Attempted suicide and suicidal gestures.

The problem of attempted suicide is attracting much attention because of the great increase in the incidence of these cases in recent years. Anyone who is clinically involved can have no doubt about the increase although, rather surprisingly, the Ministry of Health have no reliable statistics (Ministry of Health, 1967, personal communication). Those statistics which are available have been collected by psychiatrists who have a particular interest in the problem. Kessel (1965) made this the subject of his Milroy Lectures, in which he pointed out that 'the fashion has so developed over the last 20 years that today we regard it almost as commonplace'. Matthew (1966) refers to 'a major epidemic'. Having realized that approximately one-third of all new psychiatric referrals fell into this category, it was decided to carry out a prospective survey of cases arriving at The General Hospital, Ashtonunder-Lyne over a period of one year. A total of 229 cases were dealt with during the year 1 June 1964 to 31 May 1965, an incidence of just over one per thousand of the catchment area population (223,000). The incidence is almost identical to that reported at the Poisoning Centre at Edinburgh. In contrast, Hopkins (1937), who carried out an extensive investigation of all cases of attempted suicide for the whole of Liverpool over a period of four years from 1932 to 1935, could collect only 656 cases, and, even as recently as 10 years ago, Harrington and Cross (1959) were able to collect only 102 cases in a large general hospital in Birmingham over a period of three years. In order to ascertain whether in fact there had been an increase in the number of cases, a search was made through the hospital records for the sample years 1947, 1949, 1956, 1960, 1962, and 1968, and the results are shown in Table I. As no special record of these cases has been kept in the past, statistics could only be obtained by a search through the records of all types of cases dealt with by the accident and emergency room in the years selected. It will be seen that the number of cases increased by over 30 times in the period from 1947 to 1968. The problem is a complex one and can be approached in a number of different ways, but the practical aspects of it, in particular possible means of prevention or reduction in the number of cases, must surely be the main consideration. As Kessel (1965) stresses, 'the problem is no longer academic'.