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Clinical management

Suicide in middle-aged males - opportunities for intervention

  • In the UK, males aged 40–54 years have the highest age-specific suicide rate. A national case series study found that 43% of middle-aged males who died by suicide had a GP consultation in the preceding 3 months - over half regarding a mental health problem - highlighting an opportunity for early intervention.


  • Clinical factors were identified that GPs should be alert to…

o Those who had recent GP contact before their suicide were more likely to have self-harmed in the 3 months before, compared to males who had no recent GP contact.

o Males with current physical illness, work-related problems, a recent history of self-harm, those who had attended for a mental health problem or were prescribed an SSRI/SNRI antidepressant, oral antipsychotic or benzodiazepine, were more likely to consult their GP shortly before dying by suicide.


  • Personalised holistic management may have a role in preventing suicide in these individuals.

WiseGP actions:

1. Who performs medication reviews in your practice? Do they feel confident exploring self-harm and suicidal thoughts? Are they able to assess risk and discuss appropriate tailored treatment/support? Could your practice team benefit from a clinical education session?

2. Consider allocating more time or arranging follow-up appointments to carefully assess middle-aged males, particularly for those who present with a new mental health problem or major physical illness and/or work-related problems, to explore the mental health impact and discuss support available.


Read more about research informing these recommendations here:


Know how to support people bereaved by suicide

  • 6000 suicides are recorded annually in the UK, with each death impacting on an estimated 135 people. Suicide bereavement is linked to a higher risk of mental health problems and suicide attempts. Therefore, provision of care to those bereaved by suicide is a key component of suicide prevention.

WiseGP actions:

  1. Have a protocol to ensure any suicide is highlighted within your practice to the patient’s named/ usual GP.

  2. Suggest a member of your PCN attends suicide bereavement training and shares their learning with the network.

Online modules:

Training days:

Conference - September 2023:

Read more about the research informing these recommendations here:


Know how to support young people who self-harm

  • Self-harm in young people is common, but there is a lack of evidence to inform GPs regarding how to support these people.

WiseGP action:

1. Listen and act when self-harm is disclosed. Explore the young persons’ self-harm behaviour, review medication and assess risk of overdose. Discuss treatment options tailored to the individual (psychological therapy/ medication) and arrange regular review.

2. Consider saving useful links to share, writing a text message with appropriate links or developing your own leaflet to share with young people who self-harm, containing advice on developing a safety plan and distraction techniques. Mind have useful resources on managing self-harm:

3. Consider sharing resources with parents to help them support a child who is self-harming.

Read more about the qualitative work informing some of these recommendations here:


Recognise self-harm in older adults

Self-harm is a major risk for suicide, which has highest rates amongst older adults. Self-harm is often concealed, even more so in older adults, due to stigma and shame.

WiseGP actions:

1. Review the RCGP toolkit for support diagnosing and managing mental health problems in older adults.

2. Consider a practice teaching session on self-harm and suicide risk assessment, with a focus on older adults. Here is a video on mental health problems in older adults which could support training:

Read more about the research informing these recommendations here:

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