GPAtlas🧭 When to suspect
Suicidal thinking sits on a spectrum – from passive thoughts that life is not worth living, through active ideation, to ideation with a plan and intent.
• Suicidal thinking is common, often concealed, and rarely volunteered without being asked.
• The central skill in primary care is to ask directly and well.
• Then respond to the person's needs and immediate safety – not to assign a risk score.
Actively enquire about suicidal thoughts:
• In anyone presenting with low mood, depression, hopelessness or anxiety
• After an adverse life event (relationship breakdown, job loss, financial crisis, legal problems, bereavement)
• In those with chronic pain or physical illness
• In those with substance misuse
• In the perinatal period
Primary care is the service most people contact before suicide: the majority consult their GP in the year beforehand and roughly four in ten within the final three months.
Escalating or frequent attendance (more than once a month), for any reason, is itself associated with raised risk – treat a rising consultation rate as a soft warning sign.
| Who is at higher risk |
|---|
|
• Previous self-harm or suicide attempt – the single strongest risk factor |
|
• Men in midlife – the highest age-specific rates are in men around 50–54, and men die by suicide roughly three times as often as women |
|
• Mental illness (depression, bipolar disorder, psychosis, personality disorder) and alcohol or drug misuse |
|
• Social isolation, living alone, recent bereavement, and certain occupations |
|
• Autistic people and neurodivergence, and those in contact with the criminal justice system |
| Triggers & warning signs |
|---|
|
• A recent adverse life event – loss, separation, debt, shame, legal trouble |
|
• Expressing hopelessness, feeling trapped or a burden, or saying goodbye |
|
• Escalating or frequent consultations, or a striking, unexplained calm after severe distress |
|
• Withdrawing from work, family or usual activities; giving away possessions |
|
• New or worsening access to a means of harm |
|
⚠️ Common pitfall • Treating a “low risk” label as reassurance. • NICE is explicit that risk-assessment tools, scales and low/medium/high stratification must not be used to predict suicide or to decide who gets care. • The low-risk paradox is that most people in contact with services who die by suicide were rated low risk at their last contact. • Suicidal states fluctuate fast. • Assess the person's needs and immediate safety and build a collaborative formulation, rather than scoring them. |
Source: NICE NG225 · ONS · NCISH
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.