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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
In a Personal View published in August, 2022, Hawton and colleagues show the predictive limits of suicide risk assessment and call for a more comprehensive and therapeutic approach to assessing, formulating, and managing risk of suicide. Their article critiques risk prediction (risk assessment) and offers an alternative, described as "therapeutic risk assessment and formulation". We believe that the authors' criticisms of risk assessment are not comprehensive enough and that the solution they suggest--assessing suicide risk using their own list of risk factors--has the same inherent flaws as other methods.
Hawton and colleagues overlook what we see as the primary problem. They focus on three difficulties with suicide risk assessment: the limitations of clinical judgment about suicide; the unreliability of self-reports of suicidal ideation; and the poor performance of suicide risk scales. Although all these criticisms are valid, risk assessment could still be a viable way of stratifying groups of people at different likelihoods of suicide if there were a range of risk factors that could be used to usefully define risk categories. However, none exist.
Language: en |