The objective of the study was to find out the existing practices of assessment and care of suicidal people at the primary level - primary health care, schools, and ambulance and ED. The study is applied research resulting in a comprehensive proposal for improving treatment and support system for suicidal people.

The study employed a mixed-methods approach. A survey (N=571) and semi-structured qualitative individual interviews (N=40) were conducted in 2022 in Estonia with primary level healthcare professionals, school support service providers, and emergency responders regarding their experiences, perceptions, and needs.

Findings revealed a consensus among participants on the critical importance of suicide prevention, alongside widespread acknowledgment of inadequate preparedness and resources.

The absence of standardized protocols and assessment tools compounded challenges in suicide risk assessment across sectors, while networking initiatives were perceived as fragmented and ineffectual. Sometimes it´s not clear, which specialist is eventually responsible for a suicidal person, although it´s important that the patient moves smoothly from one specialist to another.
The need for uniform suicide risk assessment tools is big and they are currently used (e.g. ASQ, BSSA, C-SSRS) only by a few specialists. The awareness is greater of non-specific general mental health questionnaires and scales and less of those that specifically assess the severity of suicide risk. The ED and ambulance staff members use assessment tools less frequently than others, although their contact with suicidal persons is the most frequent and their pace of work is fast. Health care professionals use mostly free form interviews, but specialists with less experience would like to use different assessment tools.
The current system is ineffective and highly unequal across regions, and largely health care oriented. The biggest burden of treatment of suicidal persons falls on ED and ambulance, which are overburdened by their other tasks.
The initial assessment of suicide risk is currently often conducted by psychiatrists and at the primary level practice is rather poor. Improvement of early recognition and treatment at the primary level would relieve psychiatrists of patient loads. It´s crucial to adapt, validate, expand the use of specific suicide risk assessment tools. In addition, effective follow-up, safety planning and cross-disciplinary case management are essential.