Sensible risk management in mental health

Hawton et al (2022) discuss why reliance on risk prediction of suicide in clinical practice has failed and outline an alternative therapeutic risk assessment, formulation and management model, which uses a person-centred approach. The focus on risk prediction and documenting risk assessment has actually misdirected the effort to prevent suicide.

Time needs to be spent on gaining therapeutic alliances rather than ticking boxes. Risk assessment is not a separate process from a full psychiatric history and mental state examination and formulation. A psychiatric management plan includes planning for safety. 

An ever more rigid and bureaucratic interpretation of risk assessment has been counterproductive, even destructive. Merely knowing about risks, even if these could be calculated precisely, may not improve practice. The fear that things may go wrong in mental health services has distracted from the task of actually making things better for people. Health care is more than a case of following rules and procedures. Conditions to improve patient safety are those that facilitate staff to bridge gaps in care, not the reverse. Risk management is actually the management of uncertainty, not the creating of an illusion of certainty (see post on my personal blog).