One in 1,000 patients die in inpatient psychiatric care — could they be prevented?

Content warning: this article contains references to suicide, self-harm and death

Key points:

• According to a recent study, there is a possibility that 30 percent of deaths during inpatient psychiatric care in New South Wales could have been prevented

• The report found that there were 471 deaths in inpatient psychiatric wards over a 10-year period in New South Wales, with 141 considered preventable

• Suicide accounted for 17 percent of inpatient deaths, with 75 percent due to physical health causes

New research from the University of New South Wales Sydney has revealed the need for a coordinated approach to monitoring and reducing the number of inpatient deaths in psychiatric care.

The study assessed datasets of psychiatric admissions in NSW from 2002 to 2012 and found that approximately 30 percent of deaths could be prevented with timely and effective medical intervention.

Researchers noted that although the gap in life expectancy for psychiatric patients compared to the general population is reported to be between 10 and 25 years shorter, widening over time, inpatient deaths should not be occurring at such a significant rate.

Dr Pramudie Gunaratne, MD, lead author of the study and research fellow at the UNSW Department of Developmental Disability Neuropsychiatry, said there was a clear need to develop better preventative strategies and improve the overall quality of psychiatric care.

“We were originally looking to compare all-cause mortality rates in New South Wales with other States,” Dr Gunaratne said.

“It was surprising to find nothing we could benchmark with as there wasn’t a systematic monitoring process for inpatient deaths during psychiatric care in Australia.”

The leading cause of death was physical health problems, such as issues with the circulatory system, which accounted for 75 percent of all-cause mortality. Deaths from suicide and accidental death accounted for the remaining 25 percent

“Understandably, there is a focus on reducing deaths from suicide in mental health wards; these are an absolute tragedy when they occur,” Dr Gunaratne added.

“[However,] we also know people with mental illness have higher rates of physical health comorbidities — they may be taking medications with metabolic side effects and can experience stigma and other barriers that limits [sic] access to physical healthcare — all of which may contribute to the significant number of deaths from physical health problems in mental health wards.”

Although every death in a mental health ward in Australia is individually examined, the study is the first in the first of its kind in the country to systematically review all-cause mortality in mental health wards.

“Unfortunately, managing people with illnesses that span the brain-body divide is incredibly challenging from within systems that traditionally separate mental and physical healthcare,” Dr Gunaratne added.

“One of our key recommendations is that patients in inpatient psychiatric care settings have thorough physical health reviews and monitoring while in a ward.

The study’s lead author emphasised the importance of improved access to physical healthcare in the community to promote physical well-being prior to admission.

“Our dataset stopped in 2012, so we simply don’t know how the death rates and causes may have changed over the last decade,” Dr Gunaratne explained.

“So, there’s a need for more comprehensive monitoring of inpatient psychiatric deaths across a national and State-wide level.

“Until we have that data, designing the effective interventions we need will be challenging.”

Researchers from UNSW Sydney’s Big Anxiety Research Centre will host a new virtual reality workshop when they return to the regional town of Warwick in Queensland on October 19 – 20, 2023.

Warwick is a town that is particularly impacted by the high rate of youth suicide within its First Nations community. In April of 2022, researchers held the Warwick Big Anxiety Festival in the hope of shedding light on the issue.

Just two weeks before the festival was due to start, a 16-year-old First Nations young man died by suicide after visiting Warwick Hospital seeking help for his mental health. His death had a profound effect on the community, who were left feeling “angry, sad, and more hopeless.”

The upcoming VR experience, Perinatal Dreaming, will debut alongside the BARC’s film, Changing Our Ways, which documented the project’s profound impact on the community when it took place last year.

If you or someone you love is at risk of a mental health crisis, please visit the following resources:

Parent Line — NSW 1300 130 052

Beyond Blue — 1300 224 636

NSW Mental Health Line — 1800 011 511

Lifeline Australia — 13 11 14

Kids Helpline — 1800 551 800

In an emergency, call — 000 

Do you believe that more can be done to support those in inpatient care? Have you had an experience in a mental health ward? Let the team at Talking Disability know what needs to improve.