Forty seven statements, a yes or a no, and the date the service looks again
- NCISH publishes "Safer services: A toolkit for specialist mental health services and primary care" as two files that download from the University of Manchester document store: a PDF of 31 pages and a Word document that the NCISH website offers as the version "which can be used to record progress". A one-page diagram of the ten elements sits beside them. The footer of every page carries the stamp "Safer Services toolkit. Updated: 01/07/2026", and the file names repeat that date.
- The PDF holds four domains of care – specialist mental health services, the Emergency Department, primary care, and care for children and young people – and fifteen topics distributed among them. Ten topics form the list NCISH calls its 10 key elements: safer wards, early follow-up on discharge, admission within the local area, a 24-hour crisis resolution and home treatment team, family involvement, local guidance on depression and self-harm, a personalised approach to risk, outreach teams, low turnover of non-medical staff, and joint working with alcohol and drug services.
- Those topics resolve into seventeen self-assessment tables holding forty seven statements. Every statement is followed by three columns: Response, printed as a pair of tick boxes marked Yes and marked No; Date next review due; and Comments.
- Each topic opens on a spread built the same way. A box headed "Our evidence" gives the surveillance figures behind the statement, and a box headed "Guidance" names the national strategies, contracts and inquiry reports that already carry the recommendation, among them the suicide prevention strategy for England 2023-2028, the Welsh strategy Talk To Me 2, HSSIB reports and the NHS Standard Contract 2023/2024.
- The introduction fixes how the toolkit is worked. Responses "should ideally be based on recent local audit data or equivalent evidence", and "We recommend each element is reviewed annually". NCISH has collected information on all suicides in the UK since 1996 and presents the statements as the product of more than 25 years of data collection, citing Kapur et al, 2016 for the effect of the recommendations. The HQIP impact report of December 2024 records the toolkit as downloaded around 37,000 times since its launch in 2012.
A page the service fills in
Two files come out of the toolkit download, and NCISH publishes the ten elements separately as a one-page diagram. The PDF runs to 31 pages, the Word document carries the same content and is published as the copy a service uses to record progress, and the diagram sets the ten elements on a single sheet. Fifteen topics sit inside the PDF, grouped into four domains of care, and they resolve into seventeen self-assessment tables with forty seven statements between them. Each statement describes the service itself: a discharge policy that specifies follow-up within 72 hours of leaving hospital, an observation policy written around the raised risk in the first week of admission, a protocol for joint working between mental health and alcohol and drug services, a system that monitors turnover of non-medical staff. Beside each statement stand three columns – Response, with Yes and No; Date next review due; Comments.
Inside a topic spread
Every topic opens on a spread. The box headed "Our evidence" gives the counts that put the statement on the page: 2,250 suicides within three months of discharge from in-patient care in the UK and Jersey between 2013 and 2023, 13% of them within the first week and the largest numbers on days 4 and 3 after leaving hospital; an average of 189 suicides a year in England among patients of crisis resolution and home treatment teams; an average of 439 patient deaths a year preceded by self-harm in the previous three months. The box headed "Guidance" lists the documents that already carry the recommendation.
Five of the fifteen topics work outside specialist mental health services altogether: psychosocial assessment after self-harm in the Emergency Department, safer prescribing, monitoring for depression in primary care, additional measures for men in mid-life, and a closing page for children and young people. The seventh element is named a personalised approach to risk, and its table asks for a management plan, protocols that gather the current situation and the person's history, staff training in assessing and formulating risk, and a guide to communicating risk between the services around the patient.
The service ends with a dated record
The introduction sets the working order. Responses rest on recent local audit data or equivalent evidence, and each element comes back for review once a year. Filled in, the Word file turns into a local document with a date against every line and a comment saying what happens next. The toolkit is versioned in the same spirit: the stamp 01/07/2026 runs along the foot of all 31 pages and into both file names. NCISH has collected information on all suicides in the UK since 1996, builds the statements on more than 25 years of that collection, and has seen the toolkit downloaded around 37,000 times since 2012. The programme is commissioned by HQIP on behalf of NHS England, NHS Wales, the Scottish Government, the Northern Ireland Department of Health, Jersey and the Isle of Man.
The unit of this toolkit is a row – a statement about the service, a yes or a no, the date it will be looked at again, and a line for what the service intends to do.
The toolkit is a British instrument, and every figure in its evidence boxes comes from UK and Jersey surveillance, so the counts travel less well than the format does. Where NCISH reports falls in suicide rates, those figures belong to services that implemented the recommendations, and they are not a measure of completing the form. The counts of seventeen tables and forty seven statements are ours, taken from the text of the 31-page PDF, because the document prints no total of its own. Copyright rests with the University of Manchester and reproduction of the material is by permission, while both files download freely. Pages read for this note: the toolkit PDF in full, the NCISH resources and 10 ways pages, the University of Manchester copyright notice, and the HQIP impact report of December 2024. The Word file was checked for format and size and was not opened.