{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T01:25:50Z","timestamp":1766712350048,"version":"3.40.5"},"reference-count":31,"publisher":"Royal College of Psychiatrists","issue":"3","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec id=\"S2056472423000601_sec_a1\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>Little is known about the safety of mental healthcare provided remotely by digital mental health services (DMHS), which do not offer face-to-face contact.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472423000601_sec_a2\">\n\t    <jats:title>Aims<\/jats:title>\n\t    <jats:p>To examine the circumstances of suicide by patients registered with a national DMHS.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472423000601_sec_a3\" sec-type=\"methods\">\n\t    <jats:title>Method<\/jats:title>\n\t    <jats:p>Data from 59 033 consenting patients registered with a national DMHS, the MindSpot Clinic, between 1 January 2013 and 31 December 2016 were linked with the Australian National Death Index and documents held by the National Coronial Information System (NCIS). Data extracted included demographic information, the nature of contact, duration between last contact and death, symptom scores and information in police, autopsy, toxicology and coroners\u2019 reports.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472423000601_sec_a4\" sec-type=\"results\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Of the 59 033 patients, 90 (0.15%) died by suicide in a follow-up period of up to 5 years. The mean time between last contact and death was 560 days. Coroners\u2019 reports were located for 81\/90 patients. Most (87.0%) were receiving face-to-face care around the time of death, 60.9% had a documented previous suicide attempt, 52.2% had been in hospital in the previous 6 months and 22.2% had severe mental illness, mainly schizophrenia or bipolar disorder. Other common findings were current treatment with psychotropic medication (79.2%) and the presence of alcohol (41.6%), benzodiazepines (31.2%), and illegal drugs and non-prescribed opioids (20.8%) at time of death.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472423000601_sec_a5\" sec-type=\"conclusions\">\n\t    <jats:title>Conclusions<\/jats:title>\n\t    <jats:p>Those who died by suicide after contact with the DMHS had more severe illness, were mostly engaged with face-to-face services and often had disinhibiting substances, especially benzodiazepines, present at the time of death.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1192\/bjo.2023.60","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T08:23:51Z","timestamp":1684916631000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Circumstances of suicide after registration with a national digital mental health service: an analysis of coroners\u2019 reports"],"prefix":"10.1192","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5172-2781","authenticated-orcid":false,"given":"Olav","family":"Nielssen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Staples","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6152-9704","authenticated-orcid":false,"given":"Eyal","family":"Karin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rony","family":"Kayrouz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blake","family":"Dear","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane","family":"Cross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nickolai","family":"Titov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"170","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"key":"S2056472423000601_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.04.042"},{"volume-title":"National Safety and Quality Digital Mental Health Standards","year":"2020","key":"S2056472423000601_ref18"},{"key":"S2056472423000601_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291702006074"},{"key":"S2056472423000601_ref21","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"S2056472423000601_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2022.100516"},{"key":"S2056472423000601_ref11","doi-asserted-by":"publisher","DOI":"10.1080\/13284207.2020.1843968"},{"key":"S2056472423000601_ref20","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"S2056472423000601_ref24","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-113"},{"key":"S2056472423000601_ref8","doi-asserted-by":"publisher","DOI":"10.1177\/0004867416671598"},{"key":"S2056472423000601_ref14","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.17101167"},{"key":"S2056472423000601_ref5","doi-asserted-by":"publisher","DOI":"10.2196\/18100"},{"key":"S2056472423000601_ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s10865-007-9144-1"},{"key":"S2056472423000601_ref7","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201400477"},{"key":"S2056472423000601_ref12","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-015-0676-6"},{"key":"S2056472423000601_ref27","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291702006943"},{"key":"S2056472423000601_ref26","unstructured":"26 Australian Bureau of Statistics. Causes of Death. ABS, 2021 (https:\/\/www.abs.gov.au\/statistics\/health\/causes-death)."},{"key":"S2056472423000601_ref16","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.15m09776"},{"key":"S2056472423000601_ref30","doi-asserted-by":"publisher","DOI":"10.1192\/pb.bp.115.053017"},{"key":"S2056472423000601_ref3","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20610"},{"key":"S2056472423000601_ref19","unstructured":"19 New South Wales Ministry of Health. Mental Health Triage Policy (PD2012_053\/File no. H12\/49005). NSWMOH, 2012."},{"key":"S2056472423000601_ref29","doi-asserted-by":"publisher","DOI":"10.4088\/PCC.16r02037"},{"key":"S2056472423000601_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2018.07.006"},{"key":"S2056472423000601_ref28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0251938"},{"key":"S2056472423000601_ref15","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201700475"},{"key":"S2056472423000601_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(20)30224-7"},{"key":"S2056472423000601_ref6","doi-asserted-by":"publisher","DOI":"10.1177\/07067437211006873"},{"key":"S2056472423000601_ref25","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.01085"},{"key":"S2056472423000601_ref9","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2019.1666162"},{"key":"S2056472423000601_ref10","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19020905"},{"key":"S2056472423000601_ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3933"},{"key":"S2056472423000601_ref31","doi-asserted-by":"publisher","DOI":"10.3109\/10398562.2010.507816"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472423000601","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T08:23:54Z","timestamp":1684916634000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472423000601\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["S2056472423000601"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2023.60","relation":{},"ISSN":["2056-4724"],"issn-type":[{"type":"electronic","value":"2056-4724"}],"subject":[],"published":{"date-parts":[[2023,5]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e88"}}