Putting Safety-First: England’s New Suicide Prevention Guidance Explained

Around 19 people die by suicide in the UK each day. Every life lost is tragic – and, crucially, often avoidable. In June 2025, NHS England released brand-new guidance to reshape how we prevent suicide and support people in crisis. I’m going to take you through:

1. Why this guidance matters

2. The shift from risk assessment to a safety-first approach

3. What personalised safety plans look like

4. Challenges ahead – and why we need ongoing research

I’ll keep it clear and simple, so you can share these ideas with colleagues, friends or family.

1. Why This Guidance Matters

• High stakes. In 2023, England’s suicide rate was 11.2 per 100 000 people – about the same as in France and Sweden.¹

• Older guidance. The last big report on assessing and managing risk in mental-health services dates from 2009. It focused on tick-box risk tools and checklists.

• New national plan. This update is part of NHS England’s five-year suicide-prevention strategy. It aims to reduce deaths and improve mental-health care across the country.

2. From Risk Assessment to Safety-First

The biggest change is simple but profound: we’re moving away from labelling people “low risk” or “high risk” – and towards a safety-first approach.

Why old risk tools fell short

• Low accuracy. Many tools were developed for other purposes (like symptom checklists), then re-used for suicide risk. They missed too many people at real risk.

• False reassurance. Clinicians felt a “green, amber, red” score meant someone was safe – even when it wasn’t.

• Lack of evidence. Few studies tested these tools in real clinical settings.²

What safety-first means

1. Explore the presenting problem. Focus on why someone is seeking help now, not just risk factors.

2. Identify precipitants. Look at recent triggers – mental-illness flare-ups, relationship breakdowns or job loss.

3. Weigh protective factors. Family ties, stable work or other supports that keep people going.

4. Consider longstanding factors. Anything from past trauma to chronic health issues that fuel suicidal thoughts.

5. Spot perpetuating factors. Patterns that keep someone stuck – for example, isolation or substance misuse.

3. Personalised Safety Plans

Instead of one-size-fits-all checklists, the guidance asks practitioners to co-produce safety plans with patients. Here’s what they include:

• Actions in a crisis. Who to call, which services to contact (for example, crisis teams).

• Support network. Key friends, family or community links.

• Coping strategies. Practical steps – writing down thoughts, going for a walk or mindfulness exercises.

• Longer-term goals. Employment, social activities or therapy appointments to build resilience.

*“Safety plans should be reviewed, shared and woven into ongoing care.”*³

It’s still not clear which formats work best – and safety planning may not suit everyone, especially in acute distress. Training and supervision will be key.

4. Looking Ahead: Challenges & Research Needs

Cultural shift. Moving an entire health-service mindset takes time. Teams need training, resources and strong leadership to make safety-first the default.

Evidence gaps.

• We need more trials of safety-first methods in real NHS settings.

• New data-driven risk models (like those for heart disease or cancer) might offer probabilistic estimates – but they’re not in the current guidance.⁴

• Guidance must evolve at least every two years to keep pace with fresh evidence and tools, from AI algorithms to mobile health apps.

My Take & How I Can Help

As someone who teaches, speaks and consults on mental-health strategy, I believe this guidance is a vital step. It centres people – their stories, strengths and struggles – rather than a score on a form. If you’re rolling out these changes in your organisation or want to explore safety-first methods further, let’s connect.

• Training workshops. I run interactive sessions to embed safety-first practice.

• Consultancy. Tailored advice on adapting your local policies – whether you’re in a large NHS trust or a community charity.

• Collaboration. I’m always keen to work with researchers and fellow consultants on new trials and tools.

¹ England’s suicide rate in 2023 was 11.2 per 100 000 (similar to France 11.8 and Sweden 11.7).
² NICE self-harm guidance, 2022 – critique of tick-box risk tools.
³ NHS England new guidance, June 2025.
⁴ Examples in other fields: QREISK-3 (cardiovascular), SCORE2, cancer risk models.