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NCISH / Resources / Implementing a personalised approach to risk / Risk assessment scales, categories and tools should not be used to predict suicide risk

Risk assessment scales, categories and tools should not be used to predict suicide risk 

IconMany risk assessment tools and scales categorise patients into high, medium or low risk to determine treatment options and predict suicide risk. However, the accuracy of many of these has been found to be poor. These scientific articles reflect the growing evidence that risk assessment tools and scales should not be used to predict suicide risk or to allocate treatment. 

Combinations of risk factors did not accurately identify those at greatest risk of further self-harm and suicide. Risk scales should have little role in the management of people who have self-harmed. 

Risk scales did not accurately predict repeat self-harm and suicide. Findings support existing clinical guidance not to use risk classification scales alone to determine treatment or predict future risk. 

Risk scales should not be used to determine patient management following self-harm or to predict self-harm. Most risk scales following self-harm performed no better than clinician or patient ratings of risk. Some performed considerably worse.  

Risk assessment scales should not be used to predict future suicidal behaviour or allocate treatment due to their limited accuracy. 

The limited sensitivity of risk assessment scales means that some low-risk patients might be deprived of treatment options, and will go on to die by suicide. 

Use of risk assessment scales or an over-reliance on identification of risk factors in clinical practice may provide false reassurance and is therefore potentially dangerous. Comprehensive assessments of adjustable risk factors and needs of each individual should be central to the management of people who have self-harmed. 

This review showed that no risk scales following self-harm perform sufficiently well in terms of diagnostic accuracy to be recommended for routine clinical use. Risk scales should only be used in addition to assessment. 

This study examined the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months. There was little consensus over the best instruments for risk assessment following self-harm.  

Suicide risk assessment in an individual is not precise but may be life-saving when undertaken alongside clinical action.  

As a large number of people who present to hospital following self-harm are assessed as being at low or moderate risk of repeat self-harm, restricting interventions only to people assessed as being at high risk would prevent fewer than one-fifth of repeat self-harm incidents. 

Standard approaches to suicide prevention concentrate on the rigorous assessment and management of suicidal risk. A more effective approach to reduce suicide rates is to offer a basic intervention to all those who have harmed themselves, and using clinical skills and risk assessment to identify high-risk individuals who might benefit from more intensive treatment. 

The University of Manchester