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.
© Copyright 2013 GoodTherapy.org. All rights reserved.
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.