Suicide by people in contact with drug and alcohol services: a national study 2021 to 2022

Background: People with drug and alcohol use and dependence problems are at increased risk of dying by suicide. This study aimed to examine factors associated with suicide by people under the care of drug and alcohol services by linking existing databases and collecting supplementary incident report data to establishing the number of people who died by suicide within recent (12 month) contact with drug and alcohol services, comparing people who died by suicide with other people in contact with drug and alcohol services to establish clinical and psychosocial risk factors that may inform suicide prevention, and making recommendations for practice to improve safety for people under the care of drug and alcohol services.

Method: We linked mortality data on people who died by suicide from the Office for National Statistics (ONS) to national drug and alcohol treatment databases in England and Wales, for deaths registered between 1 October 2021 and 30 September 2022, to establish the sociodemographic and clinical characteristics of this group. We matched this group to controls who had been in contact with drug and alcohol services in the previous year but did not die, to establish risk factors for suicide. We also collected data from serious incident reports into these deaths.

Results: Four-hundred and twenty-eight people in England and Wales died by suicide within 12 months of contact with drug and alcohol services during the study period, 8% of all suicide deaths. Almost half of people (175, 47%) who died by suicide were unemployed at the time of death and over a third (140, 34%) lived in the 20% most deprived areas. In almost half (48%) of the people who died, the primary substance for which they were seeking help was alcohol. In total, 108 (25%) had completed treatment with services prior to death and were reported as being substance free or an occasional user. Just under half (191, 45%) of people had contact with drug and alcohol services in the month prior to their death. One hundred and sixty-one people (38%) remained in treatment at the time of death. Just under a third (127, 30%) also had contact with mental health services in the previous 12 months. These people had high rates of self-harm (76%), including in the 3 months prior to death (43%). A fifth of these people had missed their last contact with mental health services, and 14% were not adherent with prescribed medication.

Conclusion: Just over half of people who had contact with mental health services in the year prior to death had a history of drug and/or alcohol misuse, yet under a quarter of these people were under the care of specialist drug and alcohol services. Eight percent of people who died by suicide in England and Wales had contact with drug and alcohol services in the 12 months prior to death (over 400 deaths per year). Many of those were under the care of these services at the time of their death, suggesting important opportunities for intervention.