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Risk Assessment

Brown, G.S., Jones, E.R., Betts, E. & Jingyang, W. (2003). “Improving suicide risk assessment in a managed-care environment”. Crisis, 24, pp. 49-55.

An informative paper that discusses the important role that patient assessment of suicide risk may play in clinician’s assessment and management of risk. Outlines some of the important legal and social contexts within which risk is currently managed, and provides an example of one way in which risk assessment is being managed within the US.

Cochrane-Brink, K.A., Lofchy, J.S. & Sakinofsky, I. (2000). “Clinical rating scales in suicide risk assessment”. General Hospital Psychiatry, 22, pp. 445-451.

Examines some of the factors that influence the efficacy of clinical risk assessment tools. Is limited by the fact that it focuses primarily on tools related to suicide and mental health, but does usefully outline the problems with assessing people in crisis, the difference between self administered and interview based assessments, and the importance of population-specific assessment tools.

* Duffy, David & Ryan, Tony (Eds) (2004). New approaches to preventing suicide: A manual for practitioners. London: Jessica Kingsley Publishers

“Written by front line professionals in the fields of nursing, mental health, prison services and the law, this text is an essential companion to the [British] government’s new suicide prevention strategy. The contributors offer a wealth of practical guidance on issues such as risk assessment and management in a range of settings, policy and the legal framework around suicide.”

Frierson, R.L., Melikian, M. & Wadman, P.C. (2002). “Principles of suicide risk assessment: How to interview depressed patients and tailor treatment”. Postgraduate Medicine, 112, pp. 65-71.

Outlines the important role that general practitioners may play in identifying suicide risk. Acknowledges the pressures of time that exist within the consultation framework, and provides a number of relatively simple checks and responses to suicide risk. Suggests that interviews are important rather than simply checklists, and also suggests that ‘suicide contracts’ are not particularly useful in most cases.

Harriss, L. & Hawton, K. (2005). “Suicidal intent in deliberate self-harm and the risk of suicide: The predictive power of the Suicide Intent Scale”. Journal of Affective Disorders, 86, pp. 225-233.

Suggests that this particular scale, whilst able to provide important information about suicidal intent, does not actually predict suicide accurately. This points towards the fact that, like other such scales, they are useful in risk assessment, but ultimately cannot provide health professionals with clear cut answers to questions of risk.

LaRicka, R., Wingate, M.S., Joiner, T.E., Walker, R.L., Rudd, M.D. & Jobes, D.A. (2004). “Empirically informed approaches to topics in suicide risk assessment”. Behavioral Sciences and the Law. 22, pp. 651-665.

Reports a number of factors that increase suicide risk: 1) history of (often multiple) attempts to suicide and having plans (rather than having desire), 2) ‘acquired capability’ to enact lethal self-harm, sense of being a burden, and lack of sense of belonging or connectedness. Suggests that self-reports may often be more reliable than clinician’s reports.

McPherson, A. (2005). “An overview of the assessment tools available to mental health professionals to help determine patients at risk of suicide”. The International Journal of Psychiatric Nursing Research, 10, pp. 1129-1142.

Provides a summary of a small number of available assessment tools and their efficacy for use in assessing suicide. Draws attention to the importance of assessing both facts (i.e., previous suicide attempts) and feelings, and the need to include family members in assessments. Highlights the potential limitations for using positivist approaches to understanding the subjective meanings of suicide, and that health professionals need to supplement assessment tools with knowledge gained in the consultation environment.

Packman, W.L., Marlitt, R.E., Bongar, B. & O’Connor Pennuto, T. (2004). “A comprehensive and concise assessment of suicide risk”. Behavioral Sciences and the Law, 22, pp. 667-680.

Outlines some of the ways in which the values and beliefs of health professionals in regard to suicide and death may influence their ability to assess risk. In particular, this will be influenced by level of experience with suicidal clients, personal views and moralities on suicide, acceptance of death, and type of training. This suggests that it is important for practitioners to consult with colleagues in regard to risk assessment if possible/needed.

Range, L.M. & Knott, E.C. (1997). “Twenty suicide assessment instruments: Evaluation and recommendations”. Death Studies, 21, pp. 25-58.

Proposes three useful types of suicide assessments: (a) clinician-rated suicide instruments, (b) self rated suicide instruments, (c) self -rated buffers against suicide. Suggests that it is important to recognise that the type of scale used will be contingent on whether the aim is to measure risk or to screen for risk.

Rogers, R. (2000). “The uncritical acceptance of risk assessment in forensic practice”. Law and Human Behavior, 24, pp. 595-605.

Whilst relating primarily to risk assessment within forensic psychology, this paper usefully draws attention to the problems that may arise from focusing solely on risk factors to the exclusion of protective factors. Such a focus may fail to adequately assess risk, and thus assign the label of at-risk-for-suicide to individuals to whom this label is not warranted.

Saunders, B. & Goddard, C. (1998). A critique of structured risk assessment procedures: Instruments of abuse? Victoria: Australian Childhood Foundation.

An excellent critique of risk assessment in the context of child protection. Raises important points around: how risk assessment may individualise, the privileging of risk over protective factors, the categorising of risk around singular factors, the changing status of risk, and the ways in which risk assessment may be used to manage accountability. Outlines how risk assessment may be understood as complementing other approaches to understanding risk and in combination with a broader system push towards institutional change.

Schulberg, H.C., Hyg, M.S., Bruce, M.L., Lee, P.W., Williams, J.W. & Dietrich, A.J. (2004). “Preventing suicide in primary care patients: The primary care physician’s role”. General Hospital Psychiatry, 26, pp. 337-345.

Draws attention to the high numbers of people who access health services and consult with primary care providers prior to suicide, often either in the same week or month. This suggests that triggers may well be evident within the consultation, and should prompt primary care providers to assess for suicide risk. Proposes that there is a great need for increased training and awareness around risk assessment.