Suicide in the mentally ill

Suicide is a major cause of death across the world. Self-harm refers to a deliberate non-fatal act, whether physical, drug overdose or poisoning, carried out in the knowledge that it was potentially harmful. Self-harm is strongly associated with the risk of suicide but is an important public health problem in its own right. The epidemiology of suicide and self-harm is changing. Suicide in England and Wales is becoming less common, but rates for young men have doubled in the last 20 years. With respect to self-harm, paracetamol overdoses have decreased but alcohol misuse has increased. Almost as many men as women now present with self-harm in most centres. Risk factors for suicide and self-harm overlap to an extent but the clinical prediction of these behaviours is difficult because they are comparatively rare outcomes. Two sets of guidelines on the management of self-harm have recently been published. They provide a consensus view of best practice but the evidence base for them is weak. The National Suicide Prevention Strategy for England suggests both high-risk and population-based measures to reduce the rate of suicide. Recent work suggests the most effective strategies might involve restricting access to lethal methods of suicide and educating physicians to recognize and treat depression.