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Abstract
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RE:
Hawton K Lascelles K Pitman A Gilbert S Silverman M
Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management.
Lancet Psychiatry. 2022; (published online Aug 8.)
https://doi.org/10.1016/S2215-0366(22)00232-2
The Personal View by Hawton and colleagues summarises challenges associated with suicide risk assessment in mental health settings and argues for a shift away from risk prediction towards a focus on therapeutic risk assessment, collaborative formulation, and risk reduction. Each of the points raised have clear parallels to violence risk assessments (VRAs), which are valuable to highlight.
Hawton and colleagues suggest that suicide risk prediction, whether through the use of clinical judgment or structured risk tools, is ineffective. Ineffectiveness is inferred from studies showing poor predictive accuracy of risk judgements (when suicides occur in people previously judged to be either at low or high risk. Although some VRA tools fare better--showing statistically significant associations between predictions and future violence with future violence--most validation research pertains to the diagnostic, rather than prognostic, accuracy of these tools. Although frequently cited, significant area under the curve values, which reflect good discrimination between people who have already experienced an event and people who have not, do not indicate that a risk assessment instrument can identify individuals at high risk prospectively.
If, instead of predictive accuracy, efficacy is taken to reflect clinical utility--ie, whether assessment tools can reduce risk, avert harm, and promote recovery--there is little to no evidence of this type of value in research regarding suicide or violence.
This type of research is difficult to do but necessary to justify the large amount of clinical and research efforts that go into risk assessment activities...
Language: en |