Mental health service contact in 38% of suicides

Nearly four out of 10 people who died by suicide had been in contact with mental health services — most of them "actively" — according to research.

It found that less than one third of people studied were taking their prescribed medication at the time of death.

The research, thought to be the first of its kind in the country, analysed the psychiatric life history of those who died by suicide, as well as their autopsies.

A team of psychiatrists based in Galway identified 153 people who died in the area by probable suicide between 2006 and 2012.

Their study examined the records held by HSE mental health services in the region and found 58 of them (38%) were in contact, and almost 60% of those in contact were actively so.

“Thirty-three individuals who died by probable suicide were still registered [actively attending] with one of the three mental health services at the time of their death,” said the report.

It said 20 people — representing 35% of this 58 — had been in contact with the services in the month before their death, 15 of them within the previous fortnight.

In addition, 40 people had been admitted to a psychiatric unit in the past, and eight of these were discharged within a month of their death.

“There is a well-know finding that individuals post- discharge are at increased risk of suicide and this is also demonstrated in this study,” co-author Brian Hallahan, consultant psychiatrist at University Hospital Galway and senior lecturer at NUI Galway, told the Irish Examiner. “Continued vigilance in relation to supporting people post-hospital discharge [such as] early out-patient appointments of follow-up with other team members, such as community mental health nurses, is important for most individuals.”

The research, published in the Irish Journal of Psychological Medicine, also found that less than one third of people studied were taking their prescribed medication at the time of death.

It said that, of the 28 people with a documented history of depression, only nine (32%) had antidepressants detectable in toxicology screening. Only one of the five people with a diagnosis of schizophrenia had anti-psychotic agents in their screening.

“Caution has to be exercised between the association of treatment non-adherence and suicide, however this has previously been demonstrated,” said Dr Hallahan. “Treatment non-adherence is associated with relapse of mental health condition.”

The study said the high rates of suicide attempts (65%) and/or deliberate self-harm (25%) in the group emphasised the importance of the national clinical programme for the management of self-harm among individuals presenting to hospital emergency departments.

It said a previous diagnosis of depression was present in almost half of the individuals. It noted “high rates” of childhood adversity (44%), including 23% with a history of child sexual abuse.

The research said 81% were male and 19% female, with 58% unemployed.

It also noted that 23% suffered chronic pain.