Alcohol and drug misuse mean Scots are almost twice as likely to kill or take their own life compared with people living in England and Wales, researchers said today.
The findings by The University of Manchester's National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) also show that the number of mental health patients committing homicide or suicide was proportionately much higher in Scotland.
The "Lessons for Mental Health Care in Scotland" report, commissioned by the Scottish Government, blames these higher death rates on alcohol and drug consumption, both in the general population and among mental health patients.
"Our findings support the view that alcohol and drugs are the most pressing mental health problems in Scotland and mental health services can play their part," said Louis Appleby, Professor of Psychiatry and NCI Director.
"They must ensure that front-line clinical staff are skilled and confident in assessing and managing misuse; that they develop dedicated services for dual diagnosis, and that they establish close links with addiction teams."
The report also makes the following recommendations for clinical care:
Specialist community mental health teams providing an outreach service for patients who are at risk of losing contact with care.
Early follow-up following hospital discharge, requiring joint risk management by in-patient and community teams.
More intensive supervision of patients recently admitted to hospital.
Removal of ligature points from in-patient wards.
Prevention of absconding from wards through improvements in the ward environment and tighter control of exits.
Careful assessment of risk during periods of leave leading up to hospital discharge.
Improved mental health services for young people, providing better access and early intervention.
Positive clinical attitudes to the management of risk as part of a more understanding dialogue with the public
Examination of reasons for imprisonment of offenders with severe mental illness.
"No. The misery kicks in long before the drink and the drugs do, I can assure you. The poor climate/dark winters have a lot to do with it as well, in my opinion. I could say something about male sexual frustration as well but I would just be called a sexist pig!" - John M, Edinburgh