Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment.
OBJECTIVE
The authors, in collaboration with NSW Health, have recently developed a comprehensive suicide risk assessment framework. The present paper describes key concepts in the assessment of suicide risk by mental health professionals.


METHODS
A framework for conducting a comprehensive suicide risk assessment was derived from the literature, incident analysis and clinical experience. The framework underwent a consultation process involving clinicians in NSW area mental health services. The aim was to provide clinicians with a standardized conceptual map for the assessment of suicide risk. A MEDLINE search was conducted for publications dealing with 'suicide' and 'suicide risk assessment' from 1980 to 2002. The recommendations from sentinel event reviews conducted in a NSW area mental health service in the period 1999-2002 were reviewed. The lessons from a visit to a coroner's relatives support group for people who had been bereaved by suicide also informed the development of the guidelines.


RESULTS
A framework is proposed for the assessment of suicide risk. The framework promotes a reflective style of practice, encouraging clinicians to evaluate their assessment and its limitations. Risk assessment is always undertaken as part of a full clinical assessment and an evaluation of the person's current predicament and psychosocio-cultural context. The concepts of changeability, assessment confidence, common sense and the importance of corroboration are incorporated in the framework.


CONCLUSIONS
Mental health clinicians can be guided by a framework in suicide risk assessment and documentation. The assessment of suicide risk can generate a suicide risk rating for which minimum standards of care can be mandated.
O'Connor
Nick
N
Area Mental Health, Macquarie Hospital, North Ryde, NSW, Australia. noconnor@doh.health.nsw.gov.au
Warby
Monica
M
Raphael
Beverley
B
Vassallo
Tony
T
D002983:Clinical Competence / Q000592:standards*; D003419:Crisis Intervention / Q000639:trends; D003430:Cross-Sectional Studies; D003617:Dangerous Behavior; D003661:Decision Support Techniques; D006801:Humans; D015994:Incidence; D007406:Interview, Psychological / Q000592:standards; D016013:Likelihood Functions; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D009517:New South Wales; D010348:Patient Care Team / Q000592:standards*; D010817:Physician-Patient Relations; D011336:Probability; D012017:Referral and Consultation / Q000592:standards*; D018570:Risk Assessment / Q000639:trends; D013405:Suicide / Q000523:psychology / Q000639:trends; D000092864:Suicide Prevention