Researchers want new approach to suicide risk

‘Plan of hope’ better than estimation

UNIVERSITY of Otago researchers suggest that public health moves, and ‘‘a plan of hope’’ would counter suicide better than more accurately estimating the risks faced by individual patients.

Their new study: ‘‘Lowrisk and highrisk groups matter in suicide risk’’, was compiled by lead author Dr Chris Gale, and helped by coauthors Prof Paul Glue and Associate Prof Yoram Barack, of the Otago department of psychological medicine.

Dr Gale hoped that the study, recently published in the journal Psychological Medicine, would lead to a ‘‘rethink of current focus and treatment based on suiciderisk prediction’’.

The study, on the ability to predict death by suicide, highlighted problems arising from more ‘‘accurately predicting the suicide risk of individual patients’’ and also emphasised ‘‘multiple problems with current

mental health treatment models’’.

The current ‘‘zero suicide’’ policy was ‘‘an impossibility’’, he said.

‘‘We should focus our efforts on public health measures to reduce deaths by suicide such as better alcohol abuse control, and limiting size of overthecounter medication packages.’’

Everyone who had made a suicide attempt was ‘‘at higher risk’’ and any ‘‘further risk assessment’’ was ‘‘a waste of time’’.

‘‘We need to set a plan of hope for each person who is in despair, have enough people to implement it, and not criticise clinicians when the plan does not work,’’ Dr Gale said.

For patients at high risk of suicide, their death rate by suicide during followup was up to 10%, but among lowerrisk patients, the equivalent death rate was less than 0.1%.

The ‘‘pooled predictive ability’’ of the high risk group was ‘‘quite good’’, but in the second ‘‘general clinical population’’ group, predictability was ‘‘remarkably bad’’.

There was an expectation that psychiatric doctors or nurses could predict these ‘‘tragic suicide events’’, but even with perfect tests ‘‘which we don’t have, we cannot predict such an event’’, he said.

The findings should prompt a rethink of the way treatment is administered, especially after the recent mental health inquiry revealed ‘‘a culture of risk aversion and defensive practice from clinicians,’’ he said.