What are the recommended follow-up protocols for patients identified as at risk of suicide?

Patients identified as being at risk of suicide should receive a comprehensive psychosocial assessment that includes evaluation of depression, cognitive impairment, physical ill health, frailty, social and home situation, and any caregiving roles. This assessment should also consider loneliness and isolation, especially in older adults who have self-harmed, due to their higher risk of suicide. Mental health professionals experienced in assessing people with learning disabilities should conduct assessments for those individuals. If a patient wishes to leave before a full assessment, their safety and mental health must be evaluated prior to discharge.

A care plan should be developed or reviewed collaboratively with the patient and, where appropriate, their family or carers, focusing on identified needs and safety considerations. The patient should receive a copy of this care plan, which must be shared promptly with all relevant healthcare and social care professionals involved in their care. For patients with frequent self-harm episodes or ineffective treatment, a multidisciplinary review should be conducted to coordinate care, review existing support, arrange referrals, and develop both a care plan and a safety plan for future episodes. An appropriately trained professional should be designated as the care coordinator and point of contact.

Continuity of care should be ensured by minimising the number of different staff involved, and care plans must be accessible across primary, secondary, and other involved services. Staff caring for these patients should be visible and accessible to encourage interaction, especially during handovers and busy periods. The safety of the environment should be assessed, balancing respect for autonomy with the need for restrictions, using the least restrictive measures possible. Items that could be used for self-harm should be considered for removal in collaboration with the patient. Early familiarisation with the clinical setting and clear information on how to access support should be provided. Staff must be trained to raise concerns promptly if the patient’s safety is at risk.