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Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management
Open accessAbstract
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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“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]
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“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]
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“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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Metadata
- 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)
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2022-11
- Volume
- 9
- Issue
- 11
- Pages
- 922-928
- ISSN
- 2215-0366 (ISSN-L)
- 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
- bronze
- doi.org
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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