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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Suicide safety planning and follow-up

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Current plan cannot contain danger

Present intent, accessible lethal means, inability to delay action, psychotic commands, severe agitation, intoxication or collapse of accommodation and support requires emergency containment rather than a written community plan alone.

Action: Treat physical illness, remove immediate means where safe, create continuous proportionate observation and obtain urgent mental-health assessment. Use emergency services when the current setting cannot maintain safety, protect dependants and document capacity, information sharing and legal authority.

Synopsis

Convert a depression-specific suicide formulation into a usable collaborative plan, reduce access to relevant means, provide active follow-up through high-risk transitions and escalate when current intent or impairment makes community planning unreliable.

  • Build the plan with the person in their language and preferred format, involving a chosen supporter with consent when that is safe and helpful.
  • List personal warning signs such as withdrawal, searching methods, drinking, stopping sleep, medicine stockpiling or psychotic guilt.
  • Agree internal actions that create time, then safe distraction, specific supporters, professional contacts and emergency services in a graded sequence.
  • Verify phone numbers, opening hours, transport, language, digital access and alternatives when a service or supporter cannot respond.
  • Reduce access to the actual method through limited dispensing, safe storage, temporary removal, supervised access or environmental change.
  • Treat depression, insomnia, pain, substance use, psychosis, abuse and practical crisis as drivers within the safety plan rather than separate later problems.
  • For ongoing safety concerns after self-harm, arrange initial aftercare within 48 hours in line with NICE, and use earlier emergency response when needed.
  • Increase contact after discharge, antidepressant initiation or dose change, major loss and other transitions identified in the formulation.
  • Share the formulation and plan directly with the responsible clinician and define what happens after missed contact or deterioration.

Key red flags

Acquiring medicines or weapons, researching lethality, writing final messages, arranging affairs or avoiding discovery indicates preparation even when current intent is denied.

Early antidepressant activation, akathisia, reduced sleep, intoxication, humiliation, relationship rupture or recent discharge can rapidly change a previously stable formulation.

A nominal support person who is unreachable, abusive, exhausted or unaware of the plan cannot be relied upon during the anticipated crisis.

A no-suicide agreement has no dependable protective value and must not replace psychosocial assessment, means safety and specific contacts.

Missed follow-up after self-harm or severe depression should trigger active review of safety and access barriers rather than automatic discharge.

Investigation priorities

01
Scenario and warning-sign mapFirst step

Connect foreseeable suicide behaviour to triggers, means, timeframe and personally observable escalation.

Management branches

Build safety planMove from early signs to emergency help

The person can collaborate and immediate danger is contained enough for planning.

  1. Define personal warning signs and internal coping actions that create time, then add safe distraction and specific supportive people.
  2. List professional and emergency contacts in escalating order and verify availability, communication and transport.
  3. Address means, medicines, accommodation and dependants and provide an accessible copy with agreed supporter roles.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG225 self-harm recommendationsSafety plans, means restriction, risk tools and 48-hour aftercare.
  • NICE NG222 depression in adults recommendationsSuicide monitoring during treatment and early antidepressant review.
  • GMC confidentiality guidanceInformation sharing to prevent death or serious harm.
  • NICE CG136 service user experience recommendationsCrisis plans, continuity, communication and involvement.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom