Brown, RE (2014) Avoidable Mortality in Cumbria: A Case File Review of 78 Suicides. Technical Report. Centre for Public Health, Liverpool John Moores University.

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Abstract

On average, one person dies each week as a result of suicide in Cumbria. Gathering intelligence about suicide enables the identification of high-risk groups, risk factors and risk escalators, which can inform the development and implementation of local suicide prevention efforts.

An overview of avoidable mortality in Cumbria based on deaths between 2008 and 2012, it was revealed that the rate of avoidable deaths due to injuries (which include suicide) was significantly higher compared than the England average in 2011. Cumbria’s Director of Public Health then requested that an in-depth review of suicide be undertaken. A total of 78 suicides were reviewed in detail for this report (58 registered in 2012 and 20 registered in 2013), using coroner information, primary care files, and secondary mental health care files (where applicable).

A key message from this in-depth review is that the circumstances surrounding suicide are often complex characterised by a myriad of risk factors, risk escalators and precipitating factors present in an individual’s life with often no single attributable factor.

Coroner Related Information
Hanging was the most common method of male suicide, and drug related poisoning was the most common method of female suicide and this mirrors national findings. Male suicide by hanging has increased considerably over the last 9 years. There were 21 (27%) individuals who were known to have consumed alcohol at the time of death. The proportion of narrative verdicts delivered by Cumbria’s coroners has increased more than two-fold since 2006. These commonly make reference to a mental health illness. The increase in narrative verdicts mirrors an increase seen at a national level.

Primary Care History
Most individuals who died by suicide in Cumbria consulted with their GP in the year prior to death (81%), and over one fifth consulted in the week prior. Non-attenders were all male and most were under the age of 44 years. Mental illness and self-harm are well-documented risk factors for suicide, and in Cumbria 49 (63%) of individuals had a diagnosis of a current/on-going mental health condition at the time of death, most commonly depression, and 33 (42%) individuals had a history of self-harm. Alcohol and/or drug misuse/dependence was diagnosed in 13 (17%) individuals, over half of whom had a dual diagnosis (depression). The most commonly prescribed psychotropic drugs were selective serotonin reuptake inhibitors.

Psychiatric History
There were 49 (63%) individuals who had some previous contact with specialist mental health services in their lifetime. Nationally, 33% of individuals who died by suicide in 2011 had contact with mental health services in the 12 months prior to death (patient suicide) and this review found that in Cumbria there were 28 (36%) patient suicides. Of those 49 individuals who had specialist mental health service contact, 17 (35%) had been admitted to a psychiatric in-patient ward in their lifetime. Of the 28 patient suicides, 9 (32%) had been admitted to a psychiatric in-patient ward in the 12 months prior to their death.

Emerging Risk Factors
Alongside risk factors well documented in the literature, three emergent risk factors were noted in Cumbria. The first relates to welfare reform: in 5 (6%) cases a confirmed or potential change to an individual’s benefits was described to have caused worry, distress or anxiety in the days prior to death. The second relates to chronic pain and long term conditions: 18 (23%) individuals had a pain condition at the time of their death which often coexisted with a number of other suicide risk factors such as alcohol misuse/dependence. Finally, individuals in contact with the criminal justice system were also identified as a particular risk group, with 13 (17%) individuals being in contact in the 2 months prior to death.

Suicide Audit Process
In Cumbria, it is recognised that although conducting an in-depth review of suicide is a highly resource intensive process, the results are highly valued as a way of informing local suicide prevention strategies and action plans. Whilst carrying out this in-depth review, it became clear that the data collection tool being used could be adapted into a more condensed, practical and time efficient version. The way in which risk and escalating factors are documented for analytical purposes could also be improved.

Recommendations
To ensure that staff of Citizens Advice Bureau, Housing Associations, Job Centres and GPs that come into contact with individuals in distress as a result of benefit changes and other types of economic loss, know where to signpost individuals to appropriate support services.

Healthcare professionals to consider the impact of chronic pain and other long term conditions in connection with other known risk factors and escalators when carrying out individual suicide risk assessments.

To disseminate the findings of this report to the mental health and criminal justice steering group in Cumbria for further investigation and action in relation to individuals in recent contact with the criminal justice system.

To produce a data collection pro-forma for future suicide audits in Cumbria that allows data to be collected in a more time-efficient manner, but that also does not compromise on the quality of information being produced.

The production of agency specific reports in a format which can easily be updated following any successive suicide audits. Recommended agency specific reports include firstly the police (due to those in contact with the CJS identified locally and nationally as a risk group); secondly for specialist mental health services (on patient suicide) and thirdly a report for primary care professionals.

The production of local authority specific summary reports, following interest from councillors in Cumbria.

In order to make the suicide review process as complete as possible in the future, it is recommended that the primary care file of a deceased patient includes the full electronic GP summary print out.

Item Type:	Monograph (Technical Report)
Uncontrolled Keywords:	Suicide; Cumbria
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare. Criminology R Medicine > RA Public aspects of medicine
Divisions:	Public Health Institute
Publisher:	Centre for Public Health, Liverpool John Moores University
Date Deposited:	15 Apr 2015 11:47
Last Modified:	28 Jan 2022 10:39
URI:	https://researchonline.ljmu.ac.uk/id/eprint/840

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