People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
This guideline should be read in conjunction with Public Health England's Local suicide prevention planning: a practice resource.
Local authorities should work with local organisations to:
Set up a multi-agency partnership for suicide prevention. This could consist of a core group and a wider network of representatives.
Identify clear leadership for the partnership.
Ensure the partnership has clear terms of reference, based on a shared understanding that suicide can be prevented.
Ensure the partnership has clear governance and accountability structures. Include oversight from local health and care planning groups, for example health and wellbeing boards.
Include representatives from the following in the partnership's core group:
clinical commissioning groups
local public health services
healthcare providers
social care services
voluntary and other third-sector organisations, including those used by people in high-risk groups
emergency services
criminal justice services
police and custody suites
people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement.
Set up a multi-agency partnership for suicide prevention in residential custodial and detention settings. This could consist of a core group and a wider network of representatives. Ensure the partnership has:
clear leadership
clear terms of reference, based on a shared understanding that suicide can be prevented
clear governance and accountability structures.
Include representatives from the following in the partnership's core group:
governors or directors in residential custodial and detention settings
healthcare staff in residential custodial and detention settings
staff in residential custodial and detention settings
pastoral support services
voluntary and other third-sector organisations
escort custody services
liaison and diversion services
emergency services
offender management and resettlement services
people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement, to be selected according to local protocols.
Link the partnership with other relevant multi-agency partnerships in the community.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on suicide prevention partnerships.
Full details of the evidence and the committee's discussion are in:
Develop a multi-agency strategy based on the principles of the Department of Health and Social Care's suicide prevention strategy for England and other relevant strategies. It should emphasise that suicide is preventable, and it is safe to talk about it.
Identify clear leadership for the multi-agency strategy.
Consider how to measure activities to prevent suicide. Include the introduction of constructive, meaningful preventive activities (for example, education and physical activity) rather than focusing on suicide numbers alone.
Review local and national data on suicide and self-harm to ensure the strategy is as effective as possible (see recommendation 1.4.2).
Assess whether initiatives successfully adopted elsewhere are appropriate locally or can be adapted to local needs, or whether previously successful initiatives can be reintroduced.
Oversee provision and delivery of training and evaluate effectiveness.
Consider collaborating with neighbouring local authorities to deliver a single strategy.
Consider advising local institutions and organisations on what to include in their contingency plans for responding to a suicide. This includes: schools, universities, further and higher education institutions, and workplaces.
Identify and manage risk factors and behaviours that make suicide more likely.
Consider collaborating with neighbouring residential custodial and detention organisations to deliver a single strategy.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on suicide prevention strategies.
Full details of the evidence and the committee's discussion are in evidence review 1: multi-agency partnerships.
Develop and implement a plan for suicide prevention and for after a suspected suicide. Ensure the approach can be adapted according to which agencies are likely to spot emerging suicide clusters:
Identify clear leadership for the action plan.
Interpret data to determine local patterns of suicide and self-harm, particularly among groups at high suicide risk.
Compare local patterns with national trends.
Prioritise actions based on the joint strategic needs assessment and other local data to ensure the plan is tailored to local needs.
Map stakeholders and their suicide prevention activities (including support services for groups at high risk).
Share experience and knowledge between stakeholders. Also share data, subject to local information sharing agreements.
Keep up to date with suicide prevention activities by organisations in neighbouring settings.
Oversee local suicide prevention activities, including awareness raising and crisis planning.
Review the action plan at a time agreed at the outset by the multi-agency partnership.
In addition to recommendation 1.3.1, set out how to:
Promote evidence-based best practice with rail, tram and underground train companies.
Work with planners who have responsibility for designing bridges, multi-storey car parks and other structures that could potentially pose a suicide risk.
Collaborate with coroners to provide a context for local suicide data and help interpret inquest conclusions.
Build relationships with the media (including social media, broadcasting and newspapers) to promote best practice when reporting suicides or suspected suicides.
In addition to recommendation 1.3.1, set out how to:
Work with the Prison and Probation Ombudsman and coroners to ensure recommendations from investigations and inquests are implemented.
Implement recommendations from internal investigations of instances of self-harm.
Assess suicide and self-harm prevention procedures (for example, HM Prison and Probation Service's Assessment Care in Custody and Teamwork and Assessment care-planning system, and the Home Office's Assessment Care in Detention and Teamwork case management systems).
Interpret and act on the findings.
Ensure systems for identifying risk, information sharing and multidisciplinary working put the emphasis on 'early days' and transitions between estates or into the community.
Monitor the impact of restricted regimes on suicide risk.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on suicide prevention action plans.
Full details of the evidence and the committee's discussion are in:
Consider local activities to:
raise community awareness of the scale and impact of suicide and self-harm
reduce the stigma around suicide and self-harm
address common misconceptions by emphasising that:
suicide is not inevitable and can be prevented
asking someone about suicidal thoughts does not increase risk
make people aware of the support available nationally and locally
encourage help-seeking behaviours
encourage communities to recognise and respond to a suicide risk.
For residential custodial and detention settings, also consider raising awareness of:
the risk associated with 'early days' and transitions between estates or into the community
the value of peer support, for example the Samaritans' Listener scheme
the need for institutional support, such as safer custody teams (see HM Prisons and Probation Service and the Ministry of Justice's Prison Service Instructions 2011 on the management of prisoners at risk of harm to self, to others and from others).
Take into account socioeconomic deprivation, disability, physical and mental health status, and cultural, religious and social norms about suicide and help-seeking behaviour, particularly among groups at high suicide risk.
Ensure the language and content of any awareness-raising materials is:
appropriate for the target group
sensitive and compliant with media reporting guidelines, such as the Samaritans' media guidelines for the reporting of suicide.
Coordinate local activities and ensure they are consistent, and coordinated, with national initiatives.
Consider encouraging employers to develop policies to raise suicide awareness and provide support after a suspected suicide. For example, see Public Health England and Business in the Community's toolkits.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on awareness raising by suicide prevention partnerships.
Full details of the evidence and the committee's discussion are in:
Use local data including audit, Office for National Statistics and NHS data, as well as rapid intelligence gathering to:
identify emerging trends in suicide methods and locations
understand local characteristics that may influence the methods used
determine when to take action to reduce access to the means of suicide.
Ensure local compliance with national guidance to reduce access to methods of suicide:
In custodial settings, for example, provide safer cells (see the Ministry of Justice's Quick-time learning bulletin on safer cells).
In the community, for example, restrict access to painkillers (see NHS England's Items which should not be routinely prescribed in primary care: guidance for CCGs, the Medicines and Healthcare products Regulatory Agency's Best practice guidance on the sale of medicines for pain relief (appendix 4 in the Blue guide), and the Faculty of Pain Medicine's Opioids Aware resource).
Reduce the opportunity for suicide in locations where suicide is more likely, for example, by erecting physical barriers. Also see Public Health England's Preventing suicide in public places: a practice resource.
Consider other measures to reduce the opportunity for suicide. For example, at locations where suicide is more likely, consider:
providing information about how and where people can get help when they feel unable to cope
using CCTV or other surveillance to allow staff to monitor when someone may need help
increasing the number and visibility of staff, or times when staff are available.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on how suicide prevention partnerships can reduce access to methods of suicide.
Full details of the evidence and the committee's discussion are in:
Ensure training is available for:
those in contact with people or groups at high suicide risk
people working at locations where suicide is more likely
people who provide peer support in residential custodial and detention settings
people leading suicide prevention partnerships
people supporting those bereaved by suicide.
Offer training to organisations employing, working with or representing groups at high suicide risk.
Provide generic and specialist training as needed for specialists and non-specialists.
Ensure suicide awareness and prevention training helps people to:
understand local suicide incidence and its impact, and know what support services are available
encourage others to talk openly about suicidal thoughts and to seek help (this includes providing details of where they can get this help)
take into account socioeconomic deprivation, disability, physical and mental health status, and cultural, religious and social norms about suicide and help-seeking behaviour, particularly among groups at high suicide risk.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on training by suicide prevention partnerships.
Full details of the evidence and the committee's discussion are in:
Use rapid intelligence gathering and data from other sources, such as coroners to identify anyone who may be affected by a suspected suicide or may benefit from bereavement support. Those affected may include relatives, friends, classmates, colleagues, other prisoners or detainees, as well as first responders and other professionals who provided support.
Offer those who are bereaved or affected by a suspected suicide practical information expressed in a sensitive way, such as Public Health England's Help is at hand guide (this also signposts to other services). Ask them if they need more help and, if so, offer them tailored support.
Consider:
providing support from trained peers who have been bereaved or affected by a suicide or suspected suicide
whether any adjustments are needed to working patterns or the regime in residential custodial and detention settings.
See also the National Suicide Prevention Alliance's resources on support after a suicide.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on how suicide prevention partnerships can support people bereaved or affected by a suspected suicide.
Full details of the evidence and the committee's discussion are in:
Use information from the action plan and rapid intelligence gathering to identify and prevent potential suicide clusters (see recommendation 1.3.1).
After a suspected suicide in residential custodial and detention settings, undertake a serious incident review as soon as possible in partnership with the health providers. Identify how:
to improve the suicide prevention action plan
to help identify emerging clusters
others have responded to clusters.
Develop a coordinated approach to reduce the risk of additional suicides.
Develop a standard procedure for reducing, or 'stepping down', responses to any suspected suicide cluster.
Provide ongoing support for those involved, including people directly bereaved or affected and those who are responding to the situation.
See Public Health England's identifying and responding to suicide clusters and contagion: a practice resource.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on preventing and responding to suicide clusters.
Full details of the evidence and the committee's discussion are in:
Develop a clear plan for liaising with the media. Identify someone in the multi-agency partnership as the lead.
For community settings, promote guidance on best practice for media reporting of suicide (including providers of social media platforms). Highlight the need to:
use sensitive language that is not stigmatising or in any other way distressing to people who have been affected
reduce speculative reporting
avoid presenting detail on methods.
See: the World Health Organization's preventing suicide: a resource for media professionals, the Samaritans' media guidelines for reporting suicide, OFCOM's Broadcasting code and the Independent Press Standards Organisation (IPSO).
For residential custodial and detention settings, where a suspected suicide would be reported via the Ministry of Justice, ensure Ministry of Justice press officers follow good practice in suicide reporting.
Monitor media coverage of suspected suicides locally. If necessary, provide feedback to the journalist or editor in relation to their reporting (see the Samaritans' media guidelines for reporting suicide).
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact on reducing the potential harmful effects of media reporting of a suspected suicide.
Full details of the evidence and the committee's discussion are in evidence review 7: local media reporting of suicides.
This section defines terms that have been used in a particular way for this guideline. For other definitions, see the NICE glossary or, for public health and social care terms, the Think Local, Act Personal Care and Support Jargon Buster.
People in groups that have contact, because of their paid or voluntary work, with people at risk of suicide. People in these groups may be trained to identify people at risk of suicide and refer them to treatment or supporting services as appropriate.
They may include: health and social care practitioners, criminal justice and detention settings staff, police and emergency services, people who provide a paid or voluntary service for the public, faith leaders, railway and underground station staff, and staff in educational institutions.
High suicide risk means that the rate of suicide in a group or setting is higher than the expected rate based on the general population in England. Groups at high risk can include: young and middle-aged men, people who self-harm, people in care of mental health services, 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 LGBT community, people with autism, people in contact with the criminal justice system, particularly those in prisons, people in detention settings, including immigration detention settings, and specific occupation groups (see the Office for National Statistics' suicide by occupation, England: 2011 to 2015).
These include high buildings such as multi-storey car parks, railways and bridges and places where other means of suicide are accessible, such as medical, veterinary or agricultural settings where human or animal drugs may be readily available. See Public Health England's preventing suicides in public places: a practice resource.
Reduced access to time out of cell and purposeful activity, usually as a result of short staffing or serious incidents.
A series of 3 or more closely grouped deaths linked by space or social relationships. In the absence of transparent social connectedness, evidence of space and time linkages are needed to define a cluster. In the presence of a strong demonstrated social connection, only temporal significance is needed. (Adapted from Public Health England's identifying and responding to suicide clusters and contagion: a practice resource.)