Citation

Kapur N, Gorman LS, Quinlivan L, Webb RT. BMJ Qual. Saf. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, BMJ Publishing Group)

DOI

10.1136/bmjqs-2021-013532

PMID

34607913

Abstract

Suicide is a major global challenge with an estimated 700 000 people taking their lives each year.1 Each of these deaths is an individual tragedy affecting families, friends, communities and health and social care teams. As clinicians and researchers working in suicide prevention, we are sometimes contacted by people whose loved ones have died by suicide while under the care of mental health services. Although we hear about examples of high-quality care, there are also accounts of poor continuity, failed communication, diagnostic or therapeutic errors, poorly trained or resourced clinical teams or a lack of family involvement. Suicide is a complex phenomenon and many of its drivers are economic and social,2 but its prevention should be a priority for health services in general and for mental health services in particular. Specifically, mental health patients represent a group at greatly elevated risk of suicide who are accessible because they are in contact with services.

Two studies, carried out in the Veterans Health Administration (VHA) in the USA and published in this issue of BMJ Quality and Safety, have explored the relationship between different aspects of mental health provision and suicide risk. The paper by Kaboli and colleagues4 investigated the association between mental health bed occupancy and the veterans' suicide rate in the catchment areas of 111 VHA hospitals across 50 states over a 5-year period. The study found that areas with inpatient psychiatric units operating at the greatest occupancy levels had higher suicide rates than areas with the lowest occupancy levels. As the authors point out, these results make clinical sense. It is plausible that 'hospital strain' and equivalent pressures in community care make some services less safe than others. It may well be that occupancy levels are an important safety metric. Although we did not find an association between occupancy and suicide in a previous study,5 it remains a live issue in the UK with the Royal College of Psychiatrists recommending a maximum mental health bed occupancy of 85%. However, we should treat the findings of the Kaboli et al paper with some caution. This was an ecological study and an alternative explanation is that that high levels of bed occupancy in certain areas simply reflected higher underlying clinical and social need, and by implication, higher suicide risk. The researchers do make the point that any unmeasured confounding influences would need to be large to wholly account for the observed associations...

Language: en

Keywords

mental health; patient safety; health policy; clinical practice guidelines; health services research