The burden of mental illness is substantial, with an estimated one in four people in Organisation for Economic Co-operation and Development (OECD) countries affected at any time, and one in two affected during their lifetime. Timely access to high quality care has the potential to improve outcomes and may help reduce suicide and excess mortality for individuals with mental health conditions.
Internationally comparable data on the quality of mental health care is limited. This indicator draws on OECD data relating to inpatient suicide rates and suicide rates within 30 days of discharge from hospital. While these measures have the potential to be proxy measures for health care quality, their interpretation is not straightforward because suicide is a relatively rare event and is not an ideal measure of the quality of mental health care. In addition, the UK may be recording patient outcomes differently to other countries as a result of the NHS’s tendency to put physical and mental health services on different sites.
High quality care for inpatients with mental health disorders is essential, and inpatient suicide is a ‘never event’ which should be closely monitored. It gives an indication of how well inpatient settings are keeping patients safe from harm. All the comparator countries included here report inpatient suicide rates of less than 2 per 1,000 patients. The rate of inpatient suicide in the UK has decreased over time, from 0.2 suicides per 1,000 patients in 2011 to 0 per 1,000 patients in 2017. It is worth noting that this does not necessarily mean there were no inpatient suicides in 2017, but that the number was low enough that it rounds to zero when the rate is calculated. The UK has consistently had one of the lowest rates of inpatient suicide, while Denmark has had one of the highest rates.
Due to the very small number of cases, reported rates can vary over time and this data should be interpreted with caution. It is also important to remember that these rates are dependent on the severity of the case-mix. For example, Denmark’s high suicide rate may reflect that hospitalised patients have more severe psychiatric disorders than in other countries. The UK’s inpatient facilities might be capturing a wider pool of patients with mental health conditions, pushing the rate of suicide down.
Patients with mental health problems have a particularly high risk of suicide immediately following discharge from hospital. In most countries, over one quarter of suicides within the first year following discharge occur in the first month. This high-risk of suicide can be reduced through good discharge planning and follow-up, and enhanced levels of care immediately following discharge.
The UK’s suicide rate within 30 days of discharge among patients diagnosed with a mental disorder is consistently lower than comparator countries for which there is available data. In 2017, the UK’s suicide rate in the month after discharge was 0.2 per 1,000 patients. This might be influenced by the NHS’s tendency to put physical and mental health services on different sites, as patients with mental ill health who died by suicide but were discharged from physical health services might not be captured. The UK’s overall suicide rate is also relatively low, so societal factors rather than health care quality may be influencing the lower rates of patient suicide.
About this data
Definitions and comparability for the indicators are taken directly from the OECD report Health at a Glance 2019: OECD indicators. Detailed information about the definitions and the source and methods for each country can be found here.
The inpatient suicide indicator is composed of a denominator of patients discharged with a principal diagnosis or first two secondary diagnosis code of mental health and behavioural disorders (ICD-10 codes F10-F69 and F90-99) and a numerator of these patients with a discharge code of “suicide” (ICD-10 codes X60-X84). Data should be interpreted with caution due to there being a very small number of cases.
Suicide within 30 days of discharge is established by linking discharge following hospitalisation with a principal diagnosis or first two listed secondary diagnosis code of mental health and behavioural disorders (ICD-10 codes F10-F69 and F90-99), with suicides recorded in death registries (ICD-10 codes X60-X84). In cases with several admissions during the reference year, the follow-up period starts from the last discharge.
The data have been age-sex standardised to the 2010 OECD population structure, to remove the effect of different population structures across countries.