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GPs advised to monitor suicide risk in frequent patients

GPs should monitor suicide risk in patients visiting more than twice monthly, after researchers found that these patients pose a significantly greater risk of ending their lives than others.

The study, carried out by Manchester University, found that frequent attendees were 12 times more likely than typical patients to die by suicide. Patients who never visited their GP were also at a somewhat greater risk (70% more likely), prompting calls for mental health items to be added to the NHS Health Check scheme.

The researchers from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) looked at suicides in England over ten years between 2002 and 2011, finding that patients who visited their GP more than 24 times in a year posed the highest risk of suicide, with mental illness often going undiagnosed.

The findings, revealed today in the ‘Suicide in Primary Care in England: 2002-2011’ report, also showed that patients receiving a mix of mental health drugs - for example those prescribed benzodiazepines together with antidepressants - ran a higher risk of committing suicide.

Lead researcher Professor Louis Appleby said: ‘We have identified that frequent attendance can be a marker for risk, as can receiving different kinds of mental health drugs. GPs could therefore use frequent attendance and a need to change or add drugs as flags to help alert them to possible risks. Alerts of this kind are used in other areas of primary care practice.’

‘Non-attendance is hard to tackle but adding items on mental health to the NHS Health Check - offered to people aged between 40 and 74 - is a logical step.’

Readers' comments (11)

  • My local specialist MH trust has between 20 and 40 people a year on its high risk CPN/Community supervision commit suicide.
    This is well intentioned from the ivory tower , however the majority of people with frequent presentation are resistant to or in denial as to the psychological aspects of their presentations.
    They are also competnet to refuse psychological interventions- QV.
    Give me an effective intervention before calling for screening.

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  • > 25 years a GP and now thankful that the 'powers that be' are advising me how to look after patients.
    What the hell do they think we actually do in a consultation.
    Just because there is now accurate 'currency ' for assessing the impact a GP has on a patient I think we just sit in front of them and dont speak

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  • "for example those prescribed benzodiazepines together with antidepressants"

    You'd better tell our local MHT then. What "monitor" do they want? If there was a suicide risk, which I assess on every patient with mental health problem, I act accordingly. This may be close f/u, referral to crisis team, 999 (yes, 999. I once had a patient pulled out a knife during the consultation threatening to self harm). Are they expecting to produce some kind of guideline to tell us how patients should be monitored?

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  • Many MH patients go to their GP because they get better care than in the MH team. GP's are very busy but make time to listen, they make the patient feel they matter, they are kind and caring ... unlike psychiatrists who process patients as they ride along the conveyor belt!
    When a general patient has a problem, they make an appointment to see their GP, when a MH health patient has a problem, they have to wait until the psychiatrist has time to see them ...
    Psychiatrists may care, but they don't show it, they clock watch from he minute the patient walks through the door ... and when you 20 minutes is up, off you go!

    Telling GP's how to care fro the mentally ill id an insult ... they have always cared, which is why some patients prefer to go to their GP than a local MH service.

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  • Involving patients is all well and good but, depending on how you ask the question, almost every patient asked would want full access to all services 24 hours a day and we all know that, wonderful as that is, it is not an affordable option. There needs to be leadership from whoever and whichever quarter it comes from, and that means having a body in charge who has no vested interest in the outcome other than to provide the best service in the most cost effective manner possible. It has been a great idea to put clinicians in charge but only really works if they are not involved, even by association, with provision of service otherwise self-interest begins to creep in. The problem with the PCT model was that the clinicians involved in making decisions were too often removed from the reality. In CCGs, the converse is true. In addition, as Shurleea mentions, "stakeholders" is such a slippery term and the definition can vary.
    Still, wait 3 years and it will all change!

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  • The creation of GP-led CCGs was just a populist, headline-grabbing move - GPs had always been at heart of PCT-led commissioning. The principal purpose of the Statute that introduced CCGs was to re-arrange the NHS, both physically and on a legal basis, to allow the admission of more private healthcare providers.

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  • Of course its too early to expect to see real change but I think you ought to start as you mean to go on and in my view this is about a developing a completely different way of finding solutions to the real issue we face...the rising costs of care...and working differently with the public we serve holds great potential.
    I don't agree with the view that those we serve will simply want everything. If they are provided with the human and fiscal reality we face I am sure they will make the difficult decisions. They are after all,one way or the other , paying for it.We just need to have the courage to share it with them.
    Until we work differently to stabilise or reduce the costs of care, re-organisations will continue to occur and we will only be left to reflect on just how much of what we did was genuinely different from what had gone before.

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  • The last re-organisation was a legal framework to dismantle the NHS after it falls into financial deficit.

    There is no doubt there is a silent Private partnership with the politicians, all lined up to get paid once out of post with directorships as their 30 pieces of silver. The Private sector will ride in on their white horse to save the NHS and we will all pay for the priviledge for generations to come.

    The NHS will slowly die as the health insurance top up, (What exactly is NI except an NHS tax) becomes unaffordable for the ill, poor and uninsurables who will all get sub optimal care.

    The swipe your credit card before you get care ethos of the US will come in with the new NHS leader, and we will all long for the good old days with PCTs.

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  • Having worked in the NHS for 13 years in various project/ programme/ change and contract management roles, the same faces come and go, as does the initial enthusiasm and the inevitable empathy and acceptance that it will be the same goal posts dressed up in a different way before some one tells you that you are now aiming for the wrong goal. It is ludicrous at the amount of money that is spent in contractors, ill thought through projects and the powers that be never learn the "lessons learnt" from previous projects/ programmes and strategic visions. Yet, the fundamentals that underpin the governments 'strategic vision' are often ill thought through, underfunded and using out of date technology and resources.

    I have always been an advocate for involving clinicians, patients and wider stakeholders and it has served me well. However, the hoops you have to jump through to justify the time in 'networking' is farcical when others cannot see the value beyond the obvious stakeholders.

    "The road to success is to go from failure to failure without losing your enthusiasm" - Winston Churchill. Clearly the government expects the NHS to live by this ethos?

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  • What mental health patients really need is someone that actually cares!

    A ten minute trip on the conveyor belt and yet another prescription does nothing to deal with the root causes, but of course, psychiatrists never look at those. If you are depressed you get anti depressants, regardless of the cause, if you self harm you are attention seeking yet no one has the time to sit and talk to patients, if you are suicidal, you are told that is your choice!

    It is time mental health care had a revolution and psychiatrists started dealing with root causes, not just the symptoms.

    Many GP's make time for MH patients, they are kind and caring, the listen and appear to understand and show much more empathy than conveyor belt psychiatrists. My advice to any mental health patient is to stick with your GP and avoid the mental health system like the plague! Once they suck you in, you will never come out again!

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