Suicide prevention – the role of psychiatry

Purpose

This position statement outlines the RANZCP position on suicide prevention and clarifies the unique role of psychiatrists by:

• defining suicide prevention and the role of psychiatrists in reducing deaths
• outlining key factors that influence suicide prevention outcomes
• identifying system priorities to strengthen suicide prevention efforts across Australia and Aotearoa New Zealand.

Key messages

• Suicide prevention requires a unified approach spanning governments, systems, services, and communities. 
• Every interaction with a health or community service is an opportunity to reduce deaths by suicide.
• Addressing the social determinants of health—such as poverty, discrimination, trauma, and housing instability—is essential to prevention.
• Reducing access to means of suicide and promoting protective factors such as belonging, hope, and social connectedness are effective population-level strategies.
• Universal access to timely, high-quality, and culturally safe mental health care, including 24-hour crisis support, is critical. 
• Psychiatrists bring specialist medical and therapeutic expertise that is central to prevention.
• People with lived experience, must be partners in designing, delivering, and evaluating suicide prevention initiatives. 
• People working in suicide prevention should have mental health training that is culturally sensitive, trauma-informed and person-centred to enhance recovery. 
• Compassionate, kind, and non-judgemental care saves lives.

Introduction

Suicide refers to the intentional act of ending one’s life and is both complex and multi-factorial.[1] This definition is conceptually and operationally distinct from Voluntary Assisted Dying (VAD), which includes lawful and regulated deaths which are not considered suicide, and fall outside of the scope of suicide prevention and data. It has devastating, long-term impacts on families, whānau, and the wider community. Suicidality refers to the thoughts, feelings and behaviours that relate to suicide. It encompasses related terms: ‘suicidal ideation’ i.e., thinking about or planning a suicide and ‘suicidal behaviour’ i.e., thinking, planning, attempting and death by suicide.[1] 

While suicide rates fluctuate over time and have shown modest recent declines at a population level, suicide remains a leading cause of preventable death, underscoring the need for sustained advocacy at both clinical practice and system levels to ensure evidence based care, early intervention, and coordinated service responses.[2]

The mental health workforce, including psychiatrists, play an important role in acknowledging, supporting, and intervening, for individuals experiencing suicidality. This includes supporting people with suicidal ideation and their family, whānau and carers, providing appropriate aftercare for individuals who have attempted suicide, and providing postvention support for people who have had a close family member or friend die by suicide. 

Suicide prevention refers to any activities which support interrupting an individual’s movement towards suicide and to reduce suicidal thoughts, plans, attempts and deaths. It includes, but is not limited to, population-level interventions, primary care services and acute/crucial care services. Preventing suicide is a multidisciplinary effort that includes, but is not limited to, the community sector, primary health services, including general practitioners, allied health professionals, psychologists, social workers, mental health nurses, peer workers and non-government organisations. 

Psychiatrists are trained medical professionals who have expertise in mental health conditions. They undergo extensive training and have comprehensive clinical knowledge essential to informing suicide prevention activities. They are well equipped to contribute to co-designing the implementation of policy, programs and services addressing suicide. 

People with lived experience play a key role in designing and delivering appropriate suicide prevention supports. They often serve as mentors for others, can foster empathy within the service system and can enhance capacity through provision of care that is person-centred, family inclusive and culturally safe. 

The RANZCP highlights the importance of a collaborative, multidisciplinary, all-of-community approach to support best outcomes in suicide prevention and reduce death by suicide. 

Background

Suicide is a complex phenomenon of global health concern and major policy significance. Over 700,000 people worldwide are estimated to die by suicide per year,[3] and suicidal ideation is experienced by many more.[4] 

Australia and Aotearoa New Zealand report comparable rates of suicide mortality (11.8 and 11.2 per 100,000 respectively), similar across OECD countries.[5] Though there are concerning inequities affecting First Nations peoples, rural and remote populations and people experiencing socioeconomic disadvantage.[6-8]

Reducing deaths by suicide requires a systems-based approach encompassing promotion, prevention, early intervention, crisis support, and postvention. Most people who die by suicide have experienced mental ill health or substance use issues.[9] This highlights the need for earlier identification, improved access to care, and stronger continuity of support.[10] 

Population-level suicide prevention strategies, such as restricting access to means,[6, 11] reducing stigma, strengthening social networks, [12, 13] and addressing economic disadvantage must be completed by high-quality clinical care and coordinated services.[7] Psychiatrists, as medically trained specialists in mental health, play an integral role across this spectrum.

Principles and approach to suicide prevention 

Suicide prevention requires a comprehensive and multifaceted strategy to system design and service delivery based on the following principles: 

1. Person-centred and recovery-oriented care: Upholding the dignity, rights, and autonomy of every individual including the right to self-determination of risk while balancing safe and effective care plans.[14]
2. Lived and living experience: Co-designing policies, services, and supports with people who have experienced suicidal distress, their families, and carers.[15]
3. Cultural safety: Working in partnership with Aboriginal and Torres Strait Islander peoples, Māori, and other culturally and linguistically diverse communities to deliver care that is inclusive, respectful, and empowering.[16, 17]
4. Systems integration: Recognising that suicide prevention is a shared responsibility across health, social, education, and justice systems.[18]
5. Evidence and accountability: Using data, research, and evaluation to guide continuous improvement and transparency.[19]

The role of psychiatrists

Clinical expertise

Psychiatrists assess, diagnose, and treat people with mental health conditions and suicidality. Their clinical role includes:

• Conducting comprehensive risk assessment and safety planning that respects the individual’s right to self‑determination and dignity of risk, while proportionately balancing these rights against the immediacy and severity of the assessed risk.[20]
• Managing acute crises and providing follow-up support following a suicide attempt.[6]
• Treating co-occurring conditions such as depression, psychosis, anxiety, or substance use disorders.[21]
• Supporting families, whānau, and carers through crisis and recovery.[22]
• Ensuring continuity of care across services, including emergency inpatient and community settings.[23]

Systems leadership

Psychiatrists contribute leadership in:

• Shaping suicide prevention policy and service design.[10]
• Leading multidisciplinary teams and fostering collaboration between clinical and community sectors.[18]
• Supporting education and supervision to enhance workforce capacity.
• Advocating for systemic change that improves access, quality, and equity in mental healthcare.[24] 

Therapeutic partnerships and kindness

Therapeutic relationships grounded in empathy, trust, and respect are central to effective suicide prevention. Psychiatrists are encouraged to:

• Listen actively and engage collaboratively with individuals and their whānau.[25]
• Use a person-centred and trauma-informed approach.[26]
• Engage in collaborative care models as part of multidisciplinary teams. 
• Promote kindness, hope and recovery in their practice.[15]

Population and system-based considerations

A public health approach complements clinical care by addressing broader determinants of suicide risk. Effective prevention requires:

• Limiting access to means: through responsible media reporting,[27] environmental design (e.g., barriers at hospitals),[11] and regulation of substance use.[6, 28]
• Addressing inequities: tackling determinants of suicide risk such as unemployment, poverty, and housing insecurity.[7]
• Education and training: building capacity across health, education, police, and community sectors to recognise and respond to markers of suicidal distress.[6, 24]

Suicide reporting in the media

Suicide reporting can increase rates of death by suicide and suicide attempts.[29] The media’s role is reporting broader, systemic, and policy issues that impact death by suicide. Increasing awareness of risk factors, prevention mechanisms, and community supports can help support individuals with suicide ideation and their families, whānau, and carers.[29]

Crisis management vs prevention 

Prevention has been overshadowed by a focus crisis management. Emergency measures are necessary but must complement a robust proactive mental health system. As outlined in the Australian National Suicide Prevention Outcomes Framework 2024 systems-based and clinical interventions, particularly for those with mental ill-health, must be central to prevention strategies.

Responding to suicide risk in clinical practice

Risk prediction in clinical practice is a complex practice that includes the weighing of risk factors and protective factors. Each individual responds to these factors differently, further increasing difficulty. Risk factors and protective factor lists are not exhaustive. Therefore, emphasis should be placed on formulation-based clinical judgment as part of a larger therapeutic interaction.

Risk mitigation

Suicide risk can be mitigated by reducing means of suicide. The impulsivity of suicide means that restricting access to lethal means and enabling time for suicidal thoughts to subside can save lives.[11, 20]

Substance use and suicide 

The complex relationship of substance use (alcohol and other drugs) is well demonstrated.[9] Alcohol and drug policy intersections with suicide prevention policy and should be considered in parallel.[21]

The role of lived experience and multidisciplinary support

People with lived and living experience (LLE) of suicidal distress, along with their families, whānau, friends, and carers, offer invaluable insight into the realities of suicidal risk, recovery and prevention. Embedding LLE across the spectrum of suicide prevention—from service design and delivery to governance and evaluation—ensures that responses are compassionate, relevant, and human-centred. 

Current challenges

Despite increased awareness and investment, significant challenges remain:

• Fragmented services and systems hinder continuity of care.[18]
• Workforce shortages and limited psychiatric capacity, especially in rural and remote areas cause access issues.[16, 26]
• Inconsistent implementation of evidence-based interventions.[30]
• Gaps in data relating to suicidality and comorbidity limit policy and systems design.[31]

Recommendations

The RANZCP recommends:

1. A whole-of-government approach that addresses the social determinants of suicide and ensures coordinated prevention across sectors and governments.
2. Commitment to the growth and integration of the specialist, including the non-clinical psychosocial support workforce, mental health workforce that supports those at risk of death by suicide. 
3. The development of national suicide data repositories to improve real-time monitoring and evaluation. 
4. Embedding lived experience expertise into all components of suicide prevention policy and systems, including service design, delivery, and evaluation 
5. Integrating psychiatric expertise, alongside peer support and multidisciplinary partners, in suicide prevention policy and practice.
6. Integrating of alcohol and drug strategies and policy within suicide prevention policy. 
7. Investing into workforce training that expands the suicide prevention workforce and ensures culturally safe, trauma-informed, and person-centred practice. 

RANZCP resources

• Clinical Practice Guideline for the Management of Deliberate Self-harm
• Position Statement 80 The Role of the Psychiatrist in Australia and Aotearoa New Zealand 
• Position Statement 37: Principles for mental health systems 
• Position Statement 100: Trauma-informed practice

Other resources

• Australian Open Disclosure Framework
• Australia: Reporting suicide and mental ill-health: A Mindframe resource for media professionals, Mindframe.
• Aotearoa New Zealand: Media Guidelines for Reporting on Suicide, Aotearoa New Zealand Ministry of Health - Manatū Hauora.

Getting help

If you or someone you know needs immediate support, the following services offer crisis telephone support:

Australia

• Lifeline Australia 13 11 14
• Suicide Call Back Service 1300 659 467
• Beyond Blue 1300 224 636

Aotearoa New Zealand

• Suicide Crisis Helpline 0508 828 865 (0508 TAUTOKO)
• Depression Helpline 0800 111 757
• Lifeline New Zealand 0800 543 354
• Healthline NZ 0800 611 116

If you are worried about someone you know feeling suicidal, more information about how to help is available on the Your Health in Mind website.

References

1. Everymind. Glossary of terms 2024 [Available from: https://lifeinmind.org.au/suicide-prevention/about-suicide/communicating-about-suicide/glossary-of-terms.
2. Australian Bureau of S. Intentional self-harm (suicide) deaths Canberra: Australian Bureau of Statistics; 2024 [updated 2026-04-15. Available from: https://www.abs.gov.au/statistics/health/causes-death/intentional-self-harm-suicide-deaths/latest-release.
3. World Health Organization. Suicide 2024 [Available from: https://www.who.int/news-room/fact-sheets/detail/suicide.
4. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry. 2008;192(2):98-105.
5. OECD. Society at a Glance 2024: OECD Social Indicators. OECD Publishing. 2024.
6. Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, et al. Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry. 2016;3(7):646-59.
7. Frasquilho D, Matos MG, Salonna F, Guerreiro D, Storti CC, Gaspar T, Caldas-de-Almeida JM. Mental health outcomes in times of economic recession: a systematic literature review. BMC public health. 2016;16:115-.
8. Zealand. MHFoN. Statistics on suicide in New Zealand: mentalhealth.org.nz; 2022 [Available from: https://mentalhealth.org.nz/suicide-prevention/statistics-on-suicide-in-new-zealand.
9. Australian Bureau of Statistics. Causes of Death, Australia 2019, Intentional self-harm (suicides), key characterstics. Australia.2020 [Available from: https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2019#intentional-self-harm-suicides-key-characteristics.
10. Bassilios B, Dunt D, Krysinska K, Machlin A, Newton D, Currier D. Key informant perspectives of suicide prevention in Australia. BMC Public Health. 2024;24(1):3449.
11. Cox GR, Owens C, Robinson J, Nicholas A, Lockley A, Williamson M, et al. Interventions to reduce suicides at suicide hotspots: a systematic review. BMC Public Health. 2013;13(1):214.
12. Donald M, Dower J, Correa-Velez I, Jones M. Risk and protective factors for medically serious suicide attempts: a comparison of hospital-based with population-based samples of young adults. Australian & New Zealand Journal of Psychiatry. 2006;40(1):87-96.
13. Fleming TM, Merry SN, Robinson EM, Denny SJ, Watson PD. Self-reported suicide attempts and associated risk and protective factors among secondary school students in New Zealand. Australian & New Zealand Journal of Psychiatry. 2007;41(3):213-21.
14. Large MM, Ryan CJ, Carter G, Kapur N. Can we usefully stratify patients according to suicide risk? Bmj. 2017;359:j4627.
15. Maple M, Wayland S, Pearce T, Hua P. Services and programs for suicide prevention: an evidence check rapid review brokered by the Sax Institute for Beyond Blue 2018. [Available from: https://www.beyondblue.org.au/docs/default-source/policy-submissions/suicide-prevention-programs_final-1.pdf?sfvrsn=b082bcea_6.
16. Bowden M, McCoy A, Reavley N. Suicidality and suicide prevention in culturally and linguistically diverse (CALD) communities: A systematic review. International Journal of Mental Health. 2019:1-28.
17. Mental Health Foundation of New Zealand. Statistics on suicide in New Zealand. mentalhealth.org.nz; 2022.
18. Krysinska K, Batterham PJ, Tye M, Shand F, Calear AL, Cockayne N, Christensen H. Best strategies for reducing the suicide rate in Australia. Australian & New Zealand Journal of Psychiatry. 2015;50(2):115-8.
19. Department of Health. 8.2 Challenges of measuring outcomes for suicide prevention. 2014.
20. Röcker S, Bachmann S. [Suicidality in mental illness – prevention and therapy]. Ther Umsch. 2015;72(10):611-7.
21. Witt K, Lubman DI. Effective suicide prevention: Where is the discussion on alcohol? Australian & New Zealand Journal of Psychiatry. 2018;52(6):507-8.
22. Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Jama. 2001;286(24):3089-96.
23. Heinsch M, Sampson D, Huens V, Handley T, Hanstock T, Harris K, Kay-Lambkin F. Understanding ambivalence in help-seeking for suicidal people with comorbid depression and alcohol misuse. PloS one. 2020;15(4):e0231647.
24. Jorm AF. Lack of impact of past efforts to prevent suicide in Australia: Please explain. Australian & New Zealand Journal of Psychiatry. 2019;53(5):379-80.
25. Rowe SL, French RS, Henderson C, Ougrin D, Slade M, Moran P. Help-seeking behaviour and adolescent self-harm: A systematic review. Australian & New Zealand Journal of Psychiatry. 2014;48(12):1083-95.
26. Bruffaerts R, Demyttenaere K, Hwang I, Chiu W-T, Sampson N, Kessler RC, et al. Treatment of suicidal people around the world. The British Journal of Psychiatry. 2011;199(1):64-70.
27. Niederkrotenthaler T, Voracek M, Herberth A, Till B, Strauss M, Etzersdorfer E, et al. Role of media reports in completed and prevented suicide: Werther v. Papageno effects. Br J Psychiatry. 2010;197(3):234-43.
28. Xuan Z, Naimi TS, Kaplan MS, Bagge CL, Few LR, Maisto S, et al. Alcohol policies and suicide: a review of the literature. Alcoholism: clinical and experimental research. 2016;40(10):2043-55.
29. Thomas Niederkrotenthaler MB, Jane Pirkis, Benedikt Till, Steven Stack, Mark Sinyor, Ulrich S Tran, Martin Voracek, Qijin Cheng, Florian Arendt, Sebastian Scherr, Paul S F Yip, Matthew J Spittal. Association between suicide reporting in the media and suicide: systematic review and meta-analysis. British Medical Journal. 2020(368).
30. Black Dog Institute. What can be done to decrease suicidal behaviour in Australia? A call to action.2020. [Available from: https://www.blackdoginstitute.org.au/wp-content/uploads/2020/09/What-Can-Be-Done-To-Decrease-Suicide-a-call-to-action_Black-Dog-Institute.pdf.
31. McGill K, Hiles SA, Handley TE, Page A, Lewin TJ, Whyte I, Carter GL. Is the reported increase in young female hospital-treated intentional self-harm real or artefactual? Aust N Z J Psychiatry. 2019;53(7):663-72.

Disclaimer: This information is intended to provide general guide to practitioners and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation but takes no responsibility for matters arising from changed circumstances or information or material that may have become subsequently available.