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Primary care contact, clinical management and suicide risk following discharge from inpatient mental health care

Musgrove, Rebecca; Carr, Matthew J; Kapur, Nav; Chew-Graham, Carolyn A; Mughal, Faraz; Ashcroft, Darren M; Webb, Roger T


Rebecca Musgrove

Matthew J Carr

Nav Kapur

Darren M Ashcroft

Roger T Webb


Background Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.

Aim To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition.

Design & Setting A nested case-control study utilising interlinked primary and secondary care records in England for people who died within a year of discharge between 2001 and 2019, matched on age, sex, practice-level deprivation and region with up to 20 living discharged people.

Method We described patterns of consultation, prescription of psychotropic medication and continuity of care for people who died by suicide and those who survived. Mutually adjusted relative risk estimates were generated for a range of primary care and clinical variables.

Results Over 40% of patients who died within 2 weeks and 80% who died later had at least one primary care consultation. Evidence of discharge communication from hospital was infrequent. Within-practice continuity of care was relatively high. Those who died by suicide were less likely to consult within two weeks of discharge, AOR 0.61 (0.42–0.89), more likely to consult in the week before death, AOR 1.71 (1.36–2.15), to be prescribed multiple types of psychotropic medication, (AOR 1.73, 1.28–2.33), to experience readmission and have a diagnosis outside of the ‘Severe Mental Illness’ definition.

Conclusion Primary care clinicians have opportunities to intervene and should prioritise patients experiencing transition from inpatient care. Clear communication and liaison between services is essential to provide timely support.


Musgrove, R., Carr, M. J., Kapur, N., Chew-Graham, C. A., Mughal, F., Ashcroft, D. M., & Webb, R. T. (in press). Primary care contact, clinical management and suicide risk following discharge from inpatient mental health care. British Journal of General Practice Open (BJGP Open), BJGPO.2023.0165.

Journal Article Type Article
Acceptance Date May 8, 2024
Online Publication Date Jun 12, 2024
Deposit Date Jun 18, 2024
Journal BJGP Open
Print ISSN 2398-3795
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Pages BJGPO.2023.0165
Keywords primary care, suicide, psychiatric discharge
Public URL