General practice at the frontline of preventing suicide

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We welcome the important study by Alothman et al whose findings highlight the central role of general practice in supporting people who are at risk of suicide.¹ The findings however pose a key question for general practice: How should clinicians manage escalating requests of care in patients experiencing mental illness and self-harm? Two key areas to consider are the patient’s wider mental health and support needs, and the continuity of care provided.

The latest National Institute for Health and Care Excellence (NICE) self-harm guidance provides new recommendations for GPs, which include treating coexisting mental health problems.² In practice this may vary considerably depending on context. For example, up to three-quarters of people with a diagnosis of personality disorder seek help for self-harm,³ yet many are unable to access specialist care.⁴ Long waiting lists can also preclude access to prompt intervention from mental health services.² Accessing support from voluntary, community, and social enterprise (VCSE) organisations can be an important adjunct to clinician support.⁵ When managing patients in distress and who more frequently present, considering access to both clinical and non-clinical support is beneficial.

Regular GP appointments to review self-harm for patients managed in primary care is recommended.² As Alothman et al identified, increased frequency of clinician contact — one or more consultations per month — may point to deterioration of mental health and increased suicide risk. Frequent consultation patterns can, however, offer opportunities. Regular appointments, with the same clinician where possible, can help build trust and provide feelings of safety.⁶ Patients and clinicians value continuity of care and the stability it offers during periods of experiencing distress.⁶ Continuity of general practice clinician care is an important area for future research in the maturing field of suicide prevention in primary care.

Competing interests

Faraz Mughal was a member of the Guideline Committee for the NICE 2022 self-harm guideline. Sarah Steeg is funded by the National Institute for Health and Care Research (NIHR) (Fellowship award number: MHF009) as part of the Three NIHR Research Schools Mental Health Programme. Faraz Mughal, Doctoral Fellow, is funded by the NIHR (reference: 300957). The views in this article are those of the authors, and not necessarily those of the NIHR, NHS, or the Department for Health and Social Care.