The World Health Organization estimates that more than 700,000 people die by suicide every year, and that most of those deaths occur in low- and middle-income countries. Many people who die by suicide have contact with health services in the months beforehand, often not in mental health settings but in emergency departments, general wards, maternity units and primary care. That makes every nurse part of suicide prevention.
If you are struggling yourself, please talk to someone you trust or contact a local crisis line. You deserve support too.
Myths that stop nurses from asking
- Myth: “Asking about suicide puts the idea in their head.” Fact: Research consistently shows that asking does not increase risk, and many people feel relief at being asked.
- Myth: “People who talk about it won’t do it.” Fact: Many people who die by suicide have told someone.
- Myth: “It’s only a mental health problem.” Fact: Chronic pain, a new serious diagnosis, loss, debt, abuse and isolation are all risk factors.
Warning signs
- Talking about wanting to die, being a burden, or having no reason to live.
- Hopelessness, feeling trapped, unbearable emotional pain.
- Withdrawing from others, giving away possessions, saying goodbye.
- Increased alcohol or drug use.
- Searching for or collecting means, such as hoarding tablets.
- A sudden calm after a period of distress, which can sometimes mean a decision has been made.
- A previous suicide attempt: the strongest single risk factor.
How to ask
Find a private moment, sit down, and ask directly and calmly. Vague questions (“You’re not going to do anything silly, are you?”) invite a “no”.
- “You’ve told me things have been really hard. Sometimes when people feel like this, they think about ending their life. Have you had thoughts like that?”
- “Are you thinking about suicide?”
If the answer is yes, ask more, gently:
- “How often do you have these thoughts? Are they there now?”
- “Have you thought about how you would do it?”
- “Do you have access to [the means mentioned]?”
- “Have you ever acted on these thoughts before?”
- “What has stopped you so far?” (This identifies protective factors: children, faith, family, hope.)
How to respond
- Listen without judging. Don’t argue, lecture or minimise (“Others have it worse”).
- Thank them for telling you. “Thank you for trusting me with this. I want to help you stay safe.”
- Don’t promise secrecy. Explain that you need to share this with the team to keep them safe.
- Don’t leave a high-risk person alone. Arrange close observation according to policy.
- Escalate to the doctor in charge, mental health liaison team or crisis service, using SBAR.
- Document what was said, in the patient’s own words where possible, and your actions.
NICE guidance on self-harm advises against using risk assessment tools or scales alone to predict suicide or to decide who gets treatment. Use them, if your service does, to structure a conversation, but base care on a full psychosocial assessment and the person’s needs.
Make the environment safer
- Remove or secure potential means: medicines, sharps, ligature points, cords, plastic bags, belts.
- Check belongings carefully and respectfully, following policy.
- Keep medicines locked and supervise administration.
- In the community, talk with families about restricting access to medicines, pesticides (a major method in rural Asia and Africa) and firearms.
Safety planning
A safety plan is written with the person, not for them. It usually covers: their personal warning signs; things they can do to cope; people and places that help distract; people they can ask for help; professionals and crisis lines to call; and how to make their environment safer. Give them a copy.
Special situations
- After self-harm or an overdose: treat the physical injury with the same respect as any other patient. Hostile or dismissive care increases risk.
- Perinatal women: suicide is a leading cause of maternal death in high-income countries. Ask about mood in pregnancy and after birth.
- Young people: suicide is a leading cause of death among 15–29-year-olds worldwide.
- Where suicide is criminalised: in some countries, attempted suicide is still a criminal offence, which deters people from seeking help. Focus on care, not punishment, and know your local law and reporting rules.
Look after yourself
Losing a patient to suicide, or supporting someone in crisis, is distressing. Debrief with colleagues and use clinical supervision. Nurses themselves face higher suicide risk than the general population in several countries, so watch out for each other, and seek help early. See our guide to nurse burnout.
Based on WHO suicide prevention guidance (LIVE LIFE), the WHO mhGAP Intervention Guide and NICE guideline NG225 (Self-harm). Educational content: follow your local policy and escalate concerns.