Broader considerations required to improve care Around 19 people die from suicide in the UK each day,1 and every death is tragic and potentially avoidable. In 2023, England’s suicide rate was 11.2 per 100 000, similar to that in France and Sweden (11.8 and 11.7 per 100 000, respectively, in 2021).2 NHS England has released new guidance to support the national suicide prevention strategy of reducing suicides and improving mental health services,34 superseding the 2009 report on assessing and managing risk in mental health services.5 The main difference from the 2009 guidance is a move to focus on safety rather than risk in assessment, formulation, and management, including a recommendation to not use risk prediction tools.5 The safety first approach prioritises exploration of the presenting problem, precipitating factors (eg, mental illness), protective factors (eg, family or employment), longstanding factors that exacerbate current difficulties, and perpetuating factors that sustain cu