Psychological Medicine, 2000, 30, 805–812. Printed in the United Kingdom " 2000 Cambridge University Press An educational intervention for front-line health professionals in the assessment and management of suicidal patients (The STORM Project) L.APPLEBY, " R. MORRISS, L.GASK, M.ROLAND, B.LEWIS, A. PERRY, L.BATTERSBY, N.COLBERT, G.GREEN, T.AMOS, L.DAVIES  B. FARAGHER From the School of Psychiatry and Behavioural Sciences, Withington Hospital and Department of Community Psychiatry, Royal Preston Hospital, National Primary Care Research and Development Centre, Department of Postgraduate Medicine and Dentistry, and Research Support Unit, Medical School, University of Manchester ; and Centre for Health Economics, University of York ABSTRACT Background. Suicide prevention is a health priority in many countries. Improved management of suicide risk may improve suicide prevention. This study aimed to assess the feasibility of health district-wide training in the assessment and management of people at risk of suicide ; and to assess the impact of training on assessment and management skills. Methods. Staff in three health care settings, namely primary care, accident and emergency departments and mental health services (N fl 359), were offered suicide risk management training in a district-wide programme, using a flexible ‘ facilitator ’ approach. The main outcomes were the rate of attendance at training, and changes in suicide risk assessment and management skills following training. Results. It was possible to deliver training to 167 health professionals (47 % of those eligible) during a 6 month training period. This included 95 primary care staff (39 %), 21 accident and emergency staff (42 %) and 51 mental health staff (78 %). Of these, 103 (69 %) attended all training. A volunteer sample of 28 staff who underwent training showed improvements in skills in the assessment and management of suicide risk. Satisfaction with training was high. The expected costs of district-wide training, if it were able to produce a 2–5 % reduction in the suicide rate, would be £99 747 per suicide prevented and £3391 per life year gained. Conclusions. Training in the assessment and management of suicide risk can be delivered to approximately half the targeted staff in primary care, accident and emergency departments and mental health services. The current training package can improve skills and is well accepted. If it were to produce a modest fall in the suicide rate, such training would be cost-effective. However, a future training programme should develop a broader training package to reach those who will not attend. INTRODUCTION There is little research evidence linking any health service intervention with a fall in suicide rates. An educational programme on the " Address for correspondence : Professor Louis Appleby, School of Psychiatry and Behavioural Sciences, University of Manchester, Withington Hospital, Manchester M20 8LR. Swedish island of Gotland in the mid-1980s found that, following training for general practitioners in the identification and treatment of depression, the local suicide rate fell (Rutz et al. 1989) but the study can be criticized because the fall in suicide, which was not a hypothesis, was small and could have resulted from random fluctuation. It could also be argued that any training intervention designed to reduce suicide 805