The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) has published its 2025 Annual Report titled:
"The National Confidential Inquiry into Suicide and Safety in Mental Health. Annual Report: UK patient and general population data, 2012-2022. 2025. University of Manchester"
The report provides findings relating to people aged 10 and above (in line with the Office for National Statistics) who died by suicide between 2012 and 2022 across the UK (England, Northern Ireland, Scotland, and Wales) and Jersey.
Before reading the report:
This report mentions topics related to self-harm and suicide and includes some details of methods of death, which may potentially lead to distress. Before you read the report, check in with yourself. How are you feeling today? If you were negatively impacted or affected who would you contact for support? Support is available from Samaritans, for free, 24/7. Phone 116 123 or email jo@samaritans.org.uk.
This publication serves as a poignant reminder that behind every statistic is a real person with a unique story. Let's approach this data with compassion and empathy, recognising the profound impact on families, friends, and communities.
We also have a duty to those who have lost their lives and those impacted by the loss to learn from these experiences to improve our self-harm and suicide prevention efforts.
The following stats are from the reporting period 2012-2022. You can read all key findings and the report in full on the NCISH website.
Patient suicide numbers and rates
- 18,670 suicides by patients in the UK and Jersey - an average of 1,697 deaths per year.
- 26% of all people who died by suicide in 2012-2022 had recent contact with mental health services
Social and clinical characteristics
- A high proportion of patients who died by suicide showed evidence of isolation and social adversity
- 47% lived alone
- 17% had recently experienced serious financial problems
- 31% had recent self-harm
- A history of alcohol (47%) or drug (38%) misuse was common
- Over half (55%) had a comorbid (i.e. additional) mental health diagnosis
- The majority (62%) of patients who died had a history of self-harm.
Clinical care
- 4,718 mental health patients (27%) died by suicide in acute care settings (in-patients, under crisis resolution/home treatment, recently discharged from in-patient care), an average of 429 deaths per year.
Suicide and bipolar disorder
- 1,491 suicides by patients with bipolar disorder, 8% of all patient suicides, an average of 136 deaths per year.
Suicide and missed contact and/or non-adherence with medication
- 3,817 suicides by patients who missed their last contact with mental health services, 22% of all patient suicides, an average of 347 deaths per year.
- 1,998 suicides by patients who were nonadherent with drug treatment, 12% of all patient suicides, an average of 182 deaths per year.
Suicide and recent bereavement
- 1,312 suicides by patients who had been recently (<3 months) bereaved, 8% of all patient suicides, an average of 119 deaths per year.
Clinical messages
The report highlights five key suicide prevention priorities for clinicians, mental health services, Integrated Care Boards (ICBs), and Health Boards.
Clinical care and acute mental health care settings
Prevention should focus on ward safety, support after discharge, and recognition of risk after self-harm.
Real-time surveillance
Real-time surveillance of suspected in-patient and post-discharge suicides is being established nationally. All mental health trusts and clinical staff are urged to take part in this new safety initiative, which aims to provide early warning of potential safety concerns. Prevention should focus on ward safety, support after discharge, and recognition of risk after self-harm.
Suicide and bipolar disorder
As a key suicide prevention measure, treatment should be provided in line with NICE guidance. This includes the use of lithium treatment and consideration of psychological interventions.
Suicide and missed service contact and/or non-adherence with treatment
Non-receipt of planned care is identified as a crucial precursor to patient suicide. Services should prioritise follow-up efforts for patients who lose contact with services or who are non-adherent with medication. These patients have multiple clinical and social problems that likely contribute to their risk and need to be addressed in their care plan. Efforts to engage these patients should include the involvement of their family or carers.
Suicide and recent bereavement
Clinicians should be aware that bereavement may increase suicide risk and should be alert to symptoms such as insomnia and alcohol misuse. Enquiring about significant dates, such as anniversaries of deaths, should be a routine part of assessment. Services are advised to make personalised bereavement support available to patients at risk.
NCISH 11th Annual Conference - recording now available
NCISH's 11th Annual Conference took place on the 8th May 2025. Presentations included the findings and recommendations from NCISH’s 2025 Annual Report and recent research findings from NCISH and the Centre for Mental Health and Safety.
The presentations and slides are now available on their website.
Further reading and resources
Thank you to NCISH for making this resource available - it offers important insights for the self-harm and suicide prevention community.
We would also like to acknowledge that this publication serves as a poignant reminder that behind every statistic is a real person with a unique story. Let's approach this data with compassion and empathy, recognising the profound impact on families, friends, and communities.
We also have a duty to those who have lost their lives and those impacted by the loss to learn from these experiences to improve our self-harm and suicide prevention efforts.
You can read all key findings and the report in full on the NCISH website. There are also a range of useful supporting resources, including an easy-read version, infographics, and a video summary.
