Sohrab Panday is a GP, Suicide Prevention and Postvention Specialist, and Clinical Commissioning Lead for Adult Mental Health, Learning Disabilities, and Autism, NHS Derby and Derbyshire Integrated Care Board, Derby. Corresponding email: spanday @ nhs.net
Carolyn Chew-Graham OBE is a Professor of General Practice Research, Keele University, Keele; Honorary Professor of Primary Care Mental Health, Midlands Partnership University NHS Foundation Trust; and Honorary Professor of Primary Care, University of Manchester, Manchester.
Michael Doyle is a Professor of Mental Health Research and Director of the Centre for Equity in Mental Health, University of Huddersfield, Huddersfield.
Hosam Elhamoui is a Consultant in Medical Psychotherapy and General Psychiatry, Specialist Psychotherapy Service, Manchester.
Mark B Gabbay is a Professor of General Practice, University of Liverpool, Liverpool; and Director of the National Institute for Health and Care Research Applied Research Collaborative North West Coast.
Emma Tiffin is a GP; Associate Director of Mental Health & Learning Disabilities, NHS Central East Integrated Care Board; and National GP Advisor for Community and Primary Care, Adult Mental Health, NHS England.
Seamus Watson is the National Improvement Director, NHS England.
Adrian Whittington is a National Clinical Lead for Psychological Professions; and National Clinical Advisor of NHS Talking Therapies, NHS England.
Faraz Mughal is a GP and Senior Clinical Researcher, Nuffield Department of Primary Care Health Sciences, Oxford Primary Care Clinical Trials Unit, University of Oxford, Oxford.
Over 7000 people die by suicide in the UK each year. Around 25% were receiving specialist mental health care, and the majority had attended other NHS services in the weeks before death.1 General practice is often the last professional contact before suicide, and a key setting for intervention.2 Escalating, or more frequent than monthly consultations, are associated with increased suicide risk regardless of patients’ sociodemographic characteristics, and regardless of the presence or abscence of known psychiatric illnesses.2
Male suicides outnumber female suicides by about 3:1, peaking in middle age.1,3 Men in this group are more likely to be unemployed, single, exposed to recent occupational stress, and may present with self-harm or substance misuse. The months before suicide are often marked by increasing general practice attendance and polypharmacy, including opioid use.3
GPs should be vigilant about suicide risk across all ages and genders. Although middle-aged men have the highest suicide rate, young people increasingly present with distress and self-harm.4
“Take any and every disclosure of self-harm or suicidal thoughts seriously; do not minimise or dismiss it.”
Older people are a growing demographic and are vulnerable to loneliness, loss, and ill health. An older person presenting with self-harm is 20 times more likely to die an unnatural death and 145 times more likely to die by suicide.5
Mental illnesses are commonly associated with increased risk, especially previous suicide attempt and depressive disorder.6 Common mental disorders are managed largely in primary care. Autism and attention deficit hyperactivity disorder are also significant risk factors.7,8
Conversely, mental disorder is not a prerequisite for suicide and most people who die by suicide are not receiving any support from mental health services. Severe physical health conditions such as cancer, heart or lung disease, and especially neurodegenerative disease, raise the risk of depression and suicide significantly, particularly in the first 6 months after diagnosis.9
Many higher-risk patients of all ages present to general practice. Yet conversations about suicide remain among the most difficult in general practice. Time is short, confidence can be low, and fear of saying the wrong thing can lead to missed moments. Evidence is clear: asking specifically about suicide does not plant the idea or increase risk; it opens a door to identifying unmet mental health needs and planning support.10
GPs and other healthcare professionals may sometimes interpret suicidal thoughts or self-harm as ‘attention seeking’ or ‘manipulative’. This is unsafe, as such attitudes can reduce empathy and lead to missed opportunities to help someone stay safe from suicide.11
Take any and every disclosure of self-harm or suicidal thoughts seriously; do not minimise or dismiss it. Most people are seeking help for distress. Research highlights the need for accessible GP training and support in assessing and managing self-harm and suicidality, and in recognising how practice experience may shape attitudes to self-harm, suicide risk, and general practice’s preventive role.12
A resource built for general practice
This resource (Box 1) was developed by a national group of GPs, psychiatrists, and mental health experts as a clear guide for general practice. Published by NHS England, it is now endorsed by the Royal College of General Practitioners (RCGP).13
| Box 1. Helping patients stay safe from suicide: 10 tips for GPs | |
| 1. Listen attentively and acknowledge the person’s emotions | Be clinically astute about the possibility of suicidality in all groups of patients. This approach validates the person’s experience, enhances safety, and may be therapeutic. |
| 2. Ask about suicide directly | Do not hesitate to ask patients directly but calmly about suicide. It is safe to do so. Ask about self-harm and also history of self-harm attempts, current thoughts, plans, imagery, means, and preparations, and explore what is currently preventing the person from taking their life. Record these details in the patient record. |
| 3. If you have immediate safety concerns for a patient take immediate action | Keep the person safe while you engage urgent help services. When there is immediate risk to life, duty to share information overrides the duty of confidentiality. |
| 4. Provide urgent mental health help information to everyone | Even if the person does not need it today, the information may be essential at a later time. Use the format suited to the patient, written, printed out, or phone text with links (see Box 2). |
| 5. Understand the person’s story and mental pain | Protective factors from suicide such as trusted others, values, purpose, and religious and cultural views. Trigger factors for suicidal behaviour or self-harm episode, for example, intoxication or arguments. Exploring these factors will help you understand what factors are key to their safety. Document these factors clearly. |
| 6. Review medication | Always consider treatment-related causes and risks. Review the patient’s medication to identify any recent changes in type or dosage that could be a trigger to a change in mood or behaviour, such as starting or stopping antidepressants. |
| 7. Consider creating a safety plan (see Box 2) |
If a patient already has a personal safety plan, offer to review the plan together to make sure it is robust. If the patient does not have a plan, consider if a plan is clinically needed and possible. Ask the person if they would agree to co-creating a plan together before they leave. Check the individual’s understanding and acceptance of the plan, share a copy with them, and offer review ideally with continuity of reviewer. Consider discussing and including:
a) Warning signs, for example, feelings of suicide getting more frequent, feeling their older relative would be ‘better off’ without them, arguments with their partner, and drinking a greater quantity of alcohol. b) Coping strategies, for example, think of reasons for living. c) Distraction techniques, for example, going for a walk, calling a friend, writing, games, and music. d) Contacts in their trusted network, for example, a named relative or friend. e) Access to mental health support, for example, NHS 111 and mental health team. f) Limiting access to lethal means, for example, keep away from dangerous places and keep home environment safe (with attention paid to medication, sharp objects, and ligatures). Review safety plans regularly — circumstances and needs change. Agree with the individual when you review their mental health ideally with continuity of clinician care. Document a safety plan exists in the patient record. Record part, or all, of the plan, as clinically indicated. |
| 8. Involve others that the person trusts | Whenever possible, encourage the person to involve trusted other(s) to build a connection between the person, trusted others, and clinical team. This should be the norm, not exceptional. Contact details for trusted others should be recorded in shared records. |
| 9. Do not try to predict suicide using checklists or tick-boxes | It is not possible to predict suicide in individuals. Mental states are prone to change. Instead, build up trust and offer pathways for care, signposting, and support in a crisis. |
| 10. Make patients aware of your local and national support services and websites | Examples include MIND, Citizens Advice, NHS Talking Therapies, specialist mental health services, addiction services, and housing support. Consider involving a social prescriber, care coordinator, or primary care mental health worker to offer additional support as part of the strategy. |
| Box 2. Essential advice and further resources for patients and carers | |
| Essential patient information | • Where to get urgent help for mental health — https://www.nhs.uk/nhs-services/mental-health-services • Call 111 and select the mental health option |
| Consider safety planning resources | • 4 Mental Health — demonstration videos and safety plan template • Grassroots — resources, tools, and a mobile-phone app to stay safe from suicide • Samaritans – guidance on how to help someone create a safety plan |
This approach aligns with National Institute for Health and Care Excellence (NICE) guideline NG225: Self-harm: assessment, management and preventing recurrence,14 and NHS England’s Staying Safe from Suicide best practice guidance.15 It applies these evidence-based practices across all age groups, supporting safer care, collaborative safety planning, and compassionate responses.
The tips offer practical, plain-language guidance for short appointments, indirect presentations, and unexpected turns.
The core message is to build relationships and identify practical steps to improve safety, helping prevent distress and suicidal thoughts from escalating to self-harm or suicide. General practice should be a safe place to disclose suicidal thoughts, with GPs using compassionate clinical curiosity to identify risk. Using the word ‘suicide’ is safe and may reduce shame, making disclosure easier.10
A narrative approach helps people share their story and make sense of distress, such as relationship breakdown, job loss, or declining physical health. Compassionate, person-centred interactions validate distress, foster hope, and identify strengths and support.
“A GP can listen to concerns raised by family or friends without breaching confidentiality.”
Medication review
A medication review is essential in patients experiencing suicidal thoughts or feelings. First, consider whether an iatrogenic factor may be involved. Both psychotropic and non-psychotropic drugs can contribute to mood changes or suicidal ideation.
Evidence supports that selective serotonin reuptake inhibitors may increase suicidal thoughts or behaviour, especially in people aged <25 years in the early stages of treatment.16 When prescribing, ensure the patient understands this possible risk, and monitor closely during the first few weeks and after any psychotropic medication change for suicidal ideation, anxiety, and agitation.17
Non-psychotropic medicines investigated for a possible link with mood change or suicidality include calcium channel blockers, angiotensin-converting enzyme inhibitors, corticosteroids, quinolones, varenicline, isotretinoin, antiepileptics, and leukotriene receptor antagonists. Evidence from a systematic review remains largely inconclusive.18
Distinguishing medication effects from illness, or their interaction, can be difficult, and as there is no clear protocol for how to respond, the GP needs to make an individual assessment based on the clinical picture, patient’s wishes, and their medication history, seeking specialist advice as appropriate. In some cases, continuation of the medication with additional support might be justified, in other cases cessation or replacement of the medication may be preferable.
Second, review medication as a potential lethal means in patients with suicidal thoughts or previous self-poisoning.14 Drugs commonly implicated in death by overdose include opioids, gabapentinoids, antidepressants, benzodiazepines, and beta blockers. Lethality rises when these drugs are taken in combination rather than individually. Alcohol or substance misuse also increases lethality exponentially.19,20
Risk mitigation includes switching to safer alternatives, reducing dose, limiting quantities, or restricting access during crisis.
Confidentiality, documentation, and follow-up
Learning from coroners’ inquests can inform general practice. Key issues include collaborative risk assessment focused on patients’ needs and safety, coordination between primary and community care, family involvement where appropriate, and clear documentation.21 A GP can listen to concerns raised by family or friends without breaching confidentiality. Structured follow-up is safer than relying solely on a patient’s initiative. Any reasonable adjustments should be clarified, recorded, and put in place.
The 10 tips are available openly on the RCGP website13 and via NHS Futures. NHS Futures hosts related resources; users may need to request workspace access.
Why RCGP endorsement matters
RCGP endorsement makes clear that suicide prevention is fundamental to general practice, not a task to defer to specialist services. GPs are often the professional a patient trusts most, and that connection offers a critical opportunity for intervention before distress and hopelessness reach crisis point. Compassion alone is not sufficient without the knowledge and skills to act. For practices, training leads, and appraisers, RCGP endorsement confirms that this guidance provides a professionally supported foundation aligned with national policy.
“GPs are well-placed to support people contemplating suicide as trusted confidants and sources of support.”
Essential guidance and support after a patient suicide
Support for colleagues and staff
When a patient dies by suicide, the impact on the practice team can be profound. Shock, grief, guilt, and isolation are common, yet often unacknowledged. GPs and staff may experience disenfranchised grief: grief that is not fully recognised or supported, while they are still expected to continue working despite significant personal distress. The nature of this grief is individual and unpredictable, shaped by factors beyond the clinical scenario. This grief can resurface repeatedly, given how often suicide-related concerns arise in everyday practice.
Staff who have been touched by suicide in any way can find support and advice via the NHS Practitioner Health Suicide Prevention and Postvention Navigation Guide.22
Support for general practices
A National Postvention Support Pack for General Practice23,24 has been developed in Derbyshire and is now available as a national template endorsed by the RCGP and NHS Practitioner Health. This resource offers a structured response after a patient suicide. It covers legal duties, staff support, communication with bereaved families, and preparation for the coroner’s inquest. GPs have described the pack as a genuine source of support during an isolating and anxious time.25
Support for bereaved family and friends
Bereaved families are at increased risk of suicide. General practice therefore has a role in linking bereaved families to appropriate postvention support, addressing both their grief and the associated risk.
An invitation to act
GPs are well-placed to support people contemplating suicide as trusted confidants and sources of support. These interventions play a key role in reducing self-harm and suicide risk. This new guidance provides a practical framework when patients present with suicidal thoughts, plans, or intent.
Alongside Staying Safe from Suicide, the 10 tips for GPs provide an important resource for general practice. See Box 2 for patient and GP advice and signposting.
We recommend GPs and practices adopt and embed the top tips into routine general practice, continuing professional development, and GP registrar training, strengthening both clinical practice and the confidence of GPs and practice staff.
Funding
Faraz Mughal’s Senior Clinical and Practitioner Research Award (reference: 512174) is funded by the National Institute for Health and Care Research (NIHR). Mark Gabbay is part-funded by NIHR Applied Research Collaboration North West Coast. Mike Doyle is funded by NIHR Mental Health Research Group (MHRG) at the University of Huddersfield (reference: NIHR501552). Carolyn Chew-Graham is part-funded by NIHR MHRG at Keele University (reference: NIHR503483). The views expressed are those of the author(s) and not necessarily those of the NIHR, NHS, or the Department of Health and Social Care.
References
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3. Mughal F, Bojanić L, Rodway C, et al. Recent GP consultation before death by suicide in middle-aged males: a national consecutive case series study. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/BJGP.2022.0589.
4. Mughal F, Ougrin D, Stephens L, et al. Assessment and management of self-harm and suicide risk in young people. BMJ 2024; 386: e073515.
5. Morgan C, Webb RT, Carr MJ, et al. Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death. Lancet Psychiatry 2018; 5(11): 905–912.
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11. Mughal F, Troya MI, Dikomitis L, et al. Role of the GP in the management of patients with self-harm behaviour: a systematic review. Br J Gen Pract 2020; DOI: https://doi.org/10.3399/bjgp20X708257.
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13. Royal College of General Practitioners. Helping patients stay safe from suicide. 2026. https://www.rcgp.org.uk/blog/?search=suicide (accessed 7 Sep 2026).a
14. National Institute for Health and Care Excellence (NICE). Self-harm: assessment, management and preventing recurrence. NG225.
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19. Anthony G, Aronson JK, Brittain R, et al. Preventable suicides involving medicines: A systematic case series of coroners’ reports in England and Wales. Public Health Pract (Oxf) 2024; 7: 100491.
20. Gorton HC, Archer C, Algahtani T, et al. Involvement of propranolol in suicides: cross-sectional study using coroner-reported data. BJPsych Open 2024; 10(4): e127.
21. Medical Defence Union. Learning from cases involving patient suicides. 2025. https://www.themdu.com/guidance-and-advice/latest-updates-and-advice/learning-from-cases-involving-patient-suicides (accessed 25 Aug 2026).
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23. Derby and Derbyshire Emotional Health and Wellbeing. Suicide postvention support packs for general practice. 2026. https://derbyandderbyshireemotionalhealthandwellbeing.uk/suicide-prevention/suicide-postvention-primary-care (accessed 7 Sep 2026).
24. Joined Up Care Derbyshire. Postvention support pack for primary care in Derbyshire — 2024. 2024. https://joinedupcarederbyshire.co.uk/download/postvention-support-pack-for-primary-care-in-derbyshire (accessed 7 Sep 2026).
25. Chew-Graham C, Panday S. Providing support for primary care clinicians after the death of a patient by suicide. BJGP Life 2025; 28 May: https://bjgplife.com/the-need-to-support-colleagues-when-a-patient-dies-by-suicide (accessed 25 Aug 2026).
aThe authors have opted to use a URL for this reference that directs to a search for ‘suicide’ on the RCGP blog. This is because the webpage hosting the March 2026 ‘Helping patients stay safe from suicide’ article (https://www.rcgp.org.uk/Blog/Helping-Patients-Stay-Safe-from-Suicide) is in the process of being updated to the August 2026 version on NHS Futures and there are concerns that the URL will be changed on update, rendering the URL broken within the present article.
Featured photo by engin akyurt on Unsplash.
