Suicide prevention has become one of the defining public health priorities of our time, making Preventing Suicide: An Evidence-Based Approach both timely and ambitious. Written by an impressive international group of contributors, the book sets out to synthesise contemporary evidence and advocate for effective suicide prevention at clinical, societal and policy levels. Its central themes, that suicide is a major public health issue, that prevention requires both clinical and population-based approaches, that culture and social organisation influence suicide rates and that suicide has an important human rights dimension, are difficult to dispute. These chapters provide a broad and valuable overview of the field.

The book is at its strongest when it moves beyond mental health services to consider the wider determinants of suicide. Chapters on national suicide prevention strategies, media influences, substance use, decriminalisation of suicide in Ghana and practical clinical approaches are thoughtful and engaging. Particularly welcome is the repeated acknowledgement, in later chapters, that the evidence for many suicide prevention interventions remains limited and that post-implementation evaluation is often neglected because of political pressures. This willingness to recognise uncertainty gives these chapters both credibility and nuance.

My reservations concern the tone established in the opening chapters. The repeated assertion that suicide is not inevitable and that every suicide represents a potentially avoidable death risks overstating what current evidence can support. Rejecting therapeutic nihilism is important, but there is a distinction between resisting fatalism and claiming a level of certainty that the science has yet to achieve. Suicide remains a complex, deeply personal and often unknowable phenomenon. Framing every death as potentially preventable may unintentionally increase the burden carried by bereaved families and clinicians by implying that responsibility must always lie somewhere.

At times the evidence base also feels less robust than the title promises. The discussion of ligature-point reduction, for example, relies heavily on older evidence despite this being a rapidly evolving area of practice that urgently requires contemporary evaluation and cost–benefit analysis. Similarly, the chapter on male suicide presents an interesting theoretical perspective but appears to rely more on the author’s own conceptual framework than on a broad synthesis of the literature.

Interestingly, the book becomes stronger as it progresses. The early emphasis on mental health services gradually broadens into a richer discussion of social determinants, public health, culture and inequality. In doing so, it avoids reducing suicide to a purely psychiatric problem and instead acknowledges the wider contexts in which suicidal behaviour occurs.

Overall, this is an important, thought-provoking and often stimulating contribution to the suicide prevention literature. I did not agree with all of its underlying assumptions, but perhaps that is one of its greatest strengths. It provokes reflection about what we know, what we merely assume and how humility about the limits of our knowledge may itself be an essential component of compassionate, evidence-based suicide prevention.