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assessment of suicide risk
Suicide risk assessment is ethically complex: the concept of "imminent suicide" (implying the foreseeability of an inherently unpredictable act) is a legal construct in a clinical guise, which can be used to justify the rationing of emergency psychiatric resources or intrusion into patients' civil liberties. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions.〔Barker, P. (2003). Psychiatric and Mental Health Nursing: ''The craft of caring''. Pg 230. New York, NY; Oxford University Press Inc.〕
==In practice==
There are risks and disadvantages to both over-estimation and under-estimation of suicide risk. Over-sensitivity to risk can have undesirable consequences, including inappropriate deprivation of patients’ rights and squandering of scarce clinical resources. On the other hand, underestimating suicidality as a result of a dismissive attitude or lack of clinical skill jeopardizes patient safety and risks clinician liability. Some people may worry that asking about suicidal intentions will make suicide more likely. In reality, regarding that the enquiries are made sympathetically, it does not.〔Gelder, Mayou, Geddes (2005). Psychiatry: Page 170. New York, NY; Oxford University Press Inc.〕 Key areas to be assessed include the person's predisposition to suicidal behavior; identifiable precipitant or stressors such as job loss, recent death of a loved one and change of residence;〔Seaward 2006〕 the patient’s symptomatic presentation; presence of hopelessness; nature of suicidal thinking; previous suicidal behavior; impulsivity and self-control; and protective factors.
Suicide risk assessment should distinguish between acute and chronic risk. Acute risk might be raised because of recent changes in the person's circumstances or mental state, while chronic risk is determined by a diagnosis of a mental illness, and social and demographic factors. Bryan and Rudd (2006) suggest a model in which risk is categorized into one of four categories: Baseline, Acute, Chronic high risk, and Chronic high risk with acute exacerbation.〔 Risk level can also be described as Nonexistent, Mild, Moderate, Severe, or Extreme, and the clinical response can be determined accordingly.
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