Suicide is rare and the only worthwhile strategy is to target people at high risk

The National Service Framework for Mental Health1 seeks to cut the suicide rate by a further fifth from Health of the Nation targets. Standard 7, preventing suicide, advises about health promotion and improved services, including assessment and treatment of depression in primary care and assessing risk among individuals at greatest risk. Will these improvements deliver results? Are there other more promising strategies?

It is widely assumed that early and accurate identification of depressive episodes will reduce suicides. This follows from a belief that suicide is a common adverse outcome in depressive disorders: a 15% lifetime risk is often cited. However, clinical experience and population based studies challenge this view. Every week 10% of the UK population aged 16–65 report significant depressive symptoms, and one in 10 of these admits to suicidal thinking.2 But fewer than two people in a million will kill themselves. A typical primary care group of 100 000 expects 10 suicides a year.1 …