Skip to main content
×
×
Home

Suicide risk: structured professional judgement

  • Joe Bouch and John James Marshall
Abstract

Patient risk factors for suicide are well known to psychiatrists, yet the availability of clinically useful, routine and systematic methods for risk recognition are limited. This article outlines the structured professional judgement approach to suicide risk assessment and management. This method combines psychiatric assessment and formulation with the evidence base for suicide risk factors. Structured professional judgement is contrasted with actuarial and clinical judgement approaches. A categorisation of risk factors is presented, with four groups described – static, stable, dynamic and future. Case histories illustrate long-term high risk contrasted with sudden and unpredictable onset of suicidality.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Suicide risk: structured professional judgement
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Suicide risk: structured professional judgement
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Suicide risk: structured professional judgement
      Available formats
      ×
Copyright
References
Hide All
Amsel, L. & Mann, J.J. (2001) Suicide risk assessment and the suicidal process approach. In Understanding Suicidal Behaviour: The Suicidal Process Approach to Research, Treatment and Prevention (ed. van Heeringen, K.) pp. 163181. Chichester: John Wiley & Sons.
Appleby, L. (2000) Prevention of suicide in psychiatric patients. In The International Handbook of Suicide and Attempted Suicide (eds Hawton, K. & van Heeringen, K.) pp. 617630. Chichester: John Wiley & Sons.
Baldessarini, R. J., Tondo, L., Faedda, G. L. et al (1996) Effects of the rate of discontinuing lithium maintenance treatment in bipolar disorders. Journal of Clinical Psychiatry, 57, 441448.
Bertolote, J. M., Fleischmann, A., Leo, D. D. et al (2003) Suicide and mental disorders: do we know enough? British Journal of Psychiatry, 183, 382383.
Bouch, J. & Marshall, J. J. (2003) Suicide – Risk Assessment and Management Manual (S–RAMM). Research Edition. Dinas Powys, Vale of Glamorgan: Cognitive Centre Foundation.
Bridgett, C. & Polak, P. (2003a) Social systems intervention and crisis resolution. Part 1: Assessment. Advances in Psychiatric Treatment, 9, 424431.
Bridgett, C. & Polak, P. (2003b) Social systems intervention and crisis resolution. Part 2: Intervention. Advances in Psychiatric Treatment, 9, 432438.
Clark, S. E. & Goldney, R. D. (2000) The impact of suicide on relatives and friends. In The International Handbook of Suicide and Attempted Suicide (eds Hawton, K. & van Heeringen, K.) pp. 467484. Chichester: John Wiley & Sons.
Clark, D. C. & Horton-Deutsch, S. L. (1992) Assessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides. In Assessment and Prediction of Suicide (eds Maris, R. W., Berman, A. L., Maltsberger, J. T. et al), pp. 144182. New York: Guilford Press.
Davies, S., Naik, P. C. & Lee, A. S. (2001) Depression, suicide and the National Service Framework. BMJ, 322, 15001501.
De Hert, M. & Peuskens, J. (2000) Psychiatric aspects of suicidal behaviour: schizophrenia. In The International Handbook of Suicide and Attempted Suicide (eds Hawton, K. & van Heeringen, K) pp. 121134. Chichester: John Wiley & Sons.
Department of Health (2001) Safety First. Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Department of Health.
Douglas, K. S., Cox, D. N. & Webster, C. D. (1999) Violence risk assessment: Science and practice. Legal and Criminological Psychology, 4, 149184.
Duggan, A., Warner, J., Knapp, M. et al (2003) Modelling the impact of clozapine on suicide in patients with treatment-resistant schizophrenia in the UK. British Journal of Psychiatry, 182, 505508.
Dvoskin, J. A. & Heilbrun, K. (2001) Risk assessment and release decision making: toward resolving the great debate. Journal of the American Academy of Psychiatry and Law, 29, 610.
Grove, W. M. & Meehl, P. E. (1996) Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: the clinical statistical controversy. Psychology, Public Policy and Law, 2, 293323.
Hart, S. D. (1998) The role of psychopathy in assessing risk for violence: conceptual and methodological issues. Legal and Criminological Psychology, 3, 123140.
Hawton, K., Appleby, L., Platt, S. et al (1998) The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders, 50, 269276.
Lord Hutton (2004) Report of the Inquiry into the Circumstances Surrounding the Death of Dr David Kelly C.M.G. (The Hutton Inquiry). London: Stationery Office. http://www.thehutton-inquiry.org.uk/content/report/index.htm.
Jacobs, D. G., Brewer, M. & Klein-Benheim, M. (1999) Suicide assessment: an overview and recommended protocol. In The Harvard Medical School Guide to Suicide Assessment and Intervention (ed. Jacobs, D. G.) pp. 339. San Francisco, CA: Jossey-Bass.
Kapur, S., Mieczkowski, T. & Mann, J. J. (1992) Anti-depressant medications and the relative risk of suicide attempt and suicide. Journal of the American Medical Association, 268, 34413445.
Lonnqvist, J. K. (2000) Psychiatric aspects of suicidal behaviour: Depression. In The International Handbook of Suicide and Attempted Suicide (eds Hawton, K. & van Heeringen, K) pp. 107120. Chichester: John Wiley & Sons.
Meltzer, H. Y. & Okayli, G. (1995) Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk–benefit assessment. American Journal of Psychiatry, 152, 183190.
Menzies Lyth, I. (1988) The functioning of social systems as a defence against anxiety. In Containing Anxiety in Institutions, pp. 4385. London: Free Association Books.
Monahan, J. (1981) Predicting Violent Behaviour: An Assessment of Clinical Techniques. Beverly Hills, CA: Sage
Monahan, J. (1996) Violence prediction: the last 20 and the next 20 years. Criminal Justice and Behaviour, 23, 107120.
Morselli, H. (1881) Suicide: An Essay on Comparative Moral Statistics. London: Kegan Paul.
Power, A. C. & Cowen, P.J. (1992) Fluoxetine and suicidal behaviour. Some clinical and theoretical aspects of a controversy. British Journal of Psychiatry, 161, 735741.
Scottish Executive (2000) Report of the Committee on Serious Violent and Sexual Offenders. Edinburgh: Scottish Executive.
Smith, R. (2003) Editor's choice: No spitting, no smoking. BMJ, 327, 0 [ sic].
Tondo, L., Jamison, K. R. & Baldessarini, R.J. (1997) Effect of lithium maintenance on suicidal behavior in major mood disorders. Annals of New York Academy of Science, 836, 340351.
Tondo, L., Baldessarini, R. J., Hennen, J. et al (1998) Lithium treatment and risk of suicidal behaviour in bipolar disorder patients. Journal of Clinical Psychiatry, 59, 405414.
Webster, C. D. & Bailes, G. B. (2004) Assessing violence risk in mentally and personality disordered individuals. In The Essential Handbook of Offender Assessment and Treatment (ed. Hollon, C. R.) Chichester: John Wiley & Sons.
Webster, C. D., Douglas, K. S., Eaves, D. et al (1997) HCR–20: Assessing Risk for Violence. Burnaby: Mental Health Law and Policy Institute, Simon Fraser University.
World Health Organization (1996) World Health Statistics Annual, 1995. Geneva: WHO.
World Health Organization (2001) World Health Report, 2001: Mental Health: New Understanding, New Hope. Geneva: WHO.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 40 *
Loading metrics...

Abstract views

Total abstract views: 205 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 22nd April 2018. This data will be updated every 24 hours.

Suicide risk: structured professional judgement

  • Joe Bouch and John James Marshall
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *