Impact of national policy initiatives on fatal and non-fatal self-harm after psychiatric hospital discharge: time series analysis.

BACKGROUND Risk of self-harm and suicide is greatly increased in the period after discharge from psychiatric in-patient care. AIMS To investigate the impact on suicide of a series of policy initiatives to enhance care in the immediate post-discharge period. METHOD A time series analysis was based on 1997-2007 data from the National Confidential Inquiry into Suicide and from Hospital Episode Statistics for England. RESULTS There was no evidence of a reduced risk of suicide in the first 12 weeks following discharge in 2003-2007 compared with 1997-2002. In contrast, the relative risk of non-fatal self-harm in the 12 weeks after discharge declined. The risk ratio for self-harm (2003-2007 v. 1997-2002) at 0-1 week post-discharge was 0.86 (95% CI 0.80-0.92) and at 2-4 weeks it was 0.89 (95% CI 0.85-0.94). CONCLUSIONS These findings provide some support for the impact of recent policy changes on the risk of non-fatal self-harm in the immediate period after discharge from psychiatric in-patient care.