Suicide in the mentally ill

Patients with mental illness are at a greatly increased risk of suicide. Approximately 90% of those who die by suicide are suffering from a psychiatric disorder at the time of death. The relationship between mental illness and psychiatric disorder can be investigated by the retrospective collection of detailed information from interviews with informants (psychological autopsy study) or by following up those with mental illness and recording the incidence of suicide (cohort study). Affective disorder is probably associated with the greatest increase in suicide risk. Risk factors for suicide may vary from diagnosis to diagnosis, between age groups, by treatment setting, and by country. Much of what we know about suicide in the mentally ill in the UK is based on data collected for an ongoing national clinical survey (the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness). Patients who die by suicide while in-patients or shortly after discharge from hospital may be a particularly important group because the circumstances of their death could highlight deficiencies in service provision. Rates of suicide among psychiatric in-patients in the UK are falling. The rigorous clinical assessment and treatment of mental disorder is a useful starting point for reducing suicide in the mentally ill, but the evidence base for this is not strong. This is partly because suicide is a rare event. General strategies for suicide prevention and specific strategies to reduce suicide in those in mental health contact are both likely to be important.