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Cited by 196Suicide and Self-Harm StudiesPsychiatric care and mental health servicesPsychopathy, Forensic Psychiatry, Sexual Offending

Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management

Open access
Hawton, Keith, Lascelles, Karen, Pitman, Alexandra, Gilbert, Steve, Silverman, Morton·2022·The Lancet Psychiatry
DOI 10.1016/s2215-0366(22)00232-2
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Abstract

Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians' preoccupation with risk prediction, which can have negative effects on patient care and also on clinicians where prediction is seen as failing. The model of therapeutic risk assessment, formulation, and management we outline in this article regards all patients with mental health problems as potentially at increased risk of suicide. It is aimed at reducing risk through use of a person-centred approach. We describe how a move towards therapeutic risk assessment, formulation, and risk management, including collaborative safety planning, could help clinicians develop a more tailored approach to managing risk for all patients, incorporating potentially therapeutic effects as well as helping to identify other risk reduction interventions. Such an approach could lead to enhanced patient safety and quality of care, which is more acceptable to patients.

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Crossref · 10.1016/s2215-0366(22)00232-2

Cites

67 of 67 references verified0 citation errors · 0 not checkable

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Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Healthcare service design and provision too often relies on practices that ignore or minimize the basic interpersonal aspects of care and thus fail to capitalize on their potential.

    “However, healthcare service design and provision too often relies on practices that ignore or minimize the basic interpersonal aspects of care and thus fail to capitalize on their potential [2, 3].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [2]

    In “Drivers of the continuing preoccupation with suicide risk prediction” (page not provided), the paper says that pressure to document and stratify risk has grown at the expense of building a therapeutic alliance. “Therapeutic risk assessment and formulation” describes the potential benefit of an empathetic clinician–patient encounter. These passages support the point for suicide-risk assessment in mental health practice, but not the claim about healthcare service design and provision generally. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • A more thorough assessment with a clinician can have therapeutic value, particularly in engaging adolescents in treatment.

    “A more thorough assessment with a clinician can have therapeutic value, 96 particularly in engaging adolescents in treatment.”

    From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [96]

    The ‘Therapeutic risk assessment and formulation’ section says that a thoughtful clinician–patient assessment can build therapeutic rapport and affect patient engagement and recovery. The ‘Patients’ experience of risk assessment’ section also describes therapeutic benefits. The paper does not specifically say that this approach is particularly valuable for engaging adolescents in treatment; its conclusion describes applicability across age groups. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Finding meaningful ways to respond to service users in suicidal crises presents an ongoing challenge for health services internationally.

    “Yet finding meaningful ways to respond to service users in suicidal crises presents an ongoing challenge for health services internationally [2–4].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [2]

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Authors
Hawton, K., Lascelles, K., Pitman, A., Gilbert, S., & Silverman, M.
Affiliations
  • Oxford Health NHS Foundation Trust (GB)
  • University College London (GB)
  • Medical College of Wisconsin (US)
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2022-11
Volume
9
Issue
11
Pages
922-928
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(22)00232-2
OpenAlex
W4298159159
Semantic Scholar
a878d9367a25aae908dc8d4297cffd649a094150
Cited by
196
References
68
Citations by year
2026: 51 · 2025: 61 · 2024: 44 · 2023: 34 · 2022: 6
FWCI
6.05
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
suicide risk assessment, suicide prevention, risk management, clinical formulation, person-centred care, risk prediction, mental health services, patient safety
MeSH terms
Suicide Prevention, Humans, Mental Health, Risk Management, Risk Assessment, Patient Safety

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