Suicide Prevention Techniques by Joy Hibbins

Author:Joy Hibbins
Language: eng
Format: epub
ISBN: 9781784509491
Publisher: Jessica Kingsley Publishers
Published: 2018-10-23T16:00:00+00:00

— CHAPTER 6 —

ASSESSING RISK ACCURATELY

Our ability to assess risk accurately is vital and is the result of a combination of factors which include our formal training in risk assessing, our knowledge of the client, attention to detail, and the consideration of all relevant information.

FORMAL TRAINING IN ASSESSING RISK

In assessing risk, we are not only considering the person’s current presentation but also the impact of past events and known future events that are likely to affect them. In our research into deaths by suicide in Gloucestershire in 2017 (Suicide Crisis 2018), we came across evidence that clinicians had apparently not taken into account all such relevant information, and this led them to underestimate the person’s risk of suicide. This was apparent in 24 per cent of deaths by suicide in our county between June and December 2017.

In some cases, individuals were assessed as being at low risk of suicide by mental health professionals a few days before they died, despite the person having made a suicide attempt in the hours before that assessment and despite the apparent presence of other significant risk factors.

Shane was one of the individuals whose inquest took place during the second half of 2017. As well as attending his inquest, we spoke to his family on several occasions and learned about Shane from them. Families who felt able to talk to us contributed significantly to our research. Shane’s mother shared with us information from his psychiatric records, as well as the witness statements provided to the coroner by psychiatrists, clinicians and other professionals involved in his care.

Shane was assessed as being at low risk of suicide by a mental health professional in the general hospital a few days before he died. He had been admitted to hospital after making a suicide attempt the previous day. From the information in his psychiatric records and the evidence given by mental health professionals at inquest, we identified the following risk factors:

• Recent suicide attempts.

• A history of self-harm.

• An assessment by a hospital doctor as ‘suicidal’ the day before the other assessment.

• A diagnosis of borderline personality disorder and antisocial personality disorder.

• Apparently no access to NICE-recommended therapies, which can help with the symptoms of BPD and antisocial personality disorder.

• Drugs and alcohol use.

• A history of offending behaviour.

• A traumatic experience in early adulthood, apparently untreated with psychological therapy. His mother felt that this continued to have a severe impact on him.

• Fear of an imminent prison sentence.

• Fear of abandonment – he had concerns that his mother was about to emigrate.

• Difficulty engaging with services.

• An imminent change in care setting. Shane was about to move to new supported housing, and he had a history of crisis and self-harm whenever he had to make a move like this.

This shows the importance of taking into account a person’s history and any known future events likely to impact on risk, such as a change of care setting or possible prison sentence. The combination of all these risk factors would

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