Kapur et al.'s (Reference Kapur, Hunt, Windfuhr, Rodway, Webb, Rahman, Shaw and Appleby2012) research showed that in-patient suicide in England has decreased considerably, especially death through hanging. They also mentioned that they could not exclude that some of the risk might have been transferred to other services such as home treatment teams, because the absolute number of suicides in patients under the care of a home treatment team has risen. Previously published research from the same group showed that there are fewer suicides of in-patients in areas where home treatment team policies had been implemented, but the reduction of suicides in the community was not statistically significant in the same areas (While et al. Reference While, Bickley, Roscoe, Windfuhr, Rahman, Shaw, Appleby and Kapur2012). The question is what the potential consequences of these findings are for clinical practice and service organization. The level of which team looks after which type of patient does not seem the most informative.

From a clinical and public health perspective there are, broadly speaking, two types of measures one can take to prevent suicide: preventing access to means and assessing the suicide risk clinically and trying to reduce it. Suicide is a rare event and therefore very difficult to predict, even when there are scales available which show significant differences between people with high and low risk (Szmukler et al. Reference Szmukler, Everitt and Leese2012). Preventing access to means seems a more promising approach both at ward level, for example removing ligature points, and in the community, for example limiting the amount of paracetamol people can buy in one purchase (Hawton, Reference Hawton2007). The measures one can take in home treatment teams or community mental health teams are limited, although one can take medication away and the patients will benefit from the general community measures.

The authors do make a difference between suicide through hanging on the ward and outside the ward (i.e. patient on leave), but they do not report this for other methods. However, besides studying whether risk is transferred to different teams, it would be interesting to see whether there is a trend in suicide of all mental health patients who are physically outside the hospital. An increase would be worrying, even if there is decrease in the total number of suicides, because it would imply that clinical risk prediction had become less good or that health professionals had been unable to act on the high risk, for example due to lack of admission facilities.