Suicide mitigation: time for a more realistic approach

One of the great myths of health politics is that risk can ultimately be eliminated if we have the right policies, procedures, and therapies. However, in areas where health professionals feel ill equipped to manage risk, those same expectations can be a powerful disincentive, discouraging the acknowledgement and assessment of risk. When patients present with suicidal thoughts or following self harm, fear of accusation of suboptimal clinical expertise or even litigation if the patient goes on to complete a suicide may dissuade many clinicians from enquiring too deeply. This is in case they acknowledge a risk they will then be expected to manage, but which they do not believe they have the means to control. Thus, the pervasive expectation that risk must be controlled and preferably eliminated could paradoxically increase suicide risk rather than reduce it. GPs appear willing to identify suicide risk in patients with a diagnosed mental illness. A study by Pearson et al 1 investigated the frequency and nature of general practice consultations for 247 patients with a known mental illness, also in contact with specialist mental health services in the year before their suicide. In 91% of suicides the patient consulted their GP in the year before their death, half having their final GP consultation in the month before death and a sixth in the week before death. Malone et al highlighted a lack of documentation of suicide risk by mental health professionals.2 Possible factors may include not appreciating that the patient was at risk from suicide or self harm, not asking the right questions, or not understanding what the patient wanted to convey. There may be difficulty …