Helping patients stay safe from suicide

10 tips for General Practitioners

These tips are based on the principles set out in the Staying Safe from Suicide Guidance for mental health practitioners in England and associated NICE Guidance. They suggest how these principles should be used by general practitioners and may be relevant to a wider group of nonmental healthcare professionals.

Find out how to access immediate support through the NHS or call 111 and select the mental health option.

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 persons experience, enhances safety and may be therapeutic.

2. Ask about suicide directly

• Do not hesitate to ask patient's directly but calmly about suicide. It is safe to do so.
• Ask about past suicide and self harm attempts, current thoughts, plans, imagery, means and preparations, and explore whatis 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 whilst 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 doesn't 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.
  
  URGENT HELP: People who need urgent mental health help can find this here: Where to get urgent help for mental health - NHS or call 111 and select the mental health option.

5. Understand the person’s story and mental pain

• Protective factors from suicide such as trusted others, values, purpose, personal morals.
• Trigger factors for suicidal behaviour or self harm episode e.g. intoxication, 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

Safety Plans or a Mental Health Crisis Plan

• If a patient already has a plan, offer to review the plan together to make it robust.
• If the patient does not have a plan, consider if a plan is clinically needed and possible.
• Then ask the person if they would agree to cocreating a plan together before they leave.
• Check the individual's understanding and acceptance of the plan, and share a copy with them and offer review, ideally with continuity of reviewer.

Consider discussing and including:

1. Warning signs – e.g. feelings of suicide getting more frequent, feeling their elderly mother would be better off without them, arguments with their partner, drinking more.
2. Coping strategies – e.g. think of what impact it would have on loved ones.
3. Distraction techniques – e.g. going for a walk, ring a friend, writing, games, music.
4. Contacts in their trusted network - e.g. a named relative or friend.
5. Access to mental health support – e.g. NHS 111, mental health team.
6. Limiting access to lethal means - Keep away from dangerous places, keep home environment safe too – e.g. medication, sharp objects, 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 that a safety plan exists in the patient record. Record part or all of the plan.

8. Involve others that the person trusts

• Whenever possible encourage the person to involve and share their plan with their 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 bureau, 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.