Suicide Prevention Webinar Series

Second Webinar: Risk Assessment in Suicide

Introduction

• Focus on risk assessment in relation to suicide.
• Importance of discussing suicide and reflecting on practices to provide the best care.
• Acknowledgement of the difficult nature of the topic.
• Support resources mentioned: Support After Suicide, staff wellbeing hub.

Speakers

• Professor Keith Horton: Center for Suicide Research.
• Alexandra Pittman: Consultant Psychiatrist, University College London, specializes in suicide and self-harm research.
• Steve Gilbert: Experience with mental illness, Vice Chair for Mental Health Act Review, involvement with National Suicide Prevention Alliance.

Risk Assessment in Suicide

• Professor Keith Horton:
  • Discussed a paper on therapeutic risk assessment, formulation, and management.
  • Highlighted challenges of suicide risk prediction in clinical practice.

Key Points from Keith's Presentation

• Suicide Statistics in England:
  • About 5,000 suicides per year; 25-30% had contact with psychiatric services in the year before death.
• Challenges in Prediction:
  • Suicide risk prediction is largely ineffective.
  • Studies show that many who die by suicide were previously assessed at low risk.
  • Suicidal thoughts are often brief and fluctuate.

Studies and Evidence

• Retrospective assessments often identify risk inaccurately.
• Short duration of suicidal thoughts prior to attempt.
• Limitations of risk scales; poor predictive value.

Recommendations

• Shift from Prediction to Management:
  • Move focus from prediction to therapeutic assessment and management.
  • Population approach to reduce overall risk.

Dynamic Risk Formulation

• Alexandra Pittman:
  • Emphasis on dynamic risk formulation over static prediction.
  • Focus on establishing a therapeutic alliance and understanding patient-specific factors.

Risk Factors Framework

• Predisposing Factors and Strengths:
  • Consideration of modifiable factors influencing distress.
  • Anticipate changes in a patient’s situation that could alter their risk.

Safety Planning

• Safety Plan Structure:
  • Identify triggers and early warning signs.
  • Steps for distraction, support contact, and professional help.
  • Importance of tailored, written plans.

Evidence of Effectiveness

• Safety planning reduces suicidal ideation and behavior.

Involving Relatives and Collaborative Approaches

• Importance of involving relatives with consent to provide support.
• Advantages include gaining additional insights and collaborative care.

Therapeutic Relationship

• Focus on empathy and individualized care.
• Emphasizing the importance of connection over transactional approaches.

Steve Gilbert's Experience

• Shared personal experience with mental health care and suicidal crises.
• Highlighted importance of connection, trust, and not feeling like a transaction.

Q&A and Reflections

• Discussion on challenges in practice, such as balancing care and risk management.
• Need for systemic support, training, and infrastructure to enable effective care.
• Future webinars to address specific challenges in practice.

Conclusion

• Acknowledgment of the importance of human connection and empathy in suicide prevention.
• Future sessions to cover more specific issues and practical dilemmas in care.