Difficulties assessing the risk of suicide


Sir, – A recent article by two colleagues (Declan Murray and Patrick Devitt, Opinion, 24thJuly 24th), brings up the very important topic of suicide prediction and prevention.

Contrary to the gist of their piece which weighs heavily on a meta-analysis of suicide prediction, the last 50 years of psychiatry has pinpointed very valuable risk factors for this unfortunate event.

The combined wisdom of psychiatrists and psychiatric nurses and mental health professionals have agreed what could be called a “red flag” confluence of circumstances that are very frequently associated with suicide.

To say that psychiatrists or mental health staff are rudderless and grasping at straws when assessing this issue is untrue.

I agree with Drs Devitt and Murray that too much reliance on rating scales and risk assessment tools without due regard to one-to-one assessment of the individual person is dangerous.

Unfortunately, suicide is no respecter of persons and each person has his/her own story. But who can tell how many people have been rescued by empathic trained and caring mental health professionals, who relied most of all on their carefully honed clinical skills and the wealth of psychiatric experience of the specialty, plus or minus a few moderately useful rating scales and assessment tools?

We need to build better tools and aids to help us identify people at risk but always realise that really you are as good as your face-to-face clinical assessment.

I disagree that psychiatry has not got valuable and reasonably reliable ways of distinguishing suicidal risk. Eleven thousand people present to accident and emergency departments every year in Ireland with self-harm, and we have a duty to instil as much hope and expertise (which we do have) into their care as possible. – Yours, etc,


Consultant Psychiatrist,

Mater Misericordiae

University Hospital,

Eccles Street,

Dublin 7.