The first few weeks after discharge from psychiatric hospital in-patient care are a period of extremely high risk of self-harm

in-patient care are a period of extremely high risk of self-harm and suicide. Studies in the UK, Denmark, Singapore and Hong Kong show that the risk of suicide is up to 200 times higher than that of the general population around this time. Risk declines rapidly in the subsequent weeks before reaching a relatively steady state at around 6 months after discharge. In England approximately 5% of all suicides (220 per year) occur during the 3 months after discharge from psychiatric hospital. In keeping with this pattern, recent data indicate that the risk of non-fatal self-harm is also greatly increased in the post-discharge period: within 12 months of discharge, over 6% of all psychiatric hospital patients were admitted to a general hospital following an episode of self-harm. Since 2002 a number of policy initiatives aimed at reducing suicide risk in the post-discharge period have been introduced in England. A specific action recommended in the National Suicide Prevention Strategy for England (September 2002) was that following psychiatric hospital discharge, everyone with severe mental illness or a history of self-harm in the previous 3 months should be followed up in the community within 7 days. The Department of Health’s guidance for mental health services in 2003 recommended that in-patient and community teams carry out a joint case review prior to discharge; that care plans should take into account the heightened risk of suicide in the first 3 months after discharge and make specific reference to the first week; and that patients who were thought to be at high risk of suicide during their admission should be followed up within 48 h of discharge. To date, the impact of these initiatives on the risk of fatal and non-fatal self-harm in the early weeks following hospital discharge has not been assessed. In this study we use data collected in the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, and from Hospital Episode Statistics, to address the hypothesis that policy interventions have reduced fatal and non-fatal self-harm in the early weeks after psychiatric hospital discharge.