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Treatment to lower suicide risk
Treatments that lower suicide risk: safety planning, suicide-focused therapy, follow-up calls, medicines, crisis care and care after a hospital stay.
Suicidal thoughts can be treated. Several approaches have been tested to lower the risk of suicide attempts directly, not only to ease depression or other conditions. They work best when they are combined with good care for whatever lies underneath, such as depression, bipolar disorder, substance use or pain.
This page explains what the research shows, from safety planning and talk therapy to medicines and crisis care. It also explains why the weeks after a hospital stay matter so much. If you are in crisis right now, call or text 988, or call 911 if you are in danger.
Key points
- Safety planning with follow-up calls was linked to about 45% fewer suicidal acts in a large study at Veterans Affairs emergency departments.1
- Therapies that focus on suicide work. Cognitive therapy cut repeat attempts by about half in one trial. DBT and CAMS also have good evidence.2,3,4
- Staying in touch helps. Brief care during an emergency visit, often with follow-up calls or letters, was linked to fewer later attempts.5
- Some medicines have evidence. Lithium in mood disorders and clozapine in schizophrenia have been linked to lower suicide risk. Esketamine is approved for depression symptoms in people with acute suicidal thoughts, but it has not been shown to prevent suicide.7,9,10
- The first 3 months after leaving a psychiatric hospital carry the highest risk. A follow-up plan matters.11
Talk therapies and brief treatments
The badges show how strong the research is. See how we rate evidence.
Safety Planning Intervention with follow-up
Moderate evidenceA clinician helps you write a short, step-by-step plan for crisis moments. It lists your warning signs, ways to cope, people to contact, professionals to call and ways to make your surroundings safer. Follow-up phone calls check how you are doing. In a study at 9 VA emergency departments with 1,640 people, about 3 in 100 who got this care had suicidal behavior over 6 months, compared with about 5 in 100 with usual care. People with a safety plan were also more likely to go to a mental health visit.1 The study was not randomized. Make your own with our safety plan tool.
Cognitive therapy for suicide prevention (CBT-SP)
Moderate evidenceThis form of cognitive behavioral therapy (CBT) focuses directly on suicidal crises. You look closely at what led up to a crisis, learn skills for hopeless moments, and plan how to handle the next one. In a trial of 120 adults seen in an emergency room after a suicide attempt, 10 sessions of cognitive therapy were tested. Over 18 months, 24% made another attempt, compared with 42% with usual care. That is about half the risk.2 Depression and hopelessness also eased, though suicidal thoughts did not differ between groups.2 See CBT.
Dialectical behavior therapy (DBT)
Moderate evidenceDBT was built for people with long-standing suicidal behavior. It combines one-on-one therapy, a skills group and coaching between sessions. In a trial of 101 women with recent suicidal behavior and borderline personality disorder, those in DBT were about half as likely to make a suicide attempt over 2 years as those treated by expert community therapists. They also had fewer hospital stays and emergency visits, and were more likely to stay in treatment.3 See DBT and Borderline personality disorder.
Collaborative Assessment and Management of Suicidality (CAMS)
Moderate evidenceIn CAMS, you and your clinician work side by side to understand what drives your suicidal thoughts and what keeps you going. Treatment then targets those drivers. A review of 9 studies found that CAMS lowered suicidal thoughts and distress and raised hope more than other treatments. It did not clearly lower suicide attempts or self-harm.4
Brief contact and follow-up after a crisis
Moderate evidenceThese are short treatments given during an emergency visit or hospital stay. Some add phone calls, postcards or letters afterward. A review of 14 studies with 4,270 patients found they were linked to fewer later suicide attempts and more people getting follow-up care. They did not clearly ease depression. The most common ingredient was building connection with the care team and the person's community.5
Treating depression, bipolar disorder and substance use
Depression, bipolar disorder, schizophrenia and substance use all raise suicide risk. Treating them is a core part of lowering it.
One example comes from primary care for older adults. In a trial of 598 adults age 60 and older with depression, a care manager helped their doctors follow treatment guidelines. After 4 months, the share of people with suicidal thoughts fell from about 29% to 17% in that group. In usual care, it went from about 20% to 17%.6 Moderate evidence
For more, see Treatment for depression, Bipolar medicines, Schizophrenia medicines and Substance use treatment.
Medicines with evidence
No medicine replaces safety planning, therapy and close follow-up. A few medicines have evidence for lowering suicide risk in specific conditions. Your doctor weighs the benefits and risks for you.
Lithium for mood disorders
Moderate evidenceLithium is a long-used medicine for bipolar disorder that is sometimes used for depression. A review of 48 trials with 6,674 people found fewer suicides and fewer deaths from any cause with lithium than with a placebo (a dummy pill).7 But a 2022 trial in 519 veterans with depression or bipolar disorder found that adding lithium to usual care after a recent suicide-related event did not lower repeat events.8 Lithium needs regular blood tests.
Clozapine for schizophrenia
Moderate evidenceClozapine is approved by the U.S. Food and Drug Administration (FDA) to lower the risk of repeated suicidal behavior in people with schizophrenia or schizoaffective disorder who are at long-term risk.9 It can lower the white blood cell count, which can lead to serious infections, so people taking it need regular blood tests.9
Esketamine nasal spray
Limited research · for suicide risk itselfEsketamine (brand name Spravato) is FDA-approved, together with an antidepressant taken by mouth, for depressive symptoms in adults with major depression who have acute suicidal thoughts or behavior. Its label says it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It does not replace a hospital stay when one is needed.10 It is given only in a certified clinic, where you are watched for at least 2 hours after each dose.10 See Ketamine and esketamine.
About antidepressants. Antidepressants treat depression, which is a major risk factor. They carry an FDA boxed warning about suicidal thoughts and behavior in children and young adults.10 Doctors watch closely in the first weeks of treatment and after dose changes. See Antidepressant medicines.
Never start, stop or change a medicine on your own. Talk with your doctor or pharmacist before changing anything.
Crisis care: what happens when you reach out
988 Suicide & Crisis Lifeline. When you call, text or chat with 988, a trained counselor listens and helps you find a way to stay safe. Less than 2 in 100 calls involve emergency services. More than half of those happen with the caller's agreement.12
Mobile crisis teams. In some areas, 988 can connect you with a mobile crisis team. These trained workers come to you. Other options include crisis stabilization centers, urgent care and the emergency room.12 Services differ from place to place.
The emergency room. In the emergency room, staff treat any injuries first. A clinician then asks about your thoughts, your safety, your supports and what has been happening in your life. Together you decide on next steps. Often, people go home the same day with a safety plan and a follow-up appointment. Some need a short hospital stay.
Hospital stays and why the weeks after matter
A short stay in a psychiatric hospital may be needed when a person cannot stay safe. The goals are safety, starting or adjusting treatment, and a plan for going home.
Leaving the hospital is a time of high risk. A review of 100 studies found that suicide rates after discharge from a psychiatric facility were far higher than the rate in the general population. Risk was highest in the first 3 months after leaving. It was highest of all for people admitted with suicidal thoughts or behavior.11
Why? Problems that led to the hospital stay may still be waiting at home. Treatment started in the hospital may not have taken full effect yet. And there can be gaps before outpatient care begins.
Things that help close that gap:
- A follow-up appointment within days of leaving
- A written safety plan
- Follow-up phone calls from the care team, which were part of the safety planning program above1
- Family or friends who check in often
- Keeping medicines, firearms and other dangerous items away from home for now
Learn more in After a suicide attempt.
Questions to ask your care team
- What do you think is driving my suicidal thoughts?
- Can we make or update a safety plan together?
- Do you offer a therapy that focuses on suicide, such as CBT-SP, DBT or CAMS?
- Who do I call after hours or on weekends?
- When is my next appointment? Can it be within a week?
- How should my family handle medicines and firearms at home for now?
If you need to find a therapist, see how to find a therapist. If you have Medicare, see What Medicare covers for mental health.
Common questions
Is a hospital stay always needed?
No. Many people are treated safely with outpatient care, a safety plan and close follow-up. A hospital stay is for times when someone cannot stay safe.
Which therapy is best?
When to get help
Talk with a doctor or mental health professional if you have thoughts of suicide, even if they come and go. You do not need to wait for a crisis.
Call or text 988 any time you have thoughts of suicide or feel you cannot cope. Call 911 if you are in danger or have hurt yourself. See also Get help now.
Sources
- Stanley B, Brown GK, et al. Comparison of the Safety Planning Intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry, 2018. PubMed
- Brown GK, et al. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA, 2005. JAMA
- Linehan MM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry, 2006. JAMA Network
- Swift JK, Trusty WT, Penix EA. The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: a meta-analysis. Suicide Life Threat Behav, 2021. PubMed
- National Institute of Mental Health. Brief suicide prevention interventions in acute care settings may reduce subsequent suicide attempts (on Doupnik SK, et al., JAMA Psychiatry, 2020). NIMH, 2020. NIMH
- Bruce ML, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 2004. JAMA
- Cipriani A, et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ, 2013. BMJ
- Katz IR, et al. Lithium treatment in the prevention of repeat suicide-related outcomes in veterans with major depression or bipolar disorder: a randomized clinical trial. JAMA Psychiatry, 2022. Indiana University ScholarWorks
- U.S. National Library of Medicine. Clozaril (clozapine) tablets: prescribing information. DailyMed, revised 2025. DailyMed
- U.S. National Library of Medicine. Spravato (esketamine) nasal spray: prescribing information. DailyMed, revised 2026. DailyMed
- Chung DT, et al. Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA Psychiatry, 2017. University of Warwick repository
- 988 Suicide & Crisis Lifeline. FAQ: Does Vibrant use police intervention for callers, texters, and chatters to the 988 Lifeline? 988 Lifeline. 988 Lifeline
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.