Suicide outside the care of mental health services: a case-controlled psychological autopsy study

Three-quarters of people who commit suicide are not in contact with mental health services at the time of death. No previous UK study has focused specifically on this group of suicides.

To identify the characteristics of people who commit suicide while outside the care of mental health services.

A case-control study was conducted in SW England involving 100 individuals who committed suicide while not in contact with mental health services and 100 age-sex matched controls drawn from the living population. Data were collected by means of semistructured interviews with key informants and from medical records.

Key predictors of suicide were previous attempted suicide, social and interpersonal problems, current mental illness, past mental illness, and previous contact with specialist services. However, nearly a third of cases (32%) appeared to have no current mental disorder.

This group is distinguished by a markedly lower rate of mental illness than has previously been recorded. The findings highlight the difficulty of identifying individuals outside specialist mental health care who are at risk of suicide and therefore support the continued development of broad population-based measures rather than the targeting of high-risk groups.