We know that for people discharged from inpatient mental-health wards there is a higher risk of self-harm or dying by suicide than for the wider population, particularly in the first few days and weeks after they have left the unit. Follow-up support designed to help people manage this move safely should be provided by mental-health teams with input from other relevant services. However, little is known about how people access other health-care including their GP and emergency services like A&E. Although GP appointments may be part of agreed care-plans, other visits may be a sign that planned support is not meeting an individualÂ’s needs.
This study involves statistical analysis of NHS patientsÂ’ anonymised electronic records in England. Firstly, we will measure the risk of self-harm, suicide and other causes of death during the year after leaving a mental-health inpatient unit. People who have been discharged will be compared to people from the general population with the same gender, age and GP practice to see whether the risks are different. Secondly, we will describe how people access health services outside planned support from mental health teams in the first year after discharge, what the financial costs are and whether they use these services more than other people. Finally we will consider whether services were used differently by people who died by suicide in the year after discharge. It is hoped that identified patterns can be used by health service planners to better understand the risks and to provide tailored additional support.
Phase 1 is a matched cohort study aiming to estimate the absolute and relative risk of suicide, other causes of mortality, non-fatal self-harm and first psychiatric readmission, for people in the first year after discharge from inpatient psychiatric care in England. Cumulative incidence will be calculated for each examined outcome for people discharged for the first time between 1st January 2001 and 31st May 2018, and for a general population comparison cohort matched on age, gender and registered general practice. Hazard ratios comparing risks between the two groups will be calculated using Cox proportional hazards models at different time points within the first year. Where statistical power is sufficient estimates will be stratified by gender and age group (10-17, 18-64 and over 64). Phase 2 will describe general practice management (prescription of psychotropic medication and timing of first contact) and calculate rates of GP contact and hospital use (A&E attendance, admission to a general hospital, psychiatric ward or outpatient appointment) during the year after discharge from psychiatric inpatient care. Adjusted rate-ratios comparing rates of contact versus the general population will be calculated using Poisson regression. Reference costs for each component of care will be used to calculate the excess cost of care per discharged person. Phase 3 will consider how those who die by suicide within a year of discharge vary in their primary care and hospital use compared to living controls in the same cohort. Using a nested case-control design all discharged persons who die by suicide will be matched with controls by gender, age-group and year of discharge. Conditional multiple logistic regression models will be fitted to detect any associations between primary care and hospital use and likelihood of suicide occurring within a year.
Phase 1: All-cause mortality; all natural deaths; all unnatural (external cause) deaths; suicide; accidental death;
alcohol-specific death; drug-related death; non-fatal self-harm; readmission to psychiatric inpatient care
Phase 2: Rates and costs of primary care contacts and psychotropic medication use; A&E admission; admission to a psychiatric inpatient unit; admission to a general inpatient unit; outpatient visits.
Phase 3: Suicide
Roger Webb - Chief Investigator - University of Manchester
Rebecca Musgrove - Corresponding Applicant - University of Manchester
- Collaborator -
Carolyn Chew-Graham - Collaborator - Keele University
Darren Ashcroft - Collaborator - University of Manchester
Luke Munford - Collaborator - University of Manchester
Matthew Carr - Collaborator - University of Manchester
Navneet Kapur - Collaborator - University of Manchester
Thomas Allen - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation