Women nurses are mentioned once in the NHS England suicide prevention toolkit, in a section headed, ‘Gender’: ‘female nurses have a 23% higher rate of suicide than other women’, (NHS England, 2023b, p9) yet, despite the presentation of this startling fact, there is no further attention paid specifically to women nurses throughout the document. There is a small section that focuses on nurses as a whole group with the higher suicide rate explained as being due to a combination of factors including:

Causation is suggested as three factors, firstly, extra and extended shifts. The use of the term ‘mounting pressure’ suggests an expectation that nurses ‘step up’ to fill vacant shifts. As such, a systemic issue becomes a moral responsibility for individual nurses to resolve. Secondly, ‘psychological pressures’ linked to ‘patient dependence’. It is not clear whether this is a judgement on the level of patient need and nurses’ ability to respond. However, there is a further judgement in the term ‘self-imposed’, thus we understand ‘the problem’ as the nurse’s response to patient dependence, with any attribution to occupational factors obscured. An alternative reading might speak of the emotional labour that nurses typically employ to meet patient demands (Hochschild, 2003; Riley and Weiss, 2016). Thirdly, the nurse’s ‘lack of engagement’ with Mental Health support. Two reasons are stated, firstly ‘fears of job insecurity’, identifying the problem as being the nurse’s fear; secondly, ‘collegial failure’ is described as ‘perceived’, again responsibilising the nurse. We could alternately recognise the psychological pressures of patient dependence as being a rational response to a difficult situation; we could position a lack of engagement, job insecurity and collegial failure all as a systemic, procedural, economic, political or cultural issues operating within teams, across hierarchies and beyond the NHS. In re-positioning these factors, we shift the focus away from the individual nurse, toward the spheres of organisational culture, economics and politics, that is, the contexts in which the nurse is working.

The document also examines the ‘risks’ that underlie female doctors’ increased rates of suicide:

There is a stark contrast in the language used, the phrase, ‘exposure to factors’, immediately locates the ‘risk’ outside the individual practitioner. The moralising descriptors used for nurses; ‘self-imposed’, ‘fear’, ‘lack of engagement’, ‘perceived’, are absent in for doctors. The doctor is positioned in ‘close proximity’ to a traumatising and highly stressful work environment, which is presented as a reasonable explanation for increased rates of suicide. The nurse, however, who works in the same environment, is positioned as being a ‘risky’ person, due to poor coping strategies and an inability to self-regulate and self-care. The differential positioning of doctors and nurses has been documented over the decades. Stein (1967), coined the phrase, ‘the doctor-nurse game’, whereby nurses have lower status and are expected to act deferentially to doctors (Essex et al., 2023). This can affect communication including the ability to speak up and can have ‘substantial person costs’ (Essex et al., 2023, p1), on the wellbeing of practitioners in less powerful positions. In the case of the NHS Suicide Prevention Toolkit, it is evident in the tones of language that are applied to nurses compared to doctors.

The differential moral tone applied to nurses versus doctors is consistent with gendered power relations with nurses positioned as lacking self-discipline, whereas doctors are depicted as exposed to external stressors. Foucauldian analysis highlights how power operates productively, not only constraining, but actively producing subjects who internalise organisational expectations (e.g., invulnerability, perfection, composure). Riley et al. (2019) note that neoliberal postfeminist sensibility normalises a “normal-perfection” for women that is unattainable yet demanded, intensifying self-surveillance and blame when distress surfaces. In this way, policy discourse codes feminine care work as personal failure rather than institutional responsibility.

By way of explaining the higher rate of suicide among women nurses and health-workers, NHS England attribute this to:

Health workers are more likely to use poisoning as a means of suicide than the general population. For instance, 43% of women nurses who die by suicide use self-poisoning compared to 29% of women in the general population (NCISH, 2024). This statistic underpins the statement made above in the NHS suicide prevention guidance (NHS England, 2023b). It is important however, to explore the context of the statistic, as such, in the case of women nurses who were also mental health patients:

A contradiction exists between the use of prescribed medication for this purpose and the statement in the NHS England guidance, that health-workers have ‘easy access to lethal drugs’, inferring that drugs are obtained unethically and illegally from the workplace for the means of suicidal activity. However, the unauthorised procurement of hospital medication by staff for personal use would not be a simple process (CQC, 2022). The suicidal nurse, rather than receiving support at a time of distress and personal crisis, is framed as a ‘risk’ to security processes.

Framing women nurses’ suicides as a consequence of specialised knowledge or means is a classic individualising move that obscures how workplace regimes (staffing, disciplinary exposure, moral injury) and biopolitical governance shape vulnerability. A Foucauldian perspective would treat “means” not as a personal moral deficit but as an artefact of institutional arrangements, while postfeminist healthism explains how women workers are incited to privatise distress and manage it silently to remain the “good” professional.

The use of statistics to underpin this narrative is problematic for a number of reasons. It excludes a qualitative narrative, and any exploration of why this is a problem; exploration of the underlying issues that lead to suicidality is absent; health-workers who die by other means of suicide are also absent from this construction. Focusing on the behaviours of individuals who are already suicidal ignores the contextual factors that may contribute toward suicidality. Thus, opportunities for understanding to inform solutions are missing. Finally, this explanation situates the problem within members of the workforce, ignoring the workplace.

The NHS Suicide prevention toolkit is entitled, ‘working together to prevent suicide in the NHS workforce’ (NHS England, 2023b, title page), and aims to:

By constructing nurse suicide as a ‘workforce’ rather than a ‘workplace’ problem, attention is directed toward individual nurses rather than toward work environments, practices, cultures and systems. This presents two problems. First, the workforce is seen as a ‘homogenous whole’, rather than as the most diverse it has ever been (NHS England, 2025). Therefore, multiple contexts relating to social, cultural, historic and economic experiences are overlooked; as are workplace experiences such as bullying and violence, and power imbalances. Second, as workplace issues are unidentified and unaddressed, individual staff who die by suicide are seen as wholly responsible for their own deaths, which are constructed as unconnected to the workplace context (unless the means of death were illicitly obtained drugs, as mentioned above). The opportunity to understand the abundant and nuanced experiences that exist within the workforce, and their relation to suicidality, is missed.

Two related concepts are present in the NHS documents that focus attention on the individual worker and are presented as potential solutions to not only suicide, but also other issues, such as staff retention and staff sickness. They are ‘a mentally healthy workforce’ and ‘improving personal health and wellbeing’. A ‘mentally healthy workforce’ (rather than workplace) is introduced in the NHS suicide prevention toolkit (NHS England, 2023b), as a strategy for suicide prevention. The concept is defined as:

Read through Foucauldian ideas regarding governmentality, “healthy culture” checklists operate as soft governance which effectively means codifying “what good looks like” so workers govern themselves and each other (peer surveillance; “noticing” colleagues) (Riley et al., 2019). Riley et al. (2019) have shown how self-care is repackaged as moral duty within postfeminist healthism, re-legitimising scrutiny of women’s bodies and emotions under the banner of health and exporting organisational burdens onto individual workers. This subtly recasts structural harm as personal compliance, leaving workload, hierarchy and discrimination untouched.

The ‘fostering of a positive culture’ sounds like a good strategy in supporting employee wellbeing. However, the focus is on individual behaviours and actions and looking after the wellbeing of each other. Responsibility is not clarified so we do not know if some of these instructions are for employers or whether staff are being instructed in self-care. The paternalistic promotion of behaviours such as saying thank you and being kind as a route toward improving staff wellbeing feels somewhat simplistic and very patronising given that care-work is a gendered and undervalued profession, currently operating in an organisation that is under-funded, under-staffed, and operating with a workforce that continues to experience the impact of trauma following the pandemic (Maben et al., 2022; Conolly et al., 2024). The suggestion of team away days and development within a ‘healthy work environment’ also feels at odds with the current workforce and resource crises within the organisation. The desired outcome is stated as being a strengthening of team relationships, however there is no evidence is provided to underpin the assumption that stronger team relationships prevent suicide.

The NHS ‘Elements of health and wellbeing’ document (NHS England, 2021) focuses on the concept of ‘Improving personal health and wellbeing’ (pp 6–19) as one of seven strategies that together will create a ‘healthy workplace culture’. Positioning this as the first section in the document suggests it is viewed as a priority by the authors, and again responsibilises the workforce with the task of generating change in the workplace. Thirteen pages focus on educating the health workforce in how to stay physically and mentally healthy. This section has twice as much ‘page space’ as any of the other six sections, including those on ‘the workplace environment’ and the ‘role of managers and leaders’. Subheads in this and other sections include: ‘Healthy lifestyle’; ‘Bringing your whole self to work’; ‘Supporting each other’; and ‘Life balance’. Two themes run through the document, firstly, a focus on the positive and important impact that following the suggested actions will have on colleagues and patients. Secondly, a repeated theme of ‘what does good look like’, where expectations for optimum behaviours are set out for staff. Thus, the document centres on the premise that individual staff members are responsible for changing their behaviour and practice in prescriptive ways to improve the experiences of others.

Just as the ‘problem’ of nurse suicide is positioned within the workforce, so is potential solution. The NHS Suicide prevention toolkit (NHS England, 2023b) asserts that staff be made aware of those people who are at higher risk of dying by suicide and have awareness of the ‘signs’ of suicidal ideation or behaviour, to be ready to provide support or crisis intervention to their colleagues. There is no debate in the document about whether colleagues are the best placed people to raise concerns with each other about suspected suicidal behaviour, or warning signs. In fact, training for staff members is suggested (although not compulsory) via a Zero Suicide online 20-min video training (Zero Suicide Alliance, 2024) which is assumed to give staff members the skills needed to have conversations about suicidality with each other. In this way individuals within workforces can be viewed as social actors in their own policing with organisational policies dictating behavioural norms to create individual compliance in these acts of surveillance. This is reminiscent of Foucault’s ideas regarding technologies of power which govern human conduct at a distance and are frequently embodied in the form of technologies of the self in which human beings seek to regulate their conduct (Arribas-Ayllon and Walkerdine, 2017: 118).

A list of ‘signs’ that a person may be struggling (NHS England, 2023b) is organised by ‘changes in productivity; changes in social functioning; changes in personality or behaviour’ (p9). Thus, the onus is on the ‘struggling’ individual to demonstrate their vulnerability within a culture that prizes invulnerability and legitimises organisational rules regarding emotions (or ‘feeling rules’, Hochschild, 2003; Kirk et al., 2021). The responsibility is also on colleagues to notice these changes and to initiate a conversation exploring them. Reliance on a list of ‘signs’ as a preventative tool is ‘risky’ for two reasons. First, nurses are operating in a ‘patient first’ culture and are noted for their tendency to put the care of others before their own needs. It is likely, with these deeply valued professional traits (Jackson et al., 2021) that nurses will in fact hide any signs of personal struggle to comply with the expectations of their role in a work environment that busy, stressful and under-resourced (Kinman and Leggetter, 2016). In fact, a key element of nursing, intense contact with patients and delivery of compassionate care, has been shown to involve emotional labour, the performing of managed emotions to ease the fear and distress of others (patients), whilst hiding their own emotions (Hochschild, 2003). This privatisation of feelings is a form of self-regulation; possibly a response to the expectation that nurses should be ‘invulnerable’, or to the stigma of expressing emotion in the workplace. The outcome is that distress remains unseen, leading to a lack of recognition and support for the emotional and physical demands of the job. Secondly, placing the onus on colleagues to be able to observe signs of suicidality in their colleagues within a fast-paced and stressful work environment feels unachievable. We question whether nurses have the time and capacity to monitor and respond to the wellbeing needs of their colleagues? Significant silences in this narrative include debates around the emotional burden of listening to the wellbeing struggles of colleagues; the ethical dilemmas that might be presented about how to respond, who to tell, and how to keep their colleague safe; the moral distress that might be experienced if the response to a raised concern does not align with the staff members hopes or beliefs about best next steps; the conflicts of interest between giving attention or energy to the burdens of colleagues when there are patients who need time and attention; the power imbalances that leave nurses feeling unable to raise concerns about anything within work places (Jones and Kelly, 2014); or, simply, the stigma associated with, and the skill and delicacy needed when, talking about suicide.

As noted, certain groups within the workforce are identified (or labelled) as ‘risky’ in terms of suicidality. It is possible that individual staff may be singled out as ‘at risk of suicide’ and become subject of surveillance (and gossip) within their team. Such instances may allow established prejudices to be validated, or may lead to scapegoating, bullying, stigma, discrimination, racism and the denial of development and career opportunities. In responsibilising staff for their colleagues’ wellbeing, they may feel burdened with the responsibility of any staff suicides that do occur. The outcome of a colleague’s death by suicide in the NHS can include a sense of having ‘missed the signs’, of having let their colleague down, intense guilt and failure, and complex anger (Conolly et al., 2024).

The concept that suicide is everybody’s business runs through the included documents. The ‘everybody’s business’ narrative is prevalent in national suicide prevention policy, and the messaging of suicide prevention and suicide awareness organisations (Samaritans, 2025). The England suicide prevention strategy states:

This concept is underpinned by a number of strategies, including that everyone should have access to training and support; that there is ‘no wrong door’, a concept that proposes no matter who you turn to for support, that you will receive support (NHS England, 2024b); provision of workplace mental health and wellbeing support; and the idea of a ‘national conversation’, ‘using appropriate language, to nurture a sense of responsibility, to reduce shame and stigma’ (Department of Health and Social Care, 2023, p64). The assumption is that individuals and organisations could affect, through behaviours, language and policy, a reduction in the rates of suicide.

Training staff to recognise “signs” and initiate peer interventions exemplifies technologies of the self (Arribas-Ayllon and Walkerdine, 2017) embedded within participatory surveillance with colleagues enlisted to monitor productivity, affect and comportment as indicators of risk. This reproduces a culture where visibility and confession are prerequisites for care, conditions women are culturally discouraged from meeting (Riley et al., 2019).

In Scotland the concept of ‘everybody’s business’ is again employed (COSLA: The Scottish Government and the Convention of Scottish Local Authorities, 2022). Here the ‘everybody’ refers to partners in the NHS, social care, public health, criminal justice and education. The vision includes promotion of ‘awareness, understanding, knowledge and skills’ (COSLA: The Scottish Government and the Convention of Scottish Local Authorities, 2022, p27) in order to enable these workers to be proactive in suicide prevention. What is unsaid is that these groups of professionals are already carrying the burden for delivering their own remit in sectors that are underfunded and understaffed. Additionally, these are the same workers who are tasked with identifying other sets of signs and symptoms that are also ‘everybody’s business’, for instance, in safeguarding (Local Government Association, 2023). These professionals become overburdened with not only their own remit but carrying shared responsibility for everybody else’s remits too.

The notion of ‘everybody’s business’ is explicit in the NHS suicide prevention toolkit (NHS England, 2023b):

The strategies of employing staffs’ observations of each other, and the expectation that they will address concerns with each other are underpinned by this concept. It might be argued that this feels like a covert screening programme. An important question that goes unasked, and therefore unaddressed across all these documents is, does ‘everybody’s business’ result in suicide prevention being ‘nobody’s job’?