Suicide prevention for physicians: identification, intervention and mitigation of risk

General physicians and general practitioners are at the front line of suicide prevention, and patients are commonly assessed or admitted to emergency department and medical wards following self-harm. The rate of suicide is low, making it hard to determine who is at risk. Traditional suicide risk assessment tools relied mainly on demographic risk factors, despite decades of research failing to find clinically meaningful associations. Reliance upon risk factor identification fails both clinicians and patients. Prediction studies offer no clinical usefulness for individual patients, as even risk factors associated with the highest odds ratio and a significant statistical correlation may not be clinically useful when assessing individuals. Self-harm and suicidal thoughts should be taken seriously and always met with empathy and understanding. Instead of focusing on quantifying and characterising suicide risk so it can be 'managed', the emphasis is on identifying individual risk factors, needs and strengths, instilling hope and empowering individuals to seek and accept support. Suicide is preventable; we need a new narrative away from 'characterising, quantifying and managing risk' and greater focus on 'compassion, safeguarding and safety planning'. We provide an overview of current research and offer clinically useful suggestions and resources to support clinical encounters.