Can the suicide rate be used as a performance indicator in mental illness?

This paper follows from an examination of death rates from suicide as a possible performance indicator in mental illness. The wide variations observed in the proportion of undetermined deaths to suicides in Yorkshire district health authorities, suggest that coroners differ in their legal definition of suicide. To counteract the problem of coroner bias it is suggested that deaths from suicide and self-inflicted injury, and deaths from injury undetermined, whether accidentally or purposely inflicted in the 15 and over age group be combined. The paper outlines the advantages of such a performance indicator and stresses that a 'poor' indicator value merely poses questions which lead to a search for reasons for the value and is not an explanation in itself.