This report examines the details of individual cases of suicide & homicide by people with mental illness, asking: how many cases are there? what are the common themes? can we learn from them about risk & how to reduce it? Over the study period, there were around 5,000 suicides & around 500 homicides in Scotland. 28% of the people who died by suicide & 12% of those who committed a homicide had recently been mental health patients. The report highlights key areas of clinical practice where improvement is needed & suggests what changes could be made. A number of recommendations are made & the sensitive issue of violence by mental health patients is addressed.