Inaccurate suicide risk assessments could be putting lives at risk says RCPsych

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The Royal College of Psychiatrists is urging mental health providers to phase out the use of “fundamentally flawed” suicide risk assessments in England and Wales as soon as possible. 

Mental health teams have traditionally used ‘tick box’ suicide risk assessments to evaluate how likely a patient is, to try and take their own life. However, studies show these risk assessments fail many, categorising 80-90% as “no risk” or “low risk”. Many therefore potentially miss out on life-saving support.

The College is concerned these assessments are still being used by mental health teams despite new guidelines from the National Institute of Health and Care Excellence (NICE) in September 2022. The guidelines warned clinicians should “not use risk assessment tools and scales to predict future suicide”.

On World Suicide Prevention Day, the Royal College of Psychiatrists is calling on mental health services to ensure that every patient presenting with suicidal thoughts, or who has engaged in self-harm, is provided with a good psychosocial assessment and a structured dynamic clinical formulation that includes a co-produced Safety Plan. A Safety Plan is an agreed set of activities, strategies, people and organisations that a person can rely on if they become suicidal or if their suicidal feelings increase. Evidence suggests they are effective at supporting people with suicidal thoughts.

NHS mental health services will also need additional funding and resources if they are to move away from suicide risk assessments more quickly.

Dr Rachel Gibbons, Chair of the Royal College of Psychiatrists’ Patient Safety Group, said:

“With more than 100,000 registered deaths by suicide over the last 20 years, it’s crucial that mental health services do all they can to train staff to therapeutically work with those in suicidal distress.

“Good therapeutic clinical care is very likely to reduce the chance of suicide by supporting patients to put their painful feelings into words. This helps them tolerate and understand their distress and reduces the chance of action.

“Every year over 5,000 people die from suicide, yet only one in four have been in contact with mental health services. As well as there being a real need to improve access to care it’s also essential that we all learn to approach others in distress and develop confidence in emotional engagement.

“As clinicians, we know every patient is a unique individual who will benefit from personalised care and safety plans which are tailored to their specific needs as this will help in recovery.

“Despite new guidance being issued last year, we believe these changes are not being implemented quickly enough due to a lack of funding and support. The Government must provide NHS mental health services with additional resources so that they can provide staff with more training to transition away from suicide risk assessments.”