Before a suicide: half had seen a GP within three months, often without mental health being raised

Design

Explanatory sequential mixed-methods study of coroners' records

Population

157 consecutive suicides, five English local authorities, 2018-19

Primary outcome

Demographic, clinical and psychosocial characteristics before death

Effect

About half saw a GP in prior 3 months; 41% prior attempt; 62% long-term physical illness

An explanatory mixed-methods study in the British Journal of General Practice (September 2026) examined coroners' records of 157 consecutive deaths by suicide in 2018-19 across five English local authorities, combining descriptive data with thematic analysis of narrative summaries.

Of those who died, 79% were men, 65% lived in the most deprived fifth of areas, 85% had a diagnosed mental health condition, 62% a long-term physical illness and 41% a previous attempt. About half had consulted a GP in the preceding three months, and mental health featured in only about half of those consultations. Common stressors were relationship breakdown (37%), housing instability (22%) and work pressures (18%). Transitions between services stood out as points of vulnerability.

This is a descriptive study of people who died, with no comparison group, so it cannot identify who among the many patients with these features is at highest risk. But the pattern is recognisable to any GP: a man with a long-term physical illness, social stress and a history of self-harm, attending for something else.

The practical change is to ask about mood and suicidal thoughts in consultations that are not labelled as mental health — especially around relationship breakdown, loss of housing or work, and discharge from services.

• Ask about mood and suicidal thoughts when a patient with a long-term physical illness presents with a new social crisis
• Treat relationship breakdown, eviction or job loss as a prompt to ask about suicide
• Record and act on a previous suicide attempt at every consultation, not just mental health ones
• Contact patients recently discharged from mental health services rather than waiting for them to attend
• Know local crisis and social support services to refer to on the same day

Why it matters

Half of these patients were seen in general practice shortly before death, and mental health was often not on the agenda.

Don't overread it

Without a comparison group, these features describe people who died; they do not predict which patients will.

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