Part 1: Supporting the Reduction of Suicide in the General Population of Wales via the use of Structured Professional Judgement; Part 2: Identifying the Factors Moderating Suicidal Thoughts and Suicide Attempts During the COVID-19 Pandemic

Abstract

Early identification of individuals at risk of suicide represents a crucial component of effective suicide prevention. However, many of the current suicide risk assessment procedures are limited in their ability to identify and prevent future suicide attempts. This thesis aimed to investigate whether the structured professional judgement approach was an effective method of suicide risk assessment within an accident and emergency department. Chapter 1 outlined the major challenges facing the field of suicide risk assessment and introduced the structured professional judgement approach to risk assessment. Chapter 2 reviewed the various methods used to assess the risk of suicide within accident and emergency services, evaluated the efficacy of the structured professional judgement approach and outlined the new structured professional judgement scheme, the Risk of Suicide Protocol, that was investigated in this thesis. Chapter 3 compared the Risk of Suicide Protocol and assessment as usual in their ability to identify future suicide attempts in 107 participants referred for a suicide risk assessment with the accident and emergencybased Psychiatric Liaison Team. Chapter 3 also evaluated the inter-rater reliability of the Risk of Suicide Protocol, with two independent assessors completing assessments on the same 12 patients. Chapter 7 reviewed the research relating to the RoSP and discussed the wider meaning and clinical implications of the findings. The findings demonstrated that risk judgements made using the Risk of Suicide Protocol were significantly better at identifying future suicide attempts compared to assessment as usual. Additionally, the risk judgements made using the Risk of Suicide Protocol demonstrated excellent inter-rater reliability. These results indicate that the Risk of Suicide Protocol is a valid and reliable assessment for the structured clinical evaluation of suicide risk within an accident and emergency department. Overall, this thesis demonstrates that the Risk of Suicide Protocol represents a valuable method for the evaluation of suicide risk and may offer an important solution to some of the challenges facing the field of suicide risk assessment.