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Suicide risk mitigation

Last reviewed: 30 Oct 2023
Last updated: 13 Oct 2023



History and exam

Key diagnostic factors

  • previous suicide attempt or self-harm episodes
  • current suicide plan
  • access to lethal means
  • history of psychiatric disease, including substance misuse
  • family history of suicide or mental illness
More key diagnostic factors

Other diagnostic factors

  • chronic medical illness, disability, or disfigurement
  • significant psychosocial factors
  • unhelpful traits
Other diagnostic factors

Risk factors

  • current suicidal plan
  • self-harm
  • history of mental illness, including substance misuse
  • availability of lethal means
  • history of childhood abuse or neglect
  • family history of death by suicide
  • male sex
  • prison inmate
  • family history of psychiatric illness
  • physical illness
  • marital status (divorced, single, widowed)
  • professions/occupations (unemployed, self-employed, agricultural workers, medical and dental professionals)
  • psychosocial stressors
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Treatment algorithm


patients who may be vulnerable to self-harm and suicide


those left behind after a death by suicide



Alys Cole-King, MB, BCh, DGM, MSc, FRCPsych

Consultant Liaison Psychiatrist

Liaison Team

Glan Clwyd Hospital

Betsi Cadwaladr Health Board

St Asaph




ACK is an employee and director of 4Mental Health and, in this capacity, has received funding for designing and delivering training. ACK is an author of references cited in this topic.


Dr Alys Cole-King would like to gratefully acknowledge Dr Angharad de Cates, Dr Stan Kutcher and Dr Magdalena Szumilas, previous contributors to this topic.


AdeC is in receipt of a clinical doctoral training fellowship from the Wellcome Trust (since October 2018) and a travel fellowship from the Royal College of Psychiatrists/Gatsby Foundation. All are external bodies that fund research into and/or release information that includes suicide prevention. SK has received research grants from various foundations and national granting agencies (none from either the pharmaceutical nor psychotherapy industries) to support some of his academic work. He is employed by a university and hospital, and sees patients who sometimes present with a suicide attempt. He has also co-authored a textbook on suicide risk assessment and management, published in 2007 and the second edition in 2012. MS is an author of a reference cited in this topic.

Peer reviewers

Stephen Platt, BA, MSc, PhD

Emeritus Professor of Health Policy Research

University of Edinburgh





SP is a paid consultant to Samaritans, NHS Health Scotland, the Scottish Government, and the Irish National Office of Suicide Prevention. He is an unpaid adviser to The Listening Place.

Steve Gilbert, BSc Sports & Materials Science

Patient Advocate

Sports & Materials Science

University of Birmingham




SG is the vice-chair of the Independent Mental Health Act Review; an associate trainer for suicide mitigation at Connecting with People; Programme Lead for the Engager Prison Project; trustee for the Council of Management for Mind and the Association of Mental Health Providers; Service User Representative for West Midlands Mental Health (STP) Alliance; occasional advisor to the National Suicide Prevention Alliance and Public Health England; and a member of the West Midlands Service User Representative Forum, Royal College of Psychiatrists West Midlands Executive Division. He receives a salary and/or travel and subsistence expenses for these roles.

  • Differentials

    • Self-harm
    More Differentials
  • Guidelines

    • VA/DoD clinical practice guideline for assessment and management of patients at risk for suicide
    • WHO mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings
    More Guidelines
  • Patient leaflets


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