Guidance

The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) suicide in former service personnel of the UK armed forces – study information

Published 6 December 2021

Who will conduct the research?

The study will be conducted by the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) based within the Centre for Mental Health and Safety at the University of Manchester. The study has been jointly commissioned and funded by the Ministry of Defence (MOD) and NHS England.

What is the purpose of the research?

UK Armed Forces veterans are potentially a highly vulnerable group for multiple reasons, including traumatic life events, experiences whilst in Service, the difficulties associated with the transition to civilian life, mental health difficulties and high rates of homelessness and alcohol and drug misuse.

The main aim of this study is to investigate suicide risk amongst those who have left the UK Armed Forces, and to make comparisons with serving personnel and the general population. More specifically, the objectives of the study are to:

• investigate age-specific rates of suicide in veterans and compare these with rates in the serving and general populations
• identify risk factors, characteristics, and contact with health and other support services among veterans
• describe patterns in suicide rates in veterans and compare these with patterns in the serving and general populations
• use coroners’ records (or police death reports in Scotland) to understand the factors related to suicide

The study will be conducted in two phases. In Phase 1, we will conduct a retrospective UK-wide cohort study linking information held by the MOD on:

• (i) all personnel discharged from the UK armed forces (veterans) between 1997 and 2018 and,
• (ii) all in-service deaths by suicide or probable suicide in serving personnel between 1998 and 2018 with information held by NCISH on general population and mental health patient suicides.

In Phase 2, we will gather information on the factors related to suicide from other official sources (for example, coroners’ records in England and Wales) on a sample of veterans who have died by suicide.

What information will be collected?

Phase 1 of the study

The MOD will provide NCISH with the following:

Identifiable information limited to full name, date of birth and date left service on all personnel discharged from the armed forces between 1997 and 2018. This information is required to identify veterans who have died by suicide or probable suicide by linking it to information held by NCISH on all suicide deaths in the general population.

Once this done, all identifiable information will be removed and, using a unique identification number (MOD ID) as the only identifier, the MOD will provide NCISH with the following information for those veterans identified as having died by suicide:

• demographic characteristics (for example: age, gender, ethnicity, marital status)
• military service (for example: assignment type (regular/reserve), rank, training indicator, date of entry, length of service, deployment, date and type of discharge, disciplinary actions)
• healthcare (for example: contact with the MOD Department of Community Mental Health (DCMH), mental health diagnosis if treated in DCMH)

The NCISH research team will then use a second unique identification number (NCISH ID) to link this to our patient suicide database. By this stage, all identifying information will have been removed. This will identify the deaths by suicide of veterans under the care of specialist mental health services in the previous 12 months.

Fully anonymous information (for example, containing no identifying information) on living veterans and those who died by other causes, including information on demographic characteristics, military service, and healthcare. This information will be used to examine patterns in characteristics between veterans who died by suicide, veterans who died by other causes and living veterans.

Identifiable information on all in-service suicide deaths amongst serving personnel from 1997 to 2018. We will link this information to NCISH’s patient suicide database to identify people who died by suicide in-service who were under the care of specialist mental health services in the 12 months prior to death. This information is needed for comparison purposes. It will allow us, for example, to investigate the possible influence of an in-service mental health contact or diagnosis on the risk of later suicide.

Phase 2 of the study

In this stage of the study we will collect information on the factors related to suicide from coroner inquest hearings (or redacted police sudden death reports in Scotland) for approximately 200 veterans who died by suicide between 1st January 2007 and 31st December 2017. We will examine the following information, if available:

• demographic and family characteristics, including marital and employment status, provider role, life or career opportunities
• socio-economic characteristics, including debts, gambling, receipt of or problems with benefits, other financial losses, social isolation
• medical history, including health and treatment (for example, medications prescribed)
• mental health history, including any diagnosis of mental illness, history of self-harm, and the use of alcohol and drugs
• contact with services, including contact with primary and secondary health services, criminal justice, social care, and also including access to psychological and drug treatments
• recent events, including relationship, workplace and financial problems
• life events
• bereavement

All information from phases 1 and 2 of the study will be collected and stored in accordance with the General Data Protection Regulation (GDPR), and entered on a study database against a unique identifier. This study database will not contain any identifying information.

What rights do we have to hold this information?

Processing of the information that we will hold for this study is necessary in the public interest, for scientific and statistical research purposes in accordance with Article 89(1) of the GDPR. We will only hold and process information which is proportionate to our aim of informing safer practice to reduce suicide in veterans of the UK armed forces.

We will not be sent health records of people who have opted out of their health data being used for anything other than care and treatment (for example, people who have registered with the national data opt-out). The national data opt-out will be applied by the MOD before sharing any data with NCISH. This means that the MOD will remove the health data of any service personnel who opted out of having their medical data shared with a third party.

Please refer to the NCISH and MoD privacy notices for further information on the rights that you have if you think that we will hold information about you as a data subject.

What will happen to the information we obtain?

Information held by the MOD will be securely transferred to the NCISH office using an encrypted USB device through an MOD-approved courier. Once received, confidential identifiable information will be stored separately from further information collected on that individual (for example information on mental health history). This information will be linked to a veteran by means of a unique number not their name. Only authorised members of the NCISH research team will have access to confidential information (and fully anonymous information about living veterans) provided for the study. This information will be stored on a secure research site – electronic records can only be accessed via encrypted and password protected computers on a network that is not connected to the internet. Paper records will be stored in locked filing cabinets in a locked office, on a corridor that can only be accessed via swipe card entry. Confidential identifiable information will only be used to link MOD and NCISH information. Information that is not linked will be securely deleted. Therefore, the only confidential identifiable information that NCISH will retain will be about people who died by suicide. Information we receive from the MOD on living veterans will be fully anonymous.

How will we use this information?

This study will extend the research previously undertaken by NCISH. It will provide figures for suicide in UK armed forces veterans in the general population and in those under the care of mental health services, and will describe the characteristics and factors preceding these suicide deaths. Findings will help inform safer practice among agencies who work with veterans to reduce suicide in this vulnerable population.

We will publish a report for the MOD and NHS England. This will be shared amongst those responsible for delivering services to both serving and military veterans, ensuring relevant initiatives/action plans are put in place to address any adverse findings. We may also produce academic papers and presentations. We will only publish aggregate figures, and we will follow MOD guidance about small numbers – we will not publish low numbers, and we never share information about an individual.

We will not hold any identifying information on living veterans. If you have opted out of your health data being used for anything other than care and treatment, your opt-out will be applied by the MOD or by the relevant health organisation, and your health records will not be shared with us.

Who do I contact if I would like to find out more about the study?

If you wish to be informed of publication of the study’s findings or would like to find out more about the study, please contact lana.bojanic-2@manchester.ac.uk.