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The role of health professionals in assessing suicide risk 

ReportAssessing the risk of repeat self-harm and suicide is a clinical intervention with many factors to be considered. These papers review the differing approaches to suicide risk assessment.  

This editorial reviews the 2022 National Institute for Health and Care Excellence (NICE) clinical guideline for self-harm, and includes new recommendations for primary care and how they can be implemented in practice. 

Each health professional has an important role in suicide prevention, whether by sensitively assessing or treating self-harm, or advocating for the implementation of suicide prevention measures. Attempting to predict suicide is unlikely to be helpful. 

People who did not report previous self-harm were less likely to be referred to psychiatric services, though they had similar rates of repeat self-harm. This emphasises the need for careful assessment of every self-harm presentation to emergency departments. 

When self-harm assessments by nurses and psychiatrists were compared, there was strong agreement on factors associated with high risk assessment. This supports the provision of nurse-led assessment services.  

However, inpatient admission was influenced primarily by assessor type (such as nurses or psychiatrists) rather than patient characteristics. This has important implications for equity of care and may reflect professional differences in referral practices. 

Management of self-harm may be improved by shifting the views of professionals, involving users in staff training, and changing service provision – perhaps moving from risk assessment to personalised needs assessment. 

Training for emergency doctors should emphasise the importance of considering both immediate and background risk factors in assessment of suicide risk. 

Psychiatrists should have knowledge of different perspectives of risk to deal more effectively with risks that are an inherent part of clinical practice. 

The University of Manchester