Patients in the mental health and substance misuse services have a well-known elevated risk of suicide and suicidal behavior. This makes mental health and substance misuse services an important setting for suicide prevention. Despite this, we have lacked detailed information about suicide during and after treatment in these services in Norway, and had limited knowledge about the key features of patients who die in suicide.
The aim of the Surveillance System is to secure a continuous collection of national data on suicide among patients who have been in contact with the specialist mental health and substance misuse services in the 12 months preceding death. Based on systematic data collection we can better describe the circumstances around the incidents and systematically identify key features of these patient suicides. The goal is to identify new areas for suicide prevention at the system level, improve the quality of mental health services in Norway, and eventually evaluate the effectiveness of such implemented prevention strategies.
The Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse Services is partly based on The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) from the University of Manchester in the United Kingdom. Since 1994, NCISH has systematically collected data from clinicians on suicide and homicide in people who have been in contact with mental health services in the 12 months prior to death. Based on the inquiry method, NCISH has provided health professionals, policymakers, and service managers in the UK with both evidence and the practical suggestions they need to effectively implement change.
The NCISH-model has undergone adaptions to make it feasible for use in Norway. Among other things, we include existing registry data to reduce the amount of questions in the questionnaire which the health professionals need to complete after a patient has died in suicide. In order to obtain the registry data, we are collaborating with the Norwegian Cause of Death Registry and the Norwegian Patient Registry. At the moment we will not collect data on homicides or accidental overdoses. Neither will we cover treatment given by general practitioners or other services at the community level.