© 2003 The Royal College of Psychiatrists
Correspondence |
Health care contact and suicide
Neurobehavioural Unit, Haywood Hospital, High Lane, Burslem, Stoke-on-Trent, Staffordshire ST6 7AG, UK
We read with interest the study by Gairin et al (2003), which highlighted the suboptimal working relationship between the accident and emergency department as a first point of contact and psychiatric services. Thirtynine per cent of suicide victims got in contact with the accident and emergency department at some point in the last year of their lives and, according to the National Confidential Inquiry into Suicides in England and Wales, only a quarter of suicides are preceded by mental health service contact in that same period.
Although I appreciate the above point, I still think that contact with primary services has an equal if not greater role to play in reducing suicide, especially in those age groups whose members are less likely to attend the accident and emergency department at times of crisis, such as children and the elderly.
Duckworth & McBride (1996) have reported that 80% of elderly suicide victims received no psychiatric referrals, and according to Harwood et al (2001), only 15% of elderly people who died by suicide were under psychiatric care at the time of death.
In our study, analysing coroners’ inquests of 200 cases of suicide in old age in Cheshire, 1989–2001 (Salib & El-Nimr, 2003), the role of primary care was emphasised. Interestingly, even those victims who were known to psychiatric services still preferred to contact their general practitioners (GPs) in the last few weeks before the fatal act.
One conclusion might be that people whose GPs acknowledged their mental health problems and cared to refer them to a specialist service were able to build a more meaningful therapeutic relationship with their doctors and readily contacted them as a final desperate act in the last period of their lives. A well-trained GP can act not only as an effective first point of contact but also a final one!
REFERENCES
- Duckworth, G. & McBride, H. (1996) Suicide in old age: a tragedy of neglect. Canadian Journal of Psychiatry, 41, 217 –222.[Medline]
- Gairin, I., House, A. & Owens, D. (2003)
Attendance at the accident and emergency department in the year before
suicide: retrospective study. British Journal of
Psychiatry, 183, 28
–33.
[Abstract/Free Full Text] - Harwood D., Hawton, K., Hope, T., et al (2001) Psychiatric disorder and personality associated with suicide in older people: a descriptive and case–control study. International Journal of Geriatric Psychiatry, 16, 155 –156.[CrossRef][Medline]
- Salib, E. & El-Nimr, G. (2003) Gender and utilisation of psychiatric services in elderly suicide. International Journal of Psychiatry in Clinical Practice, in press.
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