Alcohol and drug misuse means Scots are almost twice as likely as people south of the border to take their own life or kill.
Research from Manchester University also showed the number of mental health patients killing themselves or others was proportionately higher in Scotland.
The report found that the north-south divide was highest among teenagers.
It said alcohol and drugs were the "most pressing mental health problems in Scotland".
The Lessons for Mental Health Care in Scotland report was commissioned by the Scottish Government.
Researchers found there were 500 killings north of the border over five years and 5,000 suicides over six years.
Suicide rates in Scotland were 18.7 per 100,000 of the population, compared with 10.2 per 100,000 in England and Wales.
Of the 1,373 patient suicides in the report, there was a history of alcohol misuse in 785 cases, an average of 131 deaths per year.
There was a history of drug misuse witnessed in 522 cases, or 87 deaths per year.
About 28% of people who took their own life and 12% of killers had recently been mental health patients, the report said.