Newly discharged mental health patients at much higher risk of death

This article was taken from: https://www.theguardian.com/society/2018/oct/02/newly-discharged-mental-health-patients-at-much-higher-risk-of-death

By Denis Campbell Health policy editor

Such patients are 90 times more likely to die from drugs overdose than general population, research finds

People with mental health problems are at a hugely increased risk of dying from unnatural causes, including suicide, soon after they have been discharged from hospital, new research reveals.

Such patients are 38 times more likely to die of fatal poisoning and 90 times more likely to perish from a drugs overdose than the general population, according to a new study.

Experts say the difficulties some people with serious mental illness have in adjusting to life after a spell of inpatient care are likely to explain the higher death rate among that group of vulnerable patients.

They are at greatest risk of dying very soon after their discharge up until three months afterwards, according to new findings by a team led by Prof Roger Webb, an academic in Manchester University’s centre for mental health and safety.

Newly-discharged patients with psychological or psychiatric conditions are also 32 times more likely to kill themselves than people who have not been admitted, they found.

They are also 41 times more likely to die as a result of intentional self-poisoning and 15 times more likely to die any unnatural death.

“The post-discharge period represents a particularly risky transition because people are returning to living in the community and often in the same or similar circumstances to the point at which they were so ill that they needed to be admitted to an inpatient unit,” said Webb.

“This may be an especially daunting experience for people when they experience discharge from an inpatient unit for the first time.”

Andy Bell, deputy chief executive of the Centre for Mental Health thinktank, said patients who had been treated in a psychiatric unit outside of their home area were even more likely to die soon after discharge.

Around 650 adults are sent out of their home area for mental health care in England every month, despite a government pledge to end the practice altogether by 2021.

Responding to the high death rates overall, Bell added: “Inevitably the reasons will be unique to each person. But it’s very often a crisis in a person’s life, for example to do with relationships, money or housing, that precede a mental health crisis and so going back can be difficult for many.

The authors based their conclusions on comparing the age and method of death among 1.64 million Danes with those of 47,077 compatriots who had received inpatient psychiatric care.

Webb said the findings applied to the UK, given that the British population and healthcare system are similar to those in Denmark. Previous research published in the BMJ in 2011 identified similarly high death rates among people with schizophrenia and bipolar disorder in England.

There were 1,353 unnatural deaths among the 47,077 discharged Danish mental health patients. That equated to 361.3 deaths per 100,000 person years, which was 15 times higher than the 24.9 incidence rate seen in the general population.

“Having a serious mental illness is the main driver for the very high relative risks that we observed,” added Webb. But the authors stress that, while they found a strong association between hospital discharge and unnatural death, they found no evidence of a causal link.

Bell said NHS services needed to do more to help such patients manage the transition back into the community, especially when they end up in a mental health crisis.

“We know that the days and weeks after someone leaves hospital can be difficult. It is essential that health and care services offer support when people need it, both in planning ahead while they are in hospital and in supporting them in the community when they return home.

“High quality help for people leaving hospital can save lives and should be the norm everywhere”, he said.

Meanwhile, campaigners are urging people to dig deeper when friends and relatives say “I’m fine”, as their answer could disguise a mental health problem they have not disclosed.

A new representative survey of more than 2,000 British adults for Time to Change found that 78% of Britons would reply that they were fine when asked how they were, even if they were struggling with an illness such as anxiety or depression. Often that is because they do not want to burden others or because they don’t think the questioner wants to listen to their troubles.

The anti-stigma campaign is urging people to “ask twice” after someone’s welfare if they receive an “I’m fine” answer, to underline that they are interested in how someone is feeling.

In the UK, Samaritans can be contacted on 116 123 or emailjo@samaritans.org. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.