Suicides in mentally ill people are preventable, says UK report

POLICY AND PEOPLE

Suicides in mentally ill people are preventable, says UK report bout 250 suicides and six homicides could be prevented each year in the UK, according to a report published on March 16 by the national confidential inquiry into suicide and homicide by people with mental illness . Researchers from the University of Manchester report that about a quarter of suicides in England, Wales, Scotland, and Northern Ireland occurred within 3 months of discharge from in-patient care. “Since most of these suicides occurred in the first 1–2 weeks after discharge, early follow-up of patients should be a priority”, says Louis Appleby, director of the inquiry, (University of Manchester, UK). The report is based on 24 079 suicides from 1996–2001. 15% of people who commited suicide were hospital in-patients and the most common method used was hanging. More than half of patients who had com-

mited homicide had a diagnosis of alcohol or drug dependence or personality disorder rather than mental illness.

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Early follow-up essential

The report recommends that patients with severe mental illness and a history of self-harm or violence should receive the most intensive care, including follow-up within 1 week of discharge. It also suggests that staff on in-patient wards remove all likely ligature points, including all non-collapsable curtain rails.

Mind, a UK mental health charity, says that the report confirms that the unacceptably high number of suicides in the community and hospital are preventable. Judi Clements, Mind’s chief executive says: “We need urgent action from the government . . . people should feel safe from harm in hospital and when they come out there must be adequate support in place from their local mental health team.” But Nick Freemantle (University of Birmingham, UK) has reservations about the recommendations to follow up patients: “I am not aware of any good evidence that making this change will lead to reductions in the rate of suicide post discharge. Follow-up in randomised trials indicates clearly that there are major problems in keeping track of discharged patients”, he says. Minal Chande

Spain prepares for national tropical medicine network pain is planning to tackle tropical infectious diseases by creating specialised units. Antonio Campos, director of the Instituto de Salud Carlos III (ISC)—a Ministry of Health-based body for biomedical research, and teaching and training activities in the State Health Service (SHS)—told the Senate’s Health Committee on March 15 that “it [ISC] intends to create a national network of tropical medicine specialised units”. He explained that the flow of immigrants from subSaharan Asian and Latin American countries was increasing and that more Spaniards were visiting tropical countries (see Lancet 2001; 357: 862). “The intercontinental migratory flow (now 150 million people per year) will increase at a rate of 2–4 million people per year”, he added.

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The network will allow health professionals working on tropical medicine in Spain to exchange information effectively. The ISC is also planning to create a national reference centre on tropical medicine for health care, research, and training activities, said Campos. Junior doctors specialising in infectious diseases or microbiology would be trained in tropical medicine. Undergraduate medicine, biology, and pharmacy students would also receive training. Tropical diseases have increased substantially in Spain as a result of the increasing number of immigrants, the adoption of children from other countries, and the increase in tourism to these countries. Most experts agree that immigrants should receive special care that takes account of their coun-

try of origin, because there is limited knowledge about diagnosis and treatment of tropical diseases. Prevention measures and advice for travellers will also be put in place. It is estimated that about 1 million Spaniards travel to tropical countries each year. The number of imported cases of malaria from Spaniards increased by 160% from 1986 to 1995. Manuel Corachán, head of the Tropical Medicine Unit of the Hospital Clínic of Barcelona welcomes the measure and says there is a “lack of expertise” in this field. He adds that the creation of a national multidisciplinary advisory board will allow yearly decisions to be made on preventive measures for travellers. Xavier Bosch

Germany plans to ban genetic tests by insurance companies

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erman ministers Ulla Schmidt and Herta Däubler-Gmelin are planning legislation to prohibit the use of genetic tests by insurance companies. “I favour a complete ban, otherwise everyone with a low risk on a test would get a cheap insurance policy, while others would not be able to get one at all”, Schmidt said. Currently Germany does not have a law regulating the use of

THE LANCET • Vol 357 • March 24, 2001

genetic tests by third parties. Austria and Denmark have laws, whereas in the UK insurers are allowed to use a limited number of results. It is expected that the new German law will prevent insurers and employers requesting, using, or communicating genetic test results. “The German insurance industry is willing to refrain from genetic screening before underwriting a policy”, Gabriele Hoffmann of the

German Insurance Association told The Lancet “But a law prohibiting any use of a known test result is unacceptable . . . We would prefer that the present situation is maintained: any applicant for an insurance policy in Germany is obliged to reveal all known medical information, including a genetic test.” Wim Weber

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For personal use only. Reproduce with permission from The Lancet Publishing Group.