Risk assessment tools

Risk assessment tools are widely used in hospitals, but guidelines recommend that they should not be used to assess risk of suicide or further self-harm.

Below is one example of a common risk assessment tool, the Sad Persons Scale (Patterson et al 1983).

S – Sex
A – Age
D – Depression
P – Previous attempts
E – Ethanol abuse
R – Rational thinking loss
S – Social support lacking
O – Organised plan
N – No spouse
S – Sickness

Although risk assessment tools might be useful as a way to help structure or encourage a wider discussion of a person’s needs, they should not be used in isolation to decide who is most at risk, or who should receive further treatment or support. This is because risk assessment tools do not accurately predict future risk of self-harm or suicide.

Research studies have shown that tools are only accurate in their assessment of future risk in about 5% of cases, which mean that risk assessment tools fail to predict future risk 95% of the time.

In summary, the NICE guidelines on the management of self-harm state that:

• risk assessment tools and scales should not be used to predict future suicide or risk of future self-harm;
• risk assessment tools and scales should not be used to determine who should and should not be offered treatment and who should be discharged;
• risk assessment tools may, however, be considered to help structure, prompt, or add detail to a broader assessment.