Suicide risk tools and scales, whether paper checklists or algorithms, have low positive predictive value for any individual because suicide is rare and its predictors are common. NICE guidance on self-harm advises against using risk tools or scales to predict future suicide or to decide who is offered treatment or who is discharged. What helps the person in front of you is a needs-based assessment: what has happened, what is driving it now, who is around them, and what they will do if things worsen. A written safety plan made with the patient — warning signs, coping steps, people and services to contact, and steps to reduce access to means — is a concrete output of that conversation.
- Do not use a risk category alone to decide on admission, discharge or follow-up.
- Ask directly about suicidal thoughts, plans and access to means.
- Write a safety plan with the patient and give them a copy.
- Involve family or carers where the patient agrees.
Why it matters
Low-risk labels give false reassurance, and most people who die by suicide were not classed as high risk.
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