According to research published today in the BMJ, the current system of categorising a patient's suicide risk isn't effective.
Co-author of the report, Associate Professor Christopher Ryan from the University of Sydney, says the current procedures of classifying patients into high, medium or low-risk categories doesn’t assist suicide prevention.
“The research tells us that we should not be trying to categorise people presenting to doctors in crisis by their likelihood of suicide. This is because there is no way of accurately categorising people into those at higher or lower risk of attempting suicide,” he says.
“The difference in risk is so small that labeling people as high or low risk can’t possibly be helpful in managing them. In fact, it may be dangerous to do this, since it can provide false reassurance – under most of these risk categorisations, more people will suicide in the “low risk” group than in the high risk group.”
According to the report, categorising doesn’t provide enough information about the likelihood of future suicide to guide clinical practice. The researchers found nearly half of all patients who die by suicide come from the lower-risk group while only five per cent of high-risk patients will suicide in the long term.
Associate Professor Ryan says that a patient’s issues should be addressed on an individual basis with a personalised treatment program.
“No one should be dismissed as low risk because there is no useful way of making that distinction. Compared to everyone else in the community, all such people are at a very high risk. All need to be listened to and carefully assessed to try to best understand what underlies their desperate state of mind.
“All need their doctors to work with them to come up with unique solutions to their problems. Since there is no way of identifying high risk individuals everyone should get the best possible care and treatment. The best way of limiting the chance of suicide is to understand people and work with them on solutions which are backed up by evidence,” says Professor Ryan.
The research was completed with the University of New South Wales, the University of Newcastle and the University of Manchester.
Dr Christopher Ryan is Clinical Associate Professor in Psychiatry at the University of Sydney’s Westmead Clinical School. He is also Director of Consultation-Liaison Psychiatry at Sydney's Westmead Hospital and an Associate of Sydney Health Ethics.