Reduction in the incidence of suicide: a health gain objective for the NHS

Much emphasis is currently being placed on the identification of possible areas of improvement concerning the health of individuals, and therefore, the general population. One health-gain objective under consideration for severe mental illness is the reduction of mortality from suicide. During 1990, 3950 people are known to have taken their own lives in England and Wales and a further 1996 deaths are likely to have been suicides. Although suicide accounts for < 1% of all deaths in the general population, in the 15-44 age group about 10% of deaths are from suicide. It is envisaged that reducing suicide rates will be achieved through the setting of specific national and local targets. This type of approach dictates explicit requirements in outcome, which clearly has implications for the shape of the National Health Service. One problem with using recorded rates of suicide is that suicide is a medico-legal verdict and its use by coroners is influenced by a number of factors. Thus, before rates of suicide can be accepted as indicators of the effectiveness of health services, the validity of the statistics being gathered must be scrutinized. Moreover, the relatively small number of cases that occur each year means that statistical analysis of the data obtained from small areas, such as district health authorities, may be problematic.