GPs have a ‘key role’ in suicide prevention when patients are discharged from inpatient mental health care, researchers have said.
More than 80% of people who died by suicide within a year of their discharge had been in recent contact with a GP, their study found.
The analysis of records from 613 adult patients who died by suicide in England between January 2001 and May 2019, also found more than 40% who died within two weeks of being discharged had at least one primary care consultation before taking their lives.
The findings highlight the opportunity that GP practices have in helping to reduce suicide risk among those recently discharged from inpatient psychiatric care, the researchers said.
Writing in BJGP Open, the team from Manchester and Keele Universities said discharged patients who died by suicide were more likely to have diagnoses of anxiety, adjustment or related disorders, depression, or personality disorders, than schizophrenia.
The study found that evidence of discharge communication from hospital was infrequent but within practice continuity of care was relatively high.
They called on hospitals to arrange post-discharge appointments for patients with a GP as soon as possible.
But also for GPs to be given more support, after the study also found that earlier visits were linked to lower suicide risk.
‘Clear communication and liaison between services is essential to provide timely support,’ they concluded.
Study author Professor Carolyn-Chew Graham, a GP and professor of general practice research at Keele University, said: ‘The investigation revealed that most patients who died by suicide within a year of discharge engaged with primary care services, and that more than 40% of those who died by suicide within two weeks of their discharge consulted with a GP.
‘This shows there are opportunities to monitor these patients following discharge and intervene during this risky transition period.’
She added: ‘General practice has a key role to play in preventing suicides among people recently discharged from inpatient psychiatric care.
‘Most recently discharged people do access primary care, and each contact presents an opportunity to reduce suicide risk.’
NICE recommends that the discharging hospital should consider organising a GP follow-up appointment within two weeks of discharge and that a discharge letter is emailed to the patient’s GP within 24 hours, and a summary sent within a week, she explained.
But in her experience, this does not always happen. ‘Letters often don’t arrive in the practice for a few weeks after a patient has been discharged, and our practice is not contacted to ask us to offer a patient an appointment just after discharge.’
Study lead investigator Professor Roger Webb, professor in mental health epidemiology at the University of Manchester said: ‘These findings will inform healthcare providers, especially those in primary care.
‘They indicate the need for GPs and mental health practice colleagues to provide timely enhanced support for discharged patients in helping to reduce their risk of dying by suicide as they return to living back in the community.’
Figures from the Office for National Statistics, published earlier this year, have revealed that suicides are their highest rate since 1999, with 6,069 suicides registered in England and Wales in 2023.
Interestig to see that the Psychiatric definition of ‘most’ includes ‘less than half’ or as little as two-fifths.
Orthopadics usually see their own patients for follow-up in ‘fracture clinic’ : why cannot inpatient psychiatric services review THEIR own discharges within the CMHT within 2 weeks, to ensure they have transitioned adequately to community living? Especially since gPs are dreadfully underfunded, whilst Mental Health has been having additional funding.
Perhaps one of the causes of suicide is when patients see the GP and find out the hospital did not care about them enough to send communications to their GP, so they feel abandoned and un-cared-for by the specialists, and find another way out?
It may also be helpful if Mental Health services would ensure the patients are stabilised on what drugs they need to be on long-term, and ensure they are NOT taking any drugs that are licensed fro only short-term use, before discharge, and initiate monitoring, or a regular basis, of those commence on drugs requiring specialisy monoitoring, like antipsychotics and hypnotics.
I often find I have a very key role in sorting out multiple problems shortly after discharge for mental health patients, at a time when one might expect their own ability to do so to be reduced, and when discharge planning has not involved necessary community services and follow-up arrangements. But this is very time-consuming and disruptive to the patients, in comparison to what could be achieved with more forethought and better communication.
Perhaps GPs could be given a veto on discharges, to exercise until they feel criteria for ‘safe discharge’ have been met?
AS Above. These patients should be discharged with outpatient psych follow up and access to an Community Psychiatric nurse. Therefore any problems can be directed to a psychiatrist. I find it hard to believe there is no mention of this in a BJGP publication, but then again it just shows how many of these Gp’s actually practice in the real world. Conflicts of interest- I used to be a MRCGP but found them unsupportive to Gp’s at the coal face.
How about funding community mental health to follow up these patients daily/weekly/bi weekly or monthly until they feel it safe to do so? Who does GP have to pick up the pieces of what is a serious risk to the patients? What next, GP to follow up all discharges for all conditions in the community in case they might get worse? GP to see all surgical discharges to check for DVT or PR risk within 48 hours of discharge? GP to visit all treated chest infections in the hospital setting to ensure they do not deteriorate further.