Suicide and self-harm

What conclusions should we draw from the article by Gairin et al (2003) on attendance at the accident and emergency department in the year before suicide? That if you do not do your homework, you will make mistakes. Although they criticise the National Confidential Inquiry and make 18 references to it, they do not seem to know what it does.

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness has been based in Manchester since 1996, covering only one of the years studied by Gairin et al. It was set up to identify all deaths by suicide of people who had been under the care of specialist mental health services in the previous 12 months (Appleby et al, 1997). Our remit (not to mention our funding) does not extend to emergency departments. Our method of case ascertainment (Appleby et al, 2001) is to obtain lists of suicides and undetermined deaths from the Office for National Statistics and to check these against records held by local mental health services. We then collect further information from each patient's consultant psychiatrist. Gairin et al seem to think that we rely on voluntary reporting by health districts.

The Inquiry has been notified of 35 000 suicides since 1996 and has collected detailed information on over 9000 people in contact with mental health services. Gairin et al's assertion that we ‘must record the occurrence of hospital attendances for self-harm’ for all patients is a bold one, especially when it is based on five misclassified cases in one region. The issue is not whether self-harm is important, but the best way of collecting information about it in a national study. As a first step we are now carrying out a psychological autopsy study of 300 suicides by mental health patients, obtaining details of attendances in emergency departments and general practice, and interviewing the families of those who have died.

Gairin et al are also critical of policy makers for not recognising that self-harm is a key indicator of suicide risk. They must have missed the fact that the National Suicide Prevention Strategy for England includes a section on preventing suicide following self-harm (Department of Health, 2002).