Being sensible about suicides

I must thank Nielssen et al for their thoughtful and concise piece on the high numbers of false positives produced by assessments of suicide risk and their conclusions that all patients, even those deemed to be at low risk of suicide, need to receive interventions. ¹ Having just been to an inquest into the death of a patient where the risk of suicide was deemed to be low, I can readily identify with the sentiments expressed in the paper, namely that our assessments of suicide risk are inadequate and that we should focus on care for all.

I am reminded of the Dangerous and Severe Personality Disorder (DSPD) Programme in this regard. This was a UK government initiative in response to a high-profile case of homicide by a patient with an antisocial personality disorder, where patients who fulfilled certain criteria (at risk of an offence causing serious physical or psychological harm, presence of a severe personality disorder, offending and disorder linked) were admitted to a treatment programme designed to reduce their risk to others. ² Unsurprisingly, there were concerns at the time that large numbers of patients who would never offend or present a significant risk to others would be incarcerated and prevented from living in the community. ³ For those who are not aware, the initiative has now ended, following strong opposition from doctors and others. ⁴

I have long been concerned about the premise that most suicides can be predicted and now I have some figures and knowledge to quote. Perhaps, like the DSDP Programme, we as a society need to recognise that prediction in retrospect is futile and follow the paper's recommendation of the provision of ‘adequate care for all our patients’.