Suicide after absconding from inpatient care in England: an exploration of mental health professionals’ experiences

Abstract

Background: Absconding from inpatient care is associated with suicide risk in psychiatric populations. However, little is known about the real world context of suicide after absconding from a psychiatric ward or the experiences of clinical staff caring for these patients.

Aims: To identify the characteristics of inpatients who died by suicide after absconding and to explore these and further key issues related to suicide risk from the perspective of clinical staff.

Methods: A mixed-methods study using quantitative data of all patient suicides in England between 1997 and 2011 and a thematic analysis of semi-structured interviews with 21 clinical staff.

Results: Four themes were identified as areas of concern for clinicians: problems with ward design, staffing problems, difficulties in assessing risk, and patient specific factors.

Conclusions: Results suggest that inpatients who died by suicide after absconding may have more complex and severe illness along with difficult life events, such as homelessness. Closer monitoring of inpatients and access points, and improved risk assessments are important to reduce suicide in this patient group.

• Absconding
• inpatient
• mental health
• mixed methods
• patient safety
• qualitative analysis
• suicide prevention
• suicide

Acknowledgements

We thank the administrative staff in NHS Trusts who helped with the NCISH processes and the clinicians and nurses who completed the questionnaires and interviews. We thank the other members of the research team: Alyson Williams, Sandra Flynn, Alison Roscoe, Cathryn Rodway, Saied Ibrahim, Su-Gwan Tham, Rebecca Lowe, James Burns, Phil Stones, Julie Hall, and Huma Daud.

Declaration of interest

NK is also supported by Manchester Mental Health and Social Care Trust. LA chairs the National Suicide Prevention Advisory Group at the Department of Health (of which NK is also a member) and is a non-executive Director for the Care Quality Commission. This study was funded by the Healthcare Quality Improvement Partnership (HQIP).