Introduction

Family doctors will be familiar with people presenting with suicidal thoughts and ideas, and less commonly with acts of deliberate selfharm, parasuicide or attempted suicide. It is much rarer to hear that a patient has actually committed suicide – in the United Kingdom only one person in 6000 will do so each year (Secretary of State for Health, 1992). Thus the average British general practitioner will meet between ten and fifteen in a professional lifetime.

Is suicide preventable?

An important point to remember is that a significant proportion of people who kill themselves go to see a general practitioner in the weeks leading up to the suicidal act (Vassilas & Morgan, 1993), which allows at least the possibility of intervention. However, there is significant debate at this time about whether suicide is truly preventable (Wilkinson & Morgan, 1994). There is evidence that many primary health care professionals are dubious that they can prevent suicide among their patients. Morgan & Evans (1994) found that 31% of nurses and 27% of general practitioners evinced equivocal or negative responses to questionnaires concerning attitudes to suicide prevention.

Whatever policies primary health care teams adopt to try to prevent suicides, it will be difficult for them to tell whether they are having a worthwhile effect on their own list of patients. As suicide is a relatively rare event, any reduction in the suicide rate may not be perceived at the level of the practice – indeed, it is doubtful if it can be noticed at the level of a town, a health district or even at regional level, from one year to the next.