Empowering staff to assess suicide risk in colleagues

Overview

During the first wave of COVID-19, University Hospitals of Northamptonshire (UHN) NHS Group, comprising Northampton General Hospital (NGH) and Kettering General Hospital (KGH), recognised that staff were facing unprecedented psychological pressures. Staff were redeployed, exposed to traumatic events outside their usual roles and asked to make exceptionally difficult decisions. Distress, trauma and moral injury became increasingly visible across both sites.

UHN developed a suicide-risk awareness resource to help staff start a compassionate, direct conversation when they were worried about a colleague. This early initiative has since been refreshed and embedded within a ratified standard operating procedure (SOP), a Group-wide Occupational Health and Wellbeing (OHWB) Single Point of Access (SPOA) and a clearer distinction between a supportive colleague-led conversation and a clinician-led suicide risk assessment.

Key benefits and outcomes 

• Any competent member of staff can use the Distressed Staff Risk Assessment (DSRA) resource to guide a brief, supportive and non-clinical conversation.
• The ratified SOP defines when immediate emergency action is required and when concerns should be referred through OHWB SPOA for follow-up.
• A clinician-led, formulation-based suicide risk assessment is available when indicated and incorporates collaborative safety planning.
• Management referrals and self-referrals are screened for suicide, self-harm and safeguarding concerns, with risk referrals prioritised for daily clinical review.
• The OHWB Nursing team reviews submitted risk referrals within 24 working hours, while immediate danger is managed through emergency and local crisis services without waiting for OHWB.
• In 2025, 149 staff risk assessments were recorded, compared with 62 in 2021. Anonymised weekly and monthly reporting supports oversight and helps the service identify changes or spikes in risk.
• Monthly training is open to all staff and embedded in several routine induction programmes, including resident doctor training.

What the organisation faced

When Dr Claire Hallas joined UHN as lead health psychologist in March 2020, there was no structured process for responding to staff suicide concerns, and internal wellbeing services operated only during normal working hours, creating gaps when distress was identified out of those hours.

Some staff were reluctant to use community crisis services or attend Emergency Departments, feeling they should be delivering those services rather than receiving them. Between August and October 2020, staff suicide was formally recognised as an organisational risk, enabling senior oversight and a consistent response across both hospital sites.

What the organisation did

UHN introduced the Distressed Staff Risk Assessment (DSRA) as a brief, supportive and non-clinical conversation guide that helps staff ask direct questions about suicidal thoughts, intent, plans, access to means and immediate safety.

Staff are asked to record who is involved, actions taken and required follow‑up. It also prompts staff to confirm whether the colleague consents to sharing information with OHWB. The DSRA does not ask colleagues to diagnose mental illness or predict suicide. The SOP reinforces that information may need to be shared with emergency services if there is an immediate concern about safety.

Clinician-led suicide risk assessment

Where risk is identified or remains uncertain, SPOA can arrange assessment by an OHWB clinician. This follows NHS England's Staying safe from suicide guidance and explores suicidal thoughts, intent, access to means, previous attempts, triggers, protective factors, occupational pressures and immediate safety. It results in a shared formulation and collaborative safety plan.

Implementation and training

Senior sponsorship and consistent communication helped embed the pathway across departments and professions. Monthly DSRA training is open to all staff and embedded in induction programmes, covering recognising distress, asking direct questions, confidentiality, emergency support and SPOA referrals. 

Manager training includes responding to remote disclosures. OHWB staff have completed Postvention: Assisting those Bereaved by Suicide (PABBS) training to strengthen support following a staff death by suicide.

For urgent mental health concerns that do not present an immediate risk to life, the Northamptonshire Mental Health Number is available 24/7. The OHWB Nursing team then provides less urgent work-focused follow-up after the submitted risk information has been reviewed.

Single Point of Access and data capture

UHN launched a Group-wide OHWB SPOA in March 2026, which centralises referrals and screens for suicidal thoughts, self-harm and safeguarding. Risk indicators are routed to the priority triage workflow and reviewed first in the daily multidisciplinary review. Automated messages provide immediate safety information, and the OHWB Nursing team reviews flagged referrals within 24 working hours. 

A confidential risk register supports clinical governance, with anonymised weekly and monthly reporting enabling oversight and identification of spikes in risk.

Results and benefits

The pathway gives staff a safe opportunity to disclose significant distress and provides managers and colleagues with a clear structure for responding. It connects emergency action, community mental health support and work-focused OHWB follow-up, helping colleagues stay in or return to work safely, while receiving the appropriate treatment and support from community services.

Centralised screening and reporting have also improved visibility across NGH and KGH. The service can identify changing patterns, coordinate follow-up and provide stronger assurance that risk concerns are being reviewed rather than remaining within separate referral routes.

In 2025, 149 staff risk assessments were recorded, up from 62 in 2021 — an increase of around 140 per cent. This reflects greater use and visibility of the pathway, though differences in reporting and access mean it should not be seen as a direct change in the prevalence of suicide risk.

Overcoming obstacles

The main challenge was the belief that only mental health professionals should ask about suicide. UHN's approach reinforces that anyone can start a direct, supportive conversation, while trained professionals retain clinical responsibility.

Embedding the pathway across two sites has required repeated communication, open training and visible leadership support. Embedding the process within the UHN OHWB SPOA referral system has helped make the route easier to find and more consistent.

Digital screening and automation improve visibility but do not replace clinical judgement, so daily clinical review remains essential.

Takeaway tips

• Give staff clear, compassionate language for asking directly about suicide and reinforce that asking does not increase risk.
• Distinguish a supportive colleague-led conversation from a clinician-led assessment and safety planning.
• Make emergency actions unambiguous: do not leave the person unsupported, do not manage alone and call 999 when life may be at immediate risk.
• Link the internal pathway to 24/7 community mental health and emergency services; an acute hospital staff-support service should not be presented as a crisis service.
• Use a single point of access to improve visibility, but retain clinical responsibility, daily review and a safe contingency when automation is unavailable.
• Use anonymised data to monitor demand and trends.
• Reinforce the message through open training, communication and routine governance rather than relying on a one-off campaign.

Future plans

UHN will continue to embed the refreshed DSRA and clinician-led pathway across both sites, strengthen experiential training, work-based safety planning and links with community mental health services. Anonymised risk data will support early identification of pressures, ensure equitable access to support, and inform preventative action at organisational level.

Further information

For further information about this case study, contact Dr Claire Hallas, group head of Occupational Health and Wellbeing, at c.hallas@nhs.net, or Moya Flaherty, deputy head of Occupational Health and Wellbeing, at moya.flaherty2@nhs.net.