Suicide is a major problem around the globe. Among various psychiatric diagnoses, schizophrenia confers the greatest risk to an individual, while depression confers the greatest risk to populations due to higher prevalence. Predicting suicide attempts with specificity is a major challenge for clinicians. Evidence-based screening and assessment tools exist, which can help standardize the evaluation process, but these tools have limited specificity, sensitivity, and negative predictive value. Best practice is to use these tools in the context of a full clinical assessment that includes a medical and psychiatric history, a mental status exam, obtaining collateral, and eliciting risk and protective factors. The stress-diathesis model posits that suicidal behavior is the result of complex interactions between an acute stressor and underlying neurobiological vulnerability. Evidence supports treating suicide risk through lethal means restriction, outreach after discharge, psychiatric medication where appropriate (antidepressants, lithium, clozapine, ketamine), psychotherapy (cognitive behavior therapy, dialectical behavior therapy), and safety planning. When clinicians identify suicide risk factors and provide appropriate interventions, lives are saved.

The suicides of important kings are recorded in the Bible, and the chapter starts with an overview of the history of suicide. It then covers suicide verdicts, international suicide rates and methods, then the epidemiology of suicide is reviewed. This includes the effect of marital status, the elderly and the young, mental illness, the emotions of hopelessness and shame, as well as suicide in major mental disorders such as depression, schizophrenia, bipolar disorder and alcoholism. Economic influences such as poverty, occupation and unemployment, as well as worldwide financial crashes are covered. Can anything reduce the rates? Does religion help prevent suicide? Does suicide prevention and risk assessment help, or is this still just ’a work in progress’? Self harm has reached almost epidemic numbers in most parts of the world. The aetiology and why this should be is covered as well as what the later risk of completed suicides is.

Case management skills are critical to the effective, efficient and ethical delivery of clinical psychological services. The chapter will outline how case management involves the combination of practice-based evidence with management and documentation tasks.We outline the key management and documentation tasks associated with specific phases of the treatment process, framing them in a context of generating practice-based evidence. We illustrate good record keeping, maintainance of confidentiality, treatment planning, treatment implementation (including suicide risk assessment) and treatment termination.