Some people using an emergency helpline for suicide prevention in Northern Ireland left the service still in severe distress, according to a report on its effectiveness.
The 24-hour Lifeline provides immediate help from experienced counsellors and can arrange therapies such as reflexology or refer clients to other service providers including social workers.
It helped decrease psychological upset in many cases and an evaluation for the Department of Health said most people had heard of it and accepted there was a need for it.
The report said: "Issues were highlighted in relation to some people leaving the service still in severe distress."
The 130-page Protect Life Evaluation Report compiled for the department by independent consultancy Moore Stephens highlighted the continued importance of frontline services in helping those in serious emotional distress.
It said long-term reduction of suicide required wide-ranging work addressing underlying social issues that contribute to increased risk.
Key evaluation recommendations said more evidence on the impact of Lifeline is needed and suicide prevention should be contained within a wider range of departmental strategies, while there is a need to refresh government and accountability structures.
Health Minister Edwin Poots said: "Despite my department having invested over £32 million in suicide prevention since 2006, the suicide rate has not fallen over this period. However, I have no doubt that lives have been saved and that a range of adverse social factors have impeded efforts to reduce the number of deaths."
The report said 72% of people had heard of the Lifeline helpline and 96% said there was a need for it.
It recorded that levels of psychological distress significantly decreased for clients between the first and final sessions and people attending counselling were significantly more likely to show improvement using psychological measures compared with those using complementary therapy.