Monday, October 14, 2013

Increase in patient suicides has followed introduction of CTOs

The headline for this piece is deliberately tongue in cheek. It's not supposed to imply that the introduction of community treatment orders (CTOs) has led to an increase in suicides, although, of course, I am aware that this is how it could be taken. It's just that the latest report from the National Confidential Inquiry (NCI) into Suicides and Homicides by People with Mental Illness has implied that CTOs have reduced homicides. I just thought it important to point out, if that claim is being made, that CTOs have not reduced suicides. In theory, CTOs could have either increased or decreased deaths by suicide and homicide. And NCI expected CTOs to have a greater impact on absolute numbers of suicides than homicides. Or maybe it thinks the increase in suicides would have been a lot worse without CTOs.

To be clear, what the report points out is that homicide by mental health patients has fallen substantially since a peak in 2006. This might not have been obvious from recent headlines in The Sun (see previous post). The report goes on to say that one of the clinical explanations may be the introduction of CTOs in 2008.

The report also notes that the number of patient suicides increased in 2011. Although the figures are provisional because the data is incomplete, a higher number of patient suicides is predicted in 2011 than in recent years. There's no speculation that this is due to CTOs; instead the "rise probably reflects the rise in suicide in the general population, which has been attributed to current economic difficulties".

After all, it was NCI that argued for the introduction of CTOs to reduce homicide and suicide. It even went as far as to predict in Safer services that 30 suicides and 2 homicides would be prevented each year. A later report, Safety first, increased that figure to 32 suicides and 3 homicides. The trouble is that the logic used to produce such estimates did not stand up, as all NCI did was assume that CTOs would prevent deaths and then produce figures based on this premise. The fact is that whatever figure was produced is not evidence of the value of CTOs, as it was only an estimate assuming they were going to be effective. Maybe that's why the latest report latches on to the reduction in homicides. NCI needs some evidence to justify its previous speculation, which it couched in pseudoscientific terms. But, of course, this isn't evidence as such because there are all sorts of reasons why the homicide figure may have gone down, in the same way as there are all sorts of reasons why the suicide figure has gone up.

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