GPs also have an important role in early prevention through advising about management of stress and mental health conditions before they become more severe. Box 1 includes some common-sense advice and resources that GPs can provide for patients to manage their mental health and build resilience during the COVID-19 pandemic.24
Studies show that many patients visit their GP in the months leading up to suicide (even for non-mental health reasons). Therefore, it is important that GPs are up to date on suicide assessment skills.25 GPs should be aware that suicide cannot always be accurately predicted even by the most highly skilled clinician with all the information available. Suicide assessment comprises multiple factors and is not a tick-box approach. Thus, although risk factors and screening tools can provide useful information, they cannot definitively predict the risk of suicide. Suicide risk assessment is unfortunately an inexact science.26 Raising the conversation with the patient requires delicate communication skills and some useful phrases are listed in Box 2. Relevance to the presenting issue and a nonjudgemental approach enhance patient acceptability of the question. Normalising and framing statements can help create a context for asking about self-harm or suicide.
Suicide prevention plans
Putting in place a suicide prevention plan with a patient is good practice and can provide a template to monitor progress during subsequent consultations. One approach developed by Beyond Blue uses the Beyond Now app (Figure), which works with the patient to identify key steps in suicide prevention. The GP can ask the patient to download the app during the consultation if they have a smart phone and work through the pages, including topics such as: my warning signs; make my space safe; my reasons to live; things I can do by myself; people and places I can connect with; people I can talk to; and professional support. Patients can also download and use the app on their own and, to date, more than 80,000 downloads have been undertaken in Australia.
Suicide contracts vs safety plans
In the past, suicide contracts were a common recommendation for managing suicide risk. Suicide contracts are now considered unhelpful as they can create a power imbalance at a time when the focus should be on empowerment. In contrast, suicide safety plans are developed with the person and consider the person’s resilience and supports to keep them safe. It is easiest to work on these when the person’s emotional distress is more contained.
Safe spaces and havens
Safe spaces and havens are another emerging, primarily peer-led initiative in some communities, providing a nontertiary alternative for people in suicidal crisis and can be crucial parts of a suicide prevention plan for vulnerable people.27 A safe space is a designated place that aims to provide a safe, welcoming and supportive environment for people experiencing psychological distress, allowing them to have an alternative to presenting to an emergency department.28