Suicide risk assessments: Why are we still relying on these a decade after the evidence showed they perform poorly?

Abstract

Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.

Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study

“…Counselors used a structured approach to conversations about suicidality and self-harm behavior with the intention of focusing on intervention with the young person and not as a risk screening tool, in line with recent evidence [ 22 ]. Counselors had conversations about suicidality using a person-centered approach by listening, understanding, empathizing, and helping the young person find solutions they could connect with in a meaningful way.…”

“…By having these conversations in a web-based, confidential environment, young people’s concerns about the consequences of disclosure in a face-to-face context can be minimized [ 45 ]. By moving away from risk assessment for the purpose of risk classification, the associated consequences of being classified in a certain way are removed, for example, being deemed low-risk and therefore not eligible for treatment [ 22 , 46 ]. LFT facilitated a real movement toward understanding the distress leading to suicidality and strategies to mitigate that distress instead of focusing on assessing the “risk” of future self-harm and suicide alone.…”

“…Traditionally, risk assessment involves asking a person about suicidal thoughts, their frequency and intensity, and the intent, plan, and access to means to act on these thoughts [ 21 ]. Risk assessment to classify levels of suicide risk has been demonstrated to have no discernible ability to predict the future risk of engaging in suicidal behavior [ 22 ]. However, services continue to use risk assessment to determine treatment access, which is not only invalidating for service users [ 23 ] but also allows clinicians to fixate on a classification of severity instead of engaging in compassionate, person-centered conversation.…”

Young people and adult stakeholders' reflections on how school staff should support students who self‐harm: A qualitative study

“…Participants also spoke of using the likelihood of a student self‐harming or dying by suicide to determine how to respond. This is particularly concerning, given that research has clearly shown that the categorization of risk for prediction and treatment planning is futile and potentially harmful, with some receiving invasive and unhelpful treatment while others are left without support (Carter et al, 2017; Fortune & Hetrick, 2022; Graney et al, 2020; Kessler et al, 2020).…”