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Substance Abuse and Mental Health Services Administration
Suicide in the Homeless Within 12 Months of Contact With Mental Health Services : a National Clinical Survey in the Uk
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Suicide prevention is a health service priority. Homeless mental health patients present a challenge to services because of their complex health and social needs. This study investigates a homeless population in Wales and England who were in contact with services before they died from suicide. The study describes their suicide methods and their social and clinical characteristics including aspects of clinical care. The authors found a total of 131 individuals who died by suicide were reported to have been homeless at the time of death—3% of all suicides by psychiatric patients, over 30 per year. Hanging was the most common cause of death. The most frequent diagnosis was schizophrenia. Around half were in-patients at the time of death. Social and clinical risk factors for suicide were common, including drug and alcohol misuse, and recent suicidal ideas and behaviour. Despite this, their clinical care was characterised by disengagement from services as a result of missed contacts, self-discharge, lack of follow-up and lack of key worker. The authors conclude that reducing the number of deaths by suicide in those who are homeless and mentally ill, requires improvements in in-patient safety and engagement in the community. This may be achieved through assertive community treatment, dual diagnosis services, and dedicated community mental health teams. (Authors)