The relationship between the use of mental health act and general population suicide rates in England and Wales

BACKGROUND: The relationship between suicide and involuntary admissions has been mainly examined in younger and mixed age groups. These studies provide mixed results with some demonstrating no relationship and others reporting increased rates of suicides in involuntarily admitted patients. However, the association between the utility of the Mental Health Act with general population suicide rates in England and Wales has not been formally studied. METHODS: Thus, an ecological study, over the 19-year period, to examine the relationship between rates of involuntary admissions and general population suicide rates in England and Wales was undertaken using nationally collected data. Data on general population suicide rates for both sexes were ascertained from the World Health Organization (WHO) website. Data on the number of detentions under the Mental Health Act were ascertained from the Office of National Statistics website. Data on the population size for the elderly age-bands were ascertained from the WHO website. Spearman's correlation coefficient was used to examine the relationship between suicide rates and rates of detention under the Mental Health Act. RESULTS: There were negative correlations between rates of involuntary admissions and general population suicide rates in both sexes. CONCLUSIONS: A causal relationship and the direction of causality cannot be assumed because this was an ecological study. There is a need for sufficiently powered study to compare the number of suicide occurring in involuntarily and voluntarily admitted patients using a case-control or cohort design and survival analysis. If an inverse association can be demonstrated between suicide and involuntary admissions then it has important implications for the development of mental health legislation as an adjunct to national suicide prevention strategies.