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Objective: To explore trends in psychiatric in-patient suicide over time in a complete national sample.Design and Setting: A prospective study of all patients admitted to National Health Service in-patient psychiatric care in England from 1997 to 2008.The study was carried out as part of the National Confidential Inquiry into Suicide.Suicide rates were determined using Hospital Episode Statistics as the denominator.Main outcome measure: Completed suicide among psychiatric in-patients.Results: Between the first two years of the study (1997, 1998) and the last two years of the study (2007, 2008) the annual number of in-patient deaths nearly halved (from 200 to 102).The rate of in-patient suicide fell by one third.This fall remained statistically significant after adjustment for falling general population suicide rates.The reduction in in-patient suicide rate was observed for both males and females, and across ethnicities.It was most marked for patients aged 15-44 years.Rates fell among those with schizophrenia and those with drug dependence.Reductions were also observed for the most common methods of death.The rate of suicide by hanging on the ward fell by 59%.Although the number of post discharge suicides fell, the rate of post-discharge suicide may have increased by 15%.The number of deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 150 annually.Conclusion: The rate of suicide among psychiatric in-patients appears to have fallen.The fall may well reflect service improvements.However, a transfer of risk to the post-discharge period or to other settings such as crisis resolution teams cannot be ruled out.