Most people who died by suicide within year of discharge from inpatient psychiatric care had recent contact with GP, study finds

More than 80 per cent of people who died by suicide within one year of being discharged from inpatient mental health care had been in recent contact with a GP, new research funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC) has found. 

The database study, which looked at the records of 613 people who died by suicide among adult patients in England between January 2001 and May 2019, also found that more than 40% of those who died within two weeks of being discharged had at least one primary care consultation before taking their lives. It further revealed  that discharged patients who died by suicide were more likely to have diagnoses of anxiety, adjustment or related disorders, depression, or personality disorders, than schizophrenia. 

Researchers at the NIHR GM PSRC, University of Manchester and at Keele University, say the study, published in BJGP Open, highlights the opportunity  that general practices have in helping to reduce suicide risk among people recently discharged from inpatient psychiatric care. 

The research team has called for hospitals to arrange post-discharge appointments for patients with a GP as soon as possible and for GPs to be given more support, with the study also finding earlier visits are linked to lower suicide risk. 

The study’s principal investigator, Professor Roger Webb (NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester) said: : “These findings will inform healthcare providers, especially those in primary care. They indicate the need for GPs and mental health practice colleagues to provide timely enhanced support for discharged patients in helping to reduce their risk of dying by suicide as they return to living back in the community.”

Professor Carolyn-Chew Graham OBE, Professor of General Practice Research at Keele University, said: “The investigation revealed that most patients who died by suicide within a year of discharge engaged with primary care services, and that more than 40% of those who died by suicide within two weeks of their discharge consulted with a GP. This shows there are opportunities to monitor these patients following discharge and intervene during this risky transition period. 

“General practice has a key role to play in preventing suicides among people recently discharged from inpatient psychiatric care. Most recently discharged people do access primary care, and each contact presents an opportunity to reduce suicide risk.” 

In England, the National Institute for Health and Care Excellence (NICE) guidance on transition between inpatient mental health settings and the community includes two primary care specific recommendations – the discharging hospital should consider organising a GP follow-up appointment within two weeks of discharge; and ensure that a discharge letter is emailed to the patient’s GP within 24 hours, and a summary sent within a week, subject to the patient’s agreement.

However, Prof Chew-Graham, who is also a practising GP, said this does not always happen, adding: “Letters often don’t arrive in the practice for a few weeks after a patient has been discharged, and our practice is not contacted to ask us to offer a patient an appointment just after discharge.”

The researchers say clear communication and liaison between services is essential to provide timely support.

 [RW1]The study was led from UoM and it was funded by the GM PSTRC, so I reckon that the two institutions ought to be mentioned in the order that I’ve indicated here.

Professor Carolyn-Chew Graham OBE, Professor of General Practice Research at Keele University, said: “The investigation revealed that most patients who died by suicide within a year of discharge engaged with primary care services, and that more than 40% of those who died by suicide within two weeks of their discharge consulted with a GP. This shows there are opportunities to monitor these patients following discharge and intervene during this risky transition period. 

“General practice has a key role to play in preventing suicides among people recently discharged from inpatient psychiatric care. Most recently discharged people do access primary care, and each contact presents an opportunity to reduce suicide risk.” 

In England, the National Institute for Health and Care Excellence (NICE) guidance on transition between inpatient mental health settings and the community includes two primary care specific recommendations – the discharging hospital should consider organising a GP follow-up appointment within two weeks of discharge; and ensure that a discharge letter is emailed to the patient’s GP within 24 hours, and a summary sent within a week, subject to the patient’s agreement.

However, Prof Chew-Graham, who is also a practising GP, said this does not always happen, adding: “Letters often don’t arrive in the practice for a few weeks after a patient has been discharged, and our practice is not contacted to ask us to offer a patient an appointment just after discharge.”

The researchers say clear communication and liaison between services is essential to provide timely support.