TY - JOUR T1 - Mental health services: quality, safety and suicide JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-013532 SP - bmjqs-2021-013532 AU - Nav Kapur AU - Louise S Gorman AU - Leah Quinlivan AU - Roger T Webb Y1 - 2021/10/03 UR - http://qualitysafety.bmj.com/content/early/2021/10/03/bmjqs-2021-013532.abstract N2 - Suicide is a major global challenge with an estimated 700 000 people taking their lives each year.1 Each of these deaths is an individual tragedy affecting families, friends, communities and health and social care teams. As clinicians and researchers working in suicide prevention, we are sometimes contacted by people whose loved ones have died by suicide while under the care of mental health services. Although we hear about examples of high-quality care, there are also accounts of poor continuity, failed communication, diagnostic or therapeutic errors, poorly trained or resourced clinical teams or a lack of family involvement. Suicide is a complex phenomenon and many of its drivers are economic and social,2 but its prevention should be a priority for health services in general and for mental health services in particular. Specifically, mental health patients represent a group at greatly elevated risk of suicide who are accessible because they are in contact with services.3Two studies, carried out in the Veterans Health Administration (VHA) in the USA and published in this issue of BMJ Quality and Safety, have explored the relationship between different aspects of mental health provision and suicide risk. The paper by Kaboli and colleagues4 investigated the association between mental health bed occupancy and the veterans’ suicide rate in the catchment areas of 111 VHA hospitals across 50 states over a 5-year period. The study found that areas with inpatient psychiatric units operating at the greatest occupancy levels had higher suicide rates than areas with the lowest occupancy levels. As the authors point out, these results make clinical sense. It is plausible that ‘hospital strain’ and equivalent pressures in community care make some services less safe than others. It may well be that occupancy levels are an important safety metric. Although we did not find … ER -