) hospital, home treatment might not be the most appropriate care setting. The success in reducing suicide among inpatients now needs to be repeated in patients receiving treatment for mental illness at home.”

In an accompanying editorial, Thomas Becker, MD, and Nicolas Rüsch, MD, both of Ulm University in Germany, wrote that because of the expansions of CRHT services, many more people are now using that care.

“However, moving the balance of care too far away from inpatient care may complicate the clinical task of coping with suicidal symptoms because those may sometimes be better dealt with in inpatient care settings,” they wrote. “Balanced care models require both a sufficient provision of high-quality inpatient care and crisis resolution and home treatment teams with high clinical aptitude.”

For more information:

Becker T. Lancet Psychiatry. 2014;doi:10.1016/S2215-0366(14)70276-7.

Hunt IM. Lancet Psychiatry. 2014;doi:10.10.16/S225-0366(14)70250-0.

Disclosure: See the study for a full list of researchers’ financial disclosures.