Inpatient suicide death in Ireland: challenges and opportunities for clinical care

Rates of admissions and residency in Irish psychiatric units and hospitals have decreased significantly over the last 30 years. Through this period national suicide rates have increased, with Ireland currently having the 17th highest suicide rate of the 27 EU countries and the fourth highest rate in males aged 15-24 years. Suicide deaths among inpatients in psychiatric care are rare but tragic occurrences. At present, little is known about the incidence, prevalence or profile of inpatient suicide in Ireland and in comparison with other European countries. Addressing a similar deficit, the United Kingdom established a National Confidential Enquiry in 1992, which over the past two decades has used a standardized research methodology to comprehensively investigate all suicide deaths of, and homicides committed by, people in contact with the mental health services. This inquiry, using a no-fault and confidential approach with all clinicians has informed and improved services and policies and possibly impacted on suicide reduction efforts in the United Kingdom. Suicide prevention efforts in Ireland are negatively influenced by an ongoing stigma of mental illness and suicide, which sustains the knowledge gap in relation to inpatient suicide. A similar method of enquiry to that of the UK confidential approach blended with current demographic and clinical data sources and including family input (from those bereaved by inpatient suicide) could inform a tailored policy and provide a valuable model for studying suicide across all inpatient and community psychiatric services.