14th December 2018, Volume 131 Number 1487

Erik Monasterio, Andrew McKean, Vimu Sinhalage Christopher Frampton, Roger Mulder

People who experience serious mental illnesses (SMI) are known to have poor health status and significantly premature mortality compared to the general population.1 Cunningham et al examined premature mortality rates…

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Summary

People who experience serious mental illnesses (SMI) are known to have poor health status and significantly premature mortality. National and international studies have shown that patients with serious mental illness have a 15- to 20-year gap in their life expectancy when compared to the general population. Of particular concern, studies also indicate that this gap in life expectancy is increasing. Our research studied the causes of sudden death for patients with SMI who received special mental health care in Canterbury between 2005 and 2009, with the aim of determining interventions to mitigate the risk of sudden death and premature mortality. This is particularly important given New Zealand’s high suicide rate.

Abstract

Aim

Sudden death is used to define a death under suspicious circumstances, where there is no clear indication of existing medical illness (natural cause) that accounts for the death or clear indication for the cause of death. This includes all deaths from suicide, unintentional poisoning, drowning, falls and violence. Sudden death contributes to the increased mortality in people with serious mental illness (premature mortality) but is far less frequently studied and understood. This study analyses data of all sudden deaths of patients who had been under the care of the Canterbury District Health Board’s Specialist Mental Health Service, New Zealand’s second-largest population region. The study identifies key sociodemographic, diagnostic, legal and causative factors in the study population. This study aims to identify targeted interventions to mitigate premature mortality in this population.

Method

Data was obtained from the clinical files and the coroner’s findings for all sudden death patients with established contact with Specialist Mental Health Services in the Canterbury region of New Zealand, between 2005 and 2009.

Results

A total of 313 patients were identified. The median age at the time of death was 42 years (IQ Range 32.5–53 years). Of these, 65% (n=203) were male. Seventy-six percent (n=239) were of European descent and 9% Māori (n=29); 68% (n=280) were under care at the time of their death and 15% (n=32) were under the Mental Health Act. The sudden death rate was 0.36% for those under voluntary care and 0.7% for those under compulsory care. The most common primary diagnoses were alcohol or other drug abuse (29%); depression (25%); psychotic disorders (18%); BPAD (9%) and personality disorder (5%). The most common cause of death was suicide (51.8%) followed by motor vehicle crashes and falls, (23.3%) medical causes (17.6%) and homicide (1.3%). Of those that died by suicide, 75% were male. Hanging was the most common method (48%) followed by carbon monoxide poisoning (9.3%); medication overdose (5.8%) and falls from a height (3.5%).

Conclusion

The most common cause of sudden death was suicide, which was overwhelmingly the leading cause of sudden death in patients discharged or lost to follow up. The most potent predisposing factor appeared to be drug and alcohol problems. Mental health services should therefore advocate for comprehensive and evidence-based alcohol and drug policies, including access and availability to treatment programmes.

Author Information

Erik Monasterio, Consultant in Forensic Psychiatry and Senior Clinical Lecturer, University of Otago, Christchurch, Hillmorton Hospital, Christchurch; Andrew McKean, Senior Pharmacist, Hillmorton Hospital, Christchurch; Vimu Sinhalage, House Surgeon, Waikato Hospital, Hamilton;
Christopher Frampton, Professor, Department of Medicine, University of Otago, Christchurch;
Roger Mulder, Professor, Department of Psychological Medicine, University of Otago, Christchurch.

Correspondence

Dr Erik Monasterio, Senior Clinical Lecturer, University of Otago, Clinical Director and Consultant in Forensic Psychiatry, Forensic Director Area Mental Health Services, Hillmorton Hospital, Private Bag 4733, Christchurch.

Correspondence Email

erik.monasterio@cdhb.health.nz

Competing Interests

Andrew McKean has received speaker fees from Novartis.

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