Suicide risk: structured professional judgement

Abstract

Patient risk factors for suicide are well known to psychiatrists, yet the availability of clinically useful, routine and systematic methods for risk recognition are limited. This article outlines the structured professional judgement approach to suicide risk assessment and management. This method combines psychiatric assessment and formulation with the evidence base for suicide risk factors. Structured professional judgement is contrasted with actuarial and clinical judgement approaches. A categorisation of risk factors is presented, with four groups described – static, stable, dynamic and future. Case histories illustrate long-term high risk contrasted with sudden and unpredictable onset of suicidality.

Long-Term Suicide Risk in Forensic Psychiatric Patients

“…Forensic services have understandably concentrated on risk to others and the use of risk assessments systems such as the HCR-20 (Webster, Douglas, Eaves et al, 1997) have been widely adopted. The risks of suicide in this patient group are substantial and similar approaches, such as that advocated by Bouch and Marshall's (2005) Suicide risk: structured professional judgment, should be considered as part of routine forensic practice.…”

Suicide prevention: are we doing enough?

“…The assessment is multidisciplinary and mainly used in forensic settings. (Bouch 2003(Bouch , 2005 et al (2007) emphasise that even brief training is sufficient to make significant improvements in attitudes towards suicidal patients. In December 2008, the House of Lords ruled that, under the European Convention on Human Rights, healthcare providers have a particular duty to protect mentally ill patients who are at risk of suicide from harming themselves (Savage v South Essex Partnership NHS Foundation Trust 2008).…”

Risk Assessment and Manage- ment of Violence in Patients with Mental Disorders: A Re- view

“…Risk assessment was redefined as "the process of identifying and studying hazards to reduce the probability of their occurrence [55]". This indicates a shift from prediction to the prevention of offending [56,57].…”