Clinical update

NICE guidance on preventing suicide in community and custodial settings

Guidelines have been set out in an attempt to reduce the number of people taking their lives 

Guidelines have been set out in an attempt to reduce the number of people taking their lives 

Picture: Alamy

Essential facts

Almost 6,000 people took their own lives in the UK last year and suicide is now the leading cause of death for men under 50. Only one third of the people who kill themselves were known to mental health services, but many of the other two-thirds will have come into contact with other health professionals, including nurses and GPs.

What’s new?

New guidance intended to help prevent suicide in community and custodial settings has been published by the National Institute for Health and Care Excellence (NICE). The guideline covers ways to reduce suicide ideation and help people who have been bereaved by or otherwise affected by suicides.

The guidance aims to:

  • Help local services work more effectively together to prevent suicide.
  • Identify and help people at risk.
  • Prevent suicide in places where it is currently more likely.

It does not cover national strategies, general mental well-being or areas covered by other NICE guidelines, such as that dealing with self-harm or mental health conditions.

Signs and symptoms

Symptoms of feeling suicidal can include:

  • Depression.
  • Withdrawal and anxiety.
  • Loss of interest in hobbies, work, socialising or physical appearance.
  • Feelings of hopelessness or purposelessness.
  • Acting impulsively or in a reckless way, not caring what happens.
  • Giving away possessions.
  • Sorting out affairs or making a will.
  • Talking about suicide, death or dying or ‘wanting it end it all’.

Causes and risk factors

Research shows that people with a diagnosed mental health condition are at a higher risk of attempting and completing suicide than the rest of the population. Other at-risk groups include:

  • Young and middle-aged men.
  • People who self-harm.
  • Family and friends of those who have died by suicide.
  • People who misuse drugs or alcohol.
  • People with a physical illness, particularly older adults.
  • People in the lesbian-gay-bisexual and trans community.
  • People with autism.
  • People in contact with the criminal justice system, particularly those in prisons.
  • People in detention settings, including immigration detention centres.

How you can help

The NICE guidance says health professionals should:

  • Make people aware of national and local support and encourage help-seeking behaviours.
  • Keep up-to-date with suicide prevention activities by organisations in neighbouring settings.
  • Ensure local compliance with national guidance to reduce access to methods of suicide, such as by restricting access to analgesic medications in the community.
  • Receive training that helps understanding of local suicide incidence and its impact, and know what support services are available.

Expert comment

Tim Coupland, RCN Mental Health Forum Steering Committee member

John Houlihan

‘This important guidance continues to stress that suicide is preventable and that local prevention plans should enable and encourage local communities to talk openly about it.

‘Suicide prevention plans and training have to feel relevant to the community that they are written for. The success of any local plan will be down to clear leadership and an ongoing multi-agency response that uses local data to tackle specific issues, difficulties and challenges, such as suicide hot-spots.

‘Any local plan needs to be dynamic and responsive, with a strong focus on training, sharing data and information, and regular forums to discuss how well the plan is being delivered.

‘The training recommendations are positive, but we need to ensure that any training is good quality and not limited to health professionals.

‘A multi-agency approach – for example including views from the local police and fire service – will help nurses develop a much broader view of what the community response to suicide prevention looks like.’


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