Inpatient Suicide Rates Drop While Outpatient Suicide Rates Rise

Whenever there is a report of decreases in suicide rates, it is good news. However, results from a recent study led by Nav Kapur of the Center for Mental Health and Risk at the University of Manchester in the UK are not entirely positive. Suicide rates have traditionally been higher among inpatient clients than outpatient clients. In recent years, the number of inpatient mental health beds has decreased dramatically as outpatient community services have been strengthened. However, little research has examined how this decline of inpatient beds has affected inpatient suicide rates. It would be presumed that decreasing inpatient services and number of clients would result in fewer suicides, while the overall rate would potentially be the same, but this has not been clearly established.

Kapur sought to do determine how this change has affected rates of suicide among both inpatient and outpatient clients. Therefore, Kapur conducted a longitudinal study of all clients receiving inpatient care over a period of 10 years to determine suicide rates. Outpatient suicides were also assessed as a comparison. The results revealed that in the first and last two years of the study period, suicides decreased by nearly 30% for inpatients, particularly those under the age of 45. For hangings, the most common suicide type in inpatient settings, the rate dropped by nearly 60%. Decreases were also found in the post-discharge period for all the participants. Long term outpatient suicide rates, however, increased by nearly 20%.

There are a number of reasons for these mixed findings. First, the decrease in beds results in fewer clients. This means that inpatient facilities are limited to only taking the highest risk clients. Although they can be managed quite well under inpatient conditions, these individuals may be more vulnerable than lower-risk clients once they are discharged. They may not continue therapy and may not adhere to treatment plans that were developed while they were inpatients. Another possibility is the shorter duration of stay that occurs as a result of fewer inpatient beds. The sooner a client is discharged, the sooner the risk transfers from the inpatient facility to outpatient care. This transfer may be premature in many cases and outpatient services may not always be equipped to handle clients’ needs. Kapur believes that these findings should be interpreted with cautious optimism. “In particular, the potentially high rates of suicide in settings that are alternatives to in-patient care warrant further exploration,” said Kapur.

Kapur, N., et al. Psychiatric in-patient care and suicide in England, 1997 to 2008: A longitudinal study. Psychological medicine 43.1 (2013): 61-71. ProQuest Research Library. Web. 30 Jan. 2013.

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  • aaron

    February 7th, 2013 at 3:49 AM

    You have to be so careful not to give a patient who is at risk for committing suicide too much too soon. I know that here in the US a lot of this would probably have to do with cuts to the health care system and a limited number of facilities that are equipped to help patients who are at a high risk for self harm. I don’t know how it is in other parts of the world, but apparently there are these same issues in other places other than just here at home. While I think that we have to give people the tools to recover and do some things on their own, if they aren’t ready, then they aren’t and should not be sent out to fend for themselves until they are equipped to be bale to do so without feeling like suicide is their last answer.

  • Clearance

    February 7th, 2013 at 6:29 AM

    Well what exactly is the point of this article? Rates are changing but not because of any change in treatment, only in the number of inpatient beds. It seems like this study was a total waste to me.


    February 7th, 2013 at 6:52 AM



    February 7th, 2013 at 7:07 AM

    Is there a standard for discharging patients who came in actively suicidal? Maybe some sort of rubric or something? How are care givers deciding when patients are ready and strong enough to be discharged?

  • Jordan

    February 7th, 2013 at 7:10 AM

    This study is very reflective of what happened in my own life. When I was nine, my mom was suicidal and she had to go to a psyhciatric facility. She was there for three weeks and the nurses and doctors felt she was ready to be released. Within 24 hours, I found her in her bed dead from a gun shot wound.

  • Collin

    February 8th, 2013 at 11:07 AM

    Makes perfect sense to me=
    those receiving inpatient care are receiving more consistent and sustained therapy
    while those who are doing only outpatient work, they may feel a little more isolated and alone
    that has to be a huge factor

  • Colin

    February 8th, 2013 at 12:10 PM

    We need to see what the differences are between inpatient care and outpatient care to come to a conclusion.. most important is sustained care n therapy. so what could help plug this gap for outpatients? care from a caregiver in family or a full time external caregiver. if a person needs such care he or she ought to get it, whether in a facility or at home. not having that can open up the suicide route. that needs help.

  • BJWilliams

    February 24th, 2013 at 10:54 PM

    My brother was hospitalized in our local VA psychiatric unit after admitting to being suicidal. He was there one week. My father and I visited him the day before his release. He had never been hospitalized for psychiatric reasons before. He was 52. The 3 days following his release he visited my home for many hours, visiting family, etc. On the fourth day I had a birthday party for his daughter (my niece) at my home. We had cake and a good time, took photos, etc. My brother followed his daughter in his car on to the expressway for an extra nice birthday goodbye to her. My father left for his home in Tulsa, OK after being with me in me in Cincinnati.
    The next day was Mother’s Day.
    My brother was found in his basement that night, a self-inflicted gun shot wound through his temples.
    The VA hospital called all 11 family members in to their unit to question us for hours as to our relationship with our brother/son/father and separated us and asked questions we had no idea what they pertained to with the shooting, and never have known.
    We were all in shock and didn’t think to ask “what the hell are you doing?” The time to check the family dynamics and concerns would have been BEFORE A SUICIDE, wouldn’t it?
    He not only lived, he was in a non-rehab condition in a lying in hospital for FIVE YEARS….immobile, conscious, retaining only long term memory.
    When he died there, the staff said they couldn’t get a family member (there were 11 in the Cincinnati area) on the phone, so they sent him to the morgue.
    My brother laid in the morgue for one month without us knowing he was there. (family visited off and on). After 5 years we typically visited about once a month.

    There’s no perfect, easy, or guaranteed way to keep a person from killing themselves.
    I wish so many things now, in retrospect. What we or doctors could have done, or known.
    My brother’s daughter acquired the entire medical records of her father from the VA.
    The most chilling information were my brother’s statements to doctors concerning his worry about being left alone when he got out of the hospital….his concern for his safety.

    I’ve lived on since all of this in 2001, but don’t wonder about how much hell it has created, it’s too much for anyone to hear, I’m sure.

  • BJWilliams

    February 24th, 2013 at 11:00 PM

    How a psychiatric facility can possibly believe they can pull a person back together who has attempted suicide, in one week, is absolutely ridiculous. I’ve known 3 people personally who have killed themselves almost immediately after being released from ‘rehab’. It almost terrifies me to see people go in! What in the world could possibly be done in slow moving group sessions with TV blasting everywhere, bad food (I betcha) and some medications that don’t even take effect for weeks and weeks give any hope to someone. I read some of the similar stories of suicides in families after they were in psych units and I’m convinced there needs to be an entire ‘re-think’ of what is most effective.

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