The rate and pattern of patients' mortality in mental institutions are important parameters in the assessment of clinical outcomes. They provide a way of measuring the effects of mental healthcare provision. The study of death rates has been an important focus of analysis since the first half of the nineteenth century. Mortality is, of course, closely related not only to the care and attention an institution bestows on its inmates, but also its patient intake and their health status on admission. Recent research in Western countries has shown that mortality among psychiatric patients in both institutional and community-based care settings remains high. In Sweden the mortality rate for 12, 103 patients in the late 1990s was three times that of the wider population; a Norwegian study of psychiatric inpatients from 1980 to 1992 concluded that ‘mortality of psychiatric patients is still unsatisfactorily high’; and an assessment of data from seven German hospitals in the mid-1990s revealed that over six times more patients died than expected. Furthermore, an Italian team of epidemiologists concluded in 1997 that: