{"id":5476,"date":"2024-10-28T10:09:15","date_gmt":"2024-10-28T10:09:15","guid":{"rendered":"https:\/\/sites.manchester.ac.uk\/ncish\/?page_id=5476"},"modified":"2026-04-29T09:17:49","modified_gmt":"2026-04-29T08:17:49","slug":"risk-scales","status":"publish","type":"page","link":"https:\/\/sites.manchester.ac.uk\/ncish\/resources\/implementing-a-personalised-approach-to-risk\/risk-scales\/","title":{"rendered":"Risk assessment scales, categories and tools should not be used to predict suicide risk"},"content":{"rendered":"<p>[et_pb_section bb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; fullwidth=&#8221;on&#8221; next_background_color=&#8221;#000000&#8243; global_module=&#8221;322&#8243;][et_pb_fullwidth_menu global_parent=&#8221;322&#8243; _builder_version=&#8221;3.0.106&#8243; menu_id=&#8221;7&#8243; submenu_direction=&#8221;downwards&#8221; fullwidth_menu=&#8221;off&#8221; background_layout=&#8221;dark&#8221; module_class=&#8221;main-navigation&#8221; \/][\/et_pb_section][et_pb_section bb_built=&#8221;1&#8243; 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specialty=&#8221;on&#8221; parallax_method_1=&#8221;off&#8221; parallax_method_2=&#8221;off&#8221; _builder_version=&#8221;3.0.74&#8243; transparent_background=&#8221;off&#8221; prev_background_color=&#8221;#000000&#8243; next_background_color=&#8221;#1d1d1d&#8221;][et_pb_column type=&#8221;1_3&#8243;][et_pb_sidebar admin_label=&#8221;Left Nav Sidebar&#8221; area=&#8221;et_pb_widget_area_1&#8243; show_border=&#8221;off&#8221; module_id=&#8221;left-nav-menu&#8221; _builder_version=&#8221;3.0.74&#8243; remove_border=&#8221;on&#8221;]<\/p>\n<p><\/p>\n<p>[\/et_pb_sidebar][\/et_pb_column][et_pb_column type=&#8221;2_3&#8243; specialty_columns=&#8221;2&#8243;][et_pb_row_inner admin_label=&#8221;Row&#8221; _builder_version=&#8221;3.0.47&#8243;][et_pb_column_inner type=&#8221;4_4&#8243; saved_specialty_column_type=&#8221;2_3&#8243;][et_pb_text admin_label=&#8221;Text: Risk assessment scales, &#8221; _builder_version=&#8221;3.17.6&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; module_alignment=&#8221;left&#8221; use_border_color=&#8221;off&#8221;]<\/p>\n<h1>Risk assessment scales, categories and tools should not be used to predict suicide risk\u00a0<i><\/i><\/h1>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5463 alignright\" src=\"https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2024\/10\/evaluation-300x300.png\" alt=\"Icon\" width=\"58\" height=\"58\" srcset=\"https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2024\/10\/evaluation-300x300.png 300w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2024\/10\/evaluation-150x150.png 150w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2024\/10\/evaluation-250x250.png 250w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2024\/10\/evaluation-350x350.png 350w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2024\/10\/evaluation.png 512w\" sizes=\"(max-width: 58px) 100vw, 58px\" \/>Many 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.<\/p>\n<p>Probabilistic suicide risk prediction tools should be approached with caution. Consideration should be given to the clinical and ethical implications of using these in clinical settings. Individualised therapeutic assessments should remain the key intervention for individuals who have self-harmed or are experiencing suicidal ideation.<\/p>\n<ul>\n<li><span class=\"x_elementtoproof\"><a href=\"https:\/\/www.cambridge.org\/core\/journals\/the-british-journal-of-psychiatry\/article\/clinicians-guide-to-probabilistic-suicide-risk-prediction-tools-cautions-and-pitfalls\/08CB3EAFBE49EFFC2CE5C2D9D16D70E1\" title=\"https:\/\/www.cambridge.org\/core\/journals\/the-british-journal-of-psychiatry\/article\/clinicians-guide-to-probabilistic-suicide-risk-prediction-tools-cautions-and-pitfalls\/08CB3EAFBE49EFFC2CE5C2D9D16D70E1\">A<\/a><a href=\"https:\/\/www.cambridge.org\/core\/journals\/the-british-journal-of-psychiatry\/article\/clinicians-guide-to-probabilistic-suicide-risk-prediction-tools-cautions-and-pitfalls\/08CB3EAFBE49EFFC2CE5C2D9D16D70E1\" title=\"https:\/\/www.cambridge.org\/core\/journals\/the-british-journal-of-psychiatry\/article\/clinicians-guide-to-probabilistic-suicide-risk-prediction-tools-cautions-and-pitfalls\/08CB3EAFBE49EFFC2CE5C2D9D16D70E1\"> clinician\u2019s guide to probabilistic suicide risk prediction tools: cautions and pitfalls<\/a><\/span><span class=\"x_elementtoproof\"><span>\u00a0(The British Journal of Psychiatry, 2025)<\/span><\/span><\/li>\n<\/ul>\n<div>\n<p class=\"x_MsoNormal\"><span class=\"x_elementtoproof\"><span>Current machine learning algorithms are not accurate enough to identify\u00a0<\/span><\/span><span class=\"x_elementtoproof\"><span>individuals<\/span><\/span><span class=\"x_elementtoproof\"><span>\u00a0at high risk of self-harm or suicide to\u00a0<\/span><\/span><span class=\"x_elementtoproof\"><span>be a<\/span><\/span><span class=\"x_elementtoproof\"><span>llocate<\/span><\/span><span class=\"x_elementtoproof\"><span>d\u00a0<\/span><\/span><span class=\"x_elementtoproof\"><span>treatment. Psychosocial assessments focused on modifiable risk factors and individual needs remain best practice for those who have self-harmed.<\/span><\/span><span><\/span><\/p>\n<\/div>\n<div>\n<ul>\n<li class=\"x_MsoNormal\"><span>\u00a0<span class=\"x_elementtoproof\"><a href=\"https:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1004581\" title=\"https:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1004581\">Machine learning algorithms and their predictive accuracy for suicide and self-harm: Systematic review and meta-analysis<\/a><\/span><span class=\"x_elementtoproof\">\u00a0(PLoS Medicine, 2025)<\/span><\/span><\/li>\n<\/ul>\n<\/div>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.cambridge.org\/core\/journals\/bjpsych-open\/article\/accuracy-of-individual-and-combined-riskscale-items-in-the-prediction-of-repetition-of-selfharm-multicentre-prospective-cohort-study\/FDACB46661DE987A20D257055F0D3704\">Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study<\/a> (BJPsych Open, 2021)<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/bmcpsychiatry.biomedcentral.com\/articles\/10.1186\/s12888-018-1693-z\">Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data<\/a>\u202f(BMC Psychiatry, 2018)<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.cambridge.org\/core\/journals\/the-british-journal-of-psychiatry\/article\/predictive-accuracy-of-risk-scales-following-selfharm-multicentre-prospective-cohort-study\/891CE425C05B32429AF140C2A8571719\">Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study<\/a> (The British Journal of Psychiatry, 2017)<\/li>\n<\/ul>\n<p>Risk assessment scales should not be used to predict future suicidal behaviour or allocate treatment due to their limited accuracy.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.cambridge.org\/core\/journals\/the-british-journal-of-psychiatry\/article\/predicting-suicidal-behaviours-using-clinical-instruments-systematic-review-and-metaanalysis-of-positive-predictive-values-for-risk-scales\/607579323D765FF9F36ED1A2D1D45C83\">Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales<\/a>\u202f(British Journal of Psychiatry, 2017)<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.bmj.com\/content\/359\/bmj.j4627\">Can we usefully stratify patients according to suicide risk?<\/a>\u202f(BMJ, 2017)<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.cambridge.org\/core\/journals\/the-british-journal-of-psychiatry\/article\/predicting-suicide-following-selfharm-systematic-review-of-risk-factors-and-risk-scales\/C9D595168EDF06401A823E2E968915E1\">Predicting suicide following self-harm: systematic review of risk factors and risk scales<\/a> (British Journal of Psychiatry, 2016)<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/bmjopen.bmj.com\/content\/6\/2\/e009297\">Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy<\/a>\u202f(BMJ Open,\u202f2016)<\/li>\n<\/ul>\n<p>This study examined the association between the use of a risk scale and measures of service quality and repeat self-harm within 6\u2005months. There was little consensus over the best instruments for risk assessment following self-harm.<\/p>\n<ul>\n<li><a href=\"https:\/\/bmjopen.bmj.com\/content\/4\/5\/e004732\">Scales for predicting risk following self-harm: An observational study in 32 hospitals in England<\/a> (BMJ Open, 2014)<\/li>\n<\/ul>\n<p>Suicide risk assessment in an individual is not precise but may be life-saving when undertaken alongside clinical action.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.bmj.com\/content\/347\/bmj.f4572\">Assessing risk of suicide or self-harm in adults<\/a> (BMJ, 2013)<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.bmj.com\/content\/330\/7488\/394\">Predicting the risk of repetition after self-harm: cohort study<\/a> (BMJ, 2005)<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.cambridge.org\/core\/journals\/psychiatric-bulletin\/article\/against-a-highrisk-strategy-in-the-prevention-of-suicide\/C7128AAA570F93581022E36225576CA4\">Against a high-risk strategy in the prevention of suicide<\/a> (Psychiatric Bulletin, 1998)<\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_divider _builder_version=&#8221;3.17.6&#8243; \/][et_pb_text admin_label=&#8221;Text: NIHR text&#8221; _builder_version=&#8221;3.17.6&#8243; saved_tabs=&#8221;all&#8221;]<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-7830\" src=\"https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310.png\" alt=\"\" width=\"356\" height=\"86\" srcset=\"https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310.png 1280w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310-300x73.png 300w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310-768x186.png 768w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310-1024x248.png 1024w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310-150x36.png 150w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310-250x61.png 250w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310-350x85.png 350w, https:\/\/sites.manchester.ac.uk\/ncish\/wp-content\/uploads\/sites\/31\/2026\/04\/NIHR-2026_1280x310-1080x262.png 1080w\" sizes=\"(max-width: 356px) 100vw, 356px\" \/><\/p>\n<p><i><span>This work was completed as part of the\u00a0<a title=\"https:\/\/www.rcpsych.ac.uk\/improving-care\/nccmh\/culture-of-care-programme\" href=\"https:\/\/www.rcpsych.ac.uk\/improving-care\/nccmh\/culture-of-care-programme\">Culture of Care Programme<\/a>. The work was supported by\u00a0the\u00a0<a title=\"https:\/\/www.psrc-gm.nihr.ac.uk\/\" href=\"https:\/\/www.psrc-gm.nihr.ac.uk\/\">National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC)<\/a>\u00a0(Grant Reference Number NIHR204295). Leah Quinlivan is fully funded by the NIHR GM PSRC, Pauline Rivart was part funded by the NIHR GM PSRC, and Professor Nav Kapur is part funded by the NIHR GM PSRC. \u00a0The views expressed on this webpage are those of the authors and not necessarily those of NICE, NIHR, NHS, or the UK Department of Health and Social Care.<\/span><\/i><\/p>\n<p class=\"x_MsoNormal\">\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][\/et_pb_column][\/et_pb_section][et_pb_section bb_built=&#8221;1&#8243; admin_label=&#8221;Connect Title&#8221; module_class=&#8221;footer-section&#8221; _builder_version=&#8221;3.0.90&#8243; background_color=&#8221;#1d1d1d&#8221; custom_padding=&#8221;0px||0px|&#8221; prev_background_color=&#8221;#ffffff&#8221; global_module=&#8221;380&#8243;][et_pb_row admin_label=&#8221;row&#8221; global_parent=&#8221;380&#8243; parallax_method_1=&#8221;off&#8221; parallax_method_2=&#8221;off&#8221; parallax_method_3=&#8221;off&#8221; module_id=&#8221;footer-row&#8221; _builder_version=&#8221;3.0.89&#8243; 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However, the accuracy of many of these has been found to be poor. These scientific articles reflect the [&hellip;]<\/p>\n","protected":false},"author":12,"featured_media":0,"parent":5435,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_exactmetrics_skip_tracking":false,"footnotes":""},"class_list":["post-5476","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/pages\/5476","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/comments?post=5476"}],"version-history":[{"count":14,"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/pages\/5476\/revisions"}],"predecessor-version":[{"id":7867,"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/pages\/5476\/revisions\/7867"}],"up":[{"embeddable":true,"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/pages\/5435"}],"wp:attachment":[{"href":"https:\/\/sites.manchester.ac.uk\/ncish\/wp-json\/wp\/v2\/media?parent=5476"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}