A just released Kiwi study of ED suicide risk assessments found some major gaps – but psychological experts argue that building a relationship with the at-risk patient is more important than risk tools.
The study published in New Zealand Medical Journal today, examined 376 patient files of patients who underwent a suicide risk assessment at Waikato Hospital’s emergency department after attempting suicide. An NZMJ editorial was also published today reviewing the study and arguing that ongoing contact was probably more important than a perfectly-completed risk assessment tool.
The audit focused on how the standards in New Zealand Ministry of Health Clinical Practice Guideline for Deliberate Self Harm (DSH) were followed and found that clinicians routinely focused on the suicide attempt and failed to record judgements about future suicidal behaviours. The study, led by Waikato District Health Board psychiatry specialist Dr Wayne de Beer, also found that interactions with family members were recorded in less than half of the cases.
“The guideline most poorly adhered to was checking whether Maori patients wanted culturally appropriate services during the assessment and treatment planning, with this recorded in less than 10% of the clinical records.”
The authors recommended to improve the quality of suicide risk assessment that clinician training should be redeveloped to focus on cultural competence and training in confidentiality and privacy relating to an attempted suicide episode.
In a linked editorial in today’s NZMJ Dr Christopher Gale and Professor Paul Glue from the University of Otago’s Department of Psychological Medicine said the study highlighted the potential for clinical documentation not complying with guidelines, no matter how well written and practical the risk assessment tool was.
Reliance on current suicide risk assessment tools to predict future suicide lacks evidential support, they said.
“Given the current state of knowledge, ongoing contact is likely to make more difference to suicide death rates than a perfectly-completed risk assessment tool.”
This required adequate time to build a relationship and develop a plan for the patient, which should be the basis for treatment, the pair said.
However, they also noted that building therapeutic relationships and developing a treatment plan to recognise future suicidality is more time-consuming for doctors and was more complex than any assessment tool.
“In the future, developing robust interventions for patients presenting with suicidal ideation and deliberate self harm might be a more appropriate focus for research than screening for suicide risk without such an intervention being readily available.”
WHERE TO GET HELP:
If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE: