1. Suicide under Crisis teams and in-patient care - England ENGLAND_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

2. 37% of those who died by suicide did not have a mental health diagnosis recorded on the GP database. 52% had not been prescribed psychotropic drug treatment in the year before they died. Suicide in primary care in England: 2002-2011. In primary care patients who die by suicide, mental illness is frequently unrecognised Suicide risk is associated with frequent GP attendance, increasing attendance, but also non- attendance.

3. Hawton, Saunders, O'Connor Self-harm and Suicide in Adolescents. The Lancet 2012, 379 ; 2373-2382 Self-harm and suicide in adolescents

4. 19% Nineteen per cent of deaths following self harm were by suicide In young people up to 50% of deaths following self harm are by suicide* Suicide occurred in 1.6% of patients (2.6% of males and 0.9% of females) after self harm Risk was 49 times greater than the general population risk Risk of suicide increased with age. Hawton. "Repetition of self‐harm and suicide following self‐harm in children and adolescents: findings from the Multicentre Study of Self‐harm in England." Journal of child psychology and psychiatry 53.12 (2012): 1212-1219.

5. What bridges the gap between self- harm and suicidality? 50% of young people who engage in self-harm may experience suicidality Those who have a history of suicidal behaviour are older, more likely to have a psychiatric diagnosis, and regularly use illicit substances Self-forgiveness and Resilience factors (support seeking and problem solving) are protective. What bridges the gap between self-harm and suicidality: the role of forgiveness, resilience and attachment Lin, Nagra and Upthegrove manuscript in preparation

6. Suicide prevention in schools Great platform for prevention efforts – Age appropriate given risk – Captive audience Few trials to date – Most from USA – Most focus on intermediate outcomes rather than suicidal behaviours

7. The SEYLE study Wasserman et al, Lancet (2015) 168 schools in 10 European countries Tested three active interventions against control – Teacher education, screening, and a student program – Primary outcome was suicide attempt at 3 or 12 month follow-up

8. The SEYLE study Results – No effects at 3 months – Significant difference at 12 months for the student program (Odds ratio for suicide attempts = 0.45) Not without problems! Nonetheless, suggests universal prevention might be possible