Helping Singaporeans in distress: A new protocol for suicide risk management

Published on 10 September 2025

NUHS has introduced a new community protocol to strengthen suicide prevention, with a focus on timely support for vulnerable groups like the ‘sandwich generation’.

In Singapore, the 'sandwich generation' refers to adults caring for children and elderly parents while managing careers. These multiple responsibilities can take a heavy toll on mental health. Recent data shows that those aged 30 to 39 are increasingly vulnerable, underscoring the need for early support and prevention.

Experts noted that such stressors can sometimes lead to emotional strain, anxiety or isolation. Without the right support, these challenges can escalate. But with timely care and community networks, many lives can be safeguarded.

“Even without expressing suicidal thoughts, many individuals may show signs of emotional strain or feeling overwhelmed,” said Dr Linus Chua, Medical Lead, Regional Health System Office, National University Health System (NUHS RHSO).

A safety net in the neighbourhood

To strengthen prevention, NUHS RHSO launched a new protocol, ‘Management of Patients with Suicidal Risk in the Community’. This ensures that individuals can now receive interventions at their own neighbourhoods through doctors from the National University Polyclinic (NUP) and General Practitioners (GPs), and the NUHS Community Care Team (NUHS CCT).

Under the protocol, NUHS CCT — multidisciplinary teams made up of doctors, nurses and allied health professionals — are equipped with the skills and tools to identify and support individuals showing signs of distress. They could be youths who are bullied at school, working adults struggling with the caregiving burden, or seniors experiencing physical ailments or loss of independence. 

“Suicide risk manifests differently across life stages, influenced by unique stressors and challenges,” said Dr Chua.

“Hence, our goal was to create a flexible framework that enables NUHS CCT to identify warning signs and connect individuals to appropriate mental health and social support services across the lifespan. We aim to take a proactive, upstream approach in line with national efforts to prevent suicide and promote mental well-being.”

During home visits or video consults, NUHS CCT uses structured screening tools like the Columbia-Suicide Severity Rating Scale (C-SSRS) and Patient Health Questionnaire 2 (PHQ-2) to assess risk. Safety plans, often involving the individual’s caregivers, are then developed, including removal of harmful items and regular check-ins. Cases deemed high risk are promptly escalated to mental health specialists, emergency services or community partners to coordinate care.

A key feature of the protocol is its integration with trusted community partners, such as Active Ageing Centres and family service centres, the primary care network of doctors from NUP and GPs, and even workplaces. As early detection points, they can spot individuals in distress and make direct referrals to NUHS CCT for a comprehensive health assessment. They can also contribute to safety planning by monitoring these individuals and providing continued community engagement and support. 

“Managing suicide risk in the community or home setting allows for more natural, familiar interactions,” explained Dr Chua. 

“Patients feel more at ease in their own environment, which fosters deeper and honest conversations. This setting helps NUHS CCT better understand the individual’s living context and support system, leading to tailored interventions. It also enables earlier detection and support before the crisis escalates to a level requiring hospitalisation.”

Turning protocols into people-first care

On the frontline, nurses emphasise empathy alongside protocol. “We prioritise building trust and listening actively while assessing risk. This allows us to adapt to each person’s unique situation and provide more effective support,” said Ms Megawati, Nurse Clinician, RHSO, NUHS.

Ms Megawati has extensive frontline experience working as a member of the NUHS CCT and has seen warning signs of suicide risk among many members of the sandwich generation. Common examples include social withdrawal, low mood, loss of interest in usual activities, and neglect of self-care.

“Rather than rigidly following the protocol, we view it as a set of flexible guidelines when visiting or consulting patients,” said Ms Megawati who helped design the protocol.

NUHS CCT works with community partners to address both health and social stressors. Financial counselling may be offered for financial pressures, while family counsellors or support groups can help with relationship strains. Caregivers are engaged to create safer home environments and connect residents with support services.

In cases where residents are assessed as having high suicide risk, the protocol details a clear escalation pathway to ensure they receive elevated levels of care. Community Resource, Engagement & Support Team (CREST) and Community Intervention Team (COMIT) agencies are paired with GPs to provide additional mental health support for these patients. 

Strengthening the GP–specialist partnership

GPs are a vital part of this ecosystem. Through NUHS’ Primary Care Network, GPs can access a virtual professional consult platform where psychiatrists from NUHS institutions provide timely advice on mental health cases. This supports GPs with specialist advice as they continue anchoring care in the community.

GPs also work closely with specialists from National University Hospital (NUH) and Ng Teng Fong General Hospital (NTFGH) to co-manage residents at risk. The Bukit Batok Integrated Dementia and Geriatric (IDG) network offers one example, bringing together GPs, community providers and grassroots organisations to support residents with complex social, medical and mental health needs. Such models of care enable earlier detection, smoother transitions, and more coordinated support for those in distress.

“This collaborative protocol ensures a seamless, integrated approach to supporting adults in distress, combining the strengths of community partners and specialised healthcare teams,” said Ms Megawati.

Breaking the silence around suicide

According to Ms Megawati, one of the biggest challenges in suicide prevention at the community level is the reluctance of residents to seek or accept help. This often stems from the stigma still attached to mental health issues. 

She believes the protocol’s emphasis on collaboration between NUHS, the primary care network, and community partners can help to normalise conversations around mental health.

“By fostering these partnerships and creating a more supportive environment, we aim to gradually reduce the stigma and encourage more people to seek help when they need it,” she said. Her message is clear: suicide is preventable, and no one should struggle alone.

In consultation with Dr Linus Chua, Medical Lead, NUHS RHSO; and Ms Megawati, Nurse Clinician, NUHS RHSO.