GP · mental-health
Suicide risk assessment and safety planning
Also known as Self-harm assessment · Safety planning · Suicidal ideation review · Crisis planning
GP-fellowship guide to suicide risk assessment and safety planning: asking directly without planting ideas, risk factors versus warning signs versus prediction tools that cannot predict, the Stanley-Brown safety plan (45% fewer suicidal behaviours), means restriction evidence, caring contacts after discharge, and referral thresholds with mental health law basics.
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Red flags
- Any plan with available means, preparatory acts (giving away possessions, note-writing) or stated intent demands same-day specialist assessment — not a routine appointment
- The first three months after psychiatric discharge carry the highest suicide rates of any period — contact the patient early and repeatedly
- A prior attempt is among the strongest single predictors of eventual suicide; every presentation of self-harm needs a psychosocial assessment, however minor it appears
- Access to highly lethal means (firearms, pesticides, stockpiled medications) converts ideation into death — asking about and restricting access is treatment, not paperwork
Overview
Pesticide self-poisoning alone accounts for 14–20% of suicides worldwide — one window onto a problem where every death is a tragedy with long-lasting effects on families and communities. Suicide arises from multi-faceted social, cultural, biological and psychological factors across the life course, and many deaths happen impulsively in moments of crisis, which is why crisis support, means restriction and follow-up contact save lives.[8][6]
General practice sits on the front line. The consultation tasks are specific — ask directly, listen without flinching, build a plan with the person, restrict the means they name, and never lose contact after a crisis. None of these requires predicting who will die; all of them change outcomes.[6]
References12ShowHide
- [1]Motto JA et al. A randomized controlled trial of postcrisis suicide prevention. Psychiatr Serv, 2001.PMID 11376235
- [2]Owens D et al. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry, 2002.PMID 12204922
- [3]Brown GK et al. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA, 2005.PMID 16077050
- [4]Hawton K et al. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ, 2013.PMID 23393081
- [5]Dazzi T et al. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med, 2014.PMID 24998511
- [6]Zalsman G et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry, 2016.PMID 27289303
- [7]Chung DT et al. Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis. JAMA Psychiatry, 2017.PMID 28564699
- [8]Gunnell D et al. Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence. Lancet Glob Health, 2017.PMID 28807587
- [9]Stanley B et al. Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry, 2018.PMID 29998307
- [10]Belsher BE et al. Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation. JAMA Psychiatry, 2019.PMID 30865249
- [11]Daray FM et al. Prediction of fatal and non-fatal suicide attempts by the Columbia Suicide Severity Rating Scale (C-SSRS): systematic review and meta-analysis. Br J Psychiatry, 2026.PMID 40936460
- [12]Steeg S et al. Effectiveness of suicide means restriction: an overview of systematic reviews. BMJ Ment Health, 2025.PMID 41365522