Background Despite various national initiatives and a strong mental health care system, the number of suicides in the Netherlands and Flanders has not changed as hoped. Aim To provide insight into the current suicide prevention policy in the Netherlands and Flanders, and the evidence on their effectiveness. Method Discussion of universal, selective and indicated prevention initiatives, and of the evidence for the various initiatives, based on the use of reviews and meta-analysis. Results There is a national suicide prevention agenda in both the Netherlands and Flanders. It is difficult to demonstrate the direct effect of the various initiatives on national suicide rates, because of the low base rate, and because of its multiple causes. Conclusion There are little evidence for suicide prevention strategies. This does not mean suicide prevention has no use, but modesty seems in place. Key words evaluation, policy, RCT, suicide prevention Tijdschrift voor Psychiatrie 63(2021)2, 133-137