The results of a trial of cognitive behaviour therapy, supportive counselling and treatment as usual in recent onset schizophrenia on suicide behaviour are reported. Treatment was delivered over a five week period during hospitalisation for an acute episode. Participants were assessed at baseline, 6 weeks, 3 and 18 months. Over the 18 months there were 3 definite suicides and 2 deaths by accidental causes. The rates of moderate to severe suicidal behaviour were 13% at admission, 4% at six weeks, 1.5% at three months and 6% at 18 months. There were no beneficial or adverse effects of psychological treatment on suicide behaviour that reduced significantly with clinical recovery. There is a general picture of those who suffer persistently higher levels of psychotic symptoms, poorer functioning, depression and low self-esteem have higher severity of suicide behaviour, although the numbers with clinically significant suicide behaviour are low. CBT may need to be modified to directly target suicide behaviour and its antecedents to significantly reduce risk; recommendations on this are made.