Suicides not in contact with mental health services: Risk indicators and determinants of referral

Abstract

Background: Three quarters of UK suicides were not in contact with mental health services one year before dying. The characteristics of this group of suicides have not been adequately explored.Aim: Identify risk factors in no-contact suicides and explain non-referral to Mental Health Services (MHS).Method: Ongoing, observational, retrospective survey of all suicides in West Kent (population 988,027) over 5 years. No contact suicides are compared with MHS suicides through standard questionnaires completed by consultant psychiatrists, and general practitioners, and by examining coroners' records.Results: No contact suicides were significantly more likely to be male, employed, living with others and not diagnosed with a mental disorder. They have a significantly lesser frequency of previous self-harm. Their suicide risk is retrospectively estimated to be lower. 50.5% of all suicides were either not registered, had no general practitioner contact, or were last seen 13 weeks or more before suicide. These characteristics can explain non referral to specialist services.Conclusion: No-contact suicides take place to a considerable extent outside the current limitations of primary health and social care systems. Many have a different risk factor profile, and are similar to people who do not seek medical help in the first place.Declaration of interest: None.