Letters
Mental health
Volume 199 - Issue 8

Suicide risk assessment: where are we now?

Authors:  Christopher J Ryan, Matthew M Large and Sascha Callaghan

Med J Aust 2013; 199 (8): 534. || doi: 10.5694/mja13.10840
Published online: 21 October 2013
In reply: It is not possible to usefully divide patients who present in psychological crisis into those at higher or lower risk of eventual suicide. Categorising patients in this way cannot assist in determining their management. Acknowledging this, Gordon and Melvin speculate that it might be possible to usefully divide such patients into those at higher or lower risk of eventual suicide attempt. That seems unlikely. ...
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In reply: It is not possible to usefully divide patients who present in psychological crisis into those at higher or lower risk of eventual suicide. Categorising patients in this way cannot assist in determining their management.

Acknowledging this, Gordon and Melvin speculate that it might be possible to usefully divide such patients into those at higher or lower risk of eventual suicide attempt. That seems unlikely. The risk factors for suicide attempt are different, but the problems with risk categorisation remain much the same. Certainly, there is no study demonstrating that suicide attempt risk assessment reduces the overall prevalence of future attempts.

Gordon and Melvin wonder about legal liability and suggest we offer no “meaningful alternative” to pointless risk assessment; we disagree. In our editorial,1 we reinforced the importance of careful clinical assessment, individualised management, and communication and negotiation with the patient and family. Undertaking this level of care, and documenting it, is a practitioner’s best defence in any future legal matter. Indeed, denying treatment on the basis of a risk assessment that indicates a patient is at low risk, when clinical factors indicate that treatment would be beneficial, could itself be a source of liability.

Authors

  • Christopher J Ryan1,2
  • Matthew M Large3
  • Sascha Callaghan2
  • 1. Discipline of Psychiatry, University of Sydney, Sydney, NSW.
  • 2. Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW.
  • 3. School of Psychiatry, University of New South Wales, Sydney, NSW.

Correspondence: christopher.ryan@sydney.edu.au

Competing interests

Matthew Large has received speaker fees from AstraZeneca.

References

View this article on Wiley Online Library