The number of beds available for psychiatric patients is shrinking. The people admitted are now sicker and the rate of death following discharge is now higher and higher. This large cohort study from Denmark is done well. An IRR (incident Risk Rate) is the difference in risk per point on scale, in this case year.

This national cohort study examined the full array of cause-specific mortality outcomes among patients recently discharged from inpatient psychiatric services. Compared with persons not admitted, these patients were at elevated risk for all types of mortality examined, and their risk for unnatural death soon after discharge was much greater than the risk for dying naturally. Clinical subgroups with particularly high risk included persons who were admitted involuntarily and those who had substance abuse disorders. The greatest relative risk observed was for suicide, followed by alcohol-related death. Among the natural causes of death, mental disorders and digestive diseases had the largest IRRs; these excess risks were largely explained by substance abuse disorders and alcohol-induced conditions, respectively. The large IRR for fatal infectious diseases can be explained by a preponderance of HIV cases,29 although the number of observed deaths for this outcome was small. Death by neoplasm had the highest incidence among natural causes, but the elevation in risk for patients who were discharged was relatively modest, with a 4-fold increase over the risk observed for those not admitted. Risk of dying within the first year following first discharge from inpatient psychiatric care was consistently greater than the risk after 1 year, and the differential in relative risk between these 2 periods was especially marked for suicide.

Although suicide is the great risk… thee risk of death from physical causes is not insignificant. You can see here though the IRR for HIV death is high, the numbers in Denmark, fortunately, are low.

In community care the need to intensively monitor these people is known… but, at least in NZ, community care is stretched and assertive community followup limited to the very high risk. We have to ask how much of this premature death is due to our deinstitutionaization, or how much is an artifact of deinstitutionalization meaning only the extremely sick ever get near a psychiatric inpatient bed.