MARK COLVIN: Officials in California have confirmed that the death of the American actor and comedian Robin Williams yesterday was suicide.
He had been open about the addictions and severe depression that he’d struggled with throughout his life.
But mental health researchers say working out whether a person is at risk of hurting themselves is incredibly hard, and around the world, clinicians almost always get those assessments wrong.
Anna Vidot reports.
ANNA VIDOT: Internationally respected mental health researcher, Professor Nav Kapur, says the science is in. Around the world, the tools and checklists clinicians commonly use to assess the risk of someone taking their own life are hopelessly flawed.
NAV KAPUR: Lots of different things cause suicide. So one of the things we do in services is we’re very, very keen to try and find out who’s most at risk. But the point is, we’re simply not very good at it. If you consider all the people that mental health services see, thankfully only a minority will die by suicide. So actually trying to pick that small number of people is a bit like looking for a needle in a haystack.
ANNA VIDOT: In Perth recently for a major suicide prevention conference, professor Kapur and others presented evidence that clinicians are wrong nine times out of ten, when they assess someone’s risk of hurting themselves as ‘high’, ‘medium’ or ‘low’.
NAV KAPUR: We need to step away from this false notion – this fallacy really – that we can predict the future in mental health services. It’s much more about assessing the patient in front of us, and providing what that patient needs.
ANNA VIDOT: That’s a position that Sydney psychiatrist and University of New South Wales researcher Matthew Large has been advocating for years.
MATTHEW LARGE: I wasn’t quite a lone voice talking about this, but there has been a radical shift in perceptions about the usefulness of risk categorisation in particular, and it’s now widely believed that we’ve been on the wrong track.
ANNA VIDOT: Dr Large says clinicians can’t predict the future, and they should top trying to.
MATTHEW LARGE: The vast majority of people who we categorise as being at high risk will not suicide, a significant proportion of the people who we regard as being at low risk will suicide. So we do it because of a sort of misplaced folk notion about what we should be doing, not because of any science.
ANNA VIDOT: Professor Nav Kapur says just because the checklists and tools don’t work, that doesn’t mean clinicians should stop assessing their patients altogether. He says it’s the way they assess them that matters.
Professor Kapur heads up the University of Manchester’s Centre for Suicide Prevention. One of their studies tracked 35,000 patients who presented to UK hospitals after making an attempt on their own life.
NAV KAPUR: From our research, just doing an assessment of a suicidal person can reduce their risks of repeating that behaviour by about 40 per cent. So just assessing someone.
So if a service user or a patient is feeling listened to, that the person in front of them is interacting with them positively and is giving them time and space – that in itself is therapeutic.
ANNA VIDOT: Professor Kapur says broader systemic changes have also had a big impact on reducing the number of suicides in the UK.
NAV KAPUR: The implementation of crisis care, providing services for people with psychiatric disorders, but also drug and alcohol misuse, reviews after adverse instance happen. Our estimates are that system-wide changes are probably saving between two and 300 lives per year in the UK.
ANNA VIDOT: Professor Kapur says resourcing for changes like that is a challenge for mental health services in the UK, as it is in Australia.
But he says rethinking the focus on risk assessment means existing resources can be put to better use.
NAV KAPUR: If we’re taking mental health professionals and others away from form filling and tick box exercises and back to the basic and fundamental assessments they’re doing, some of these simple things will actually save time and save money.
MARK COLVIN: Professor Nav Kapur from the University of Manchester’s Centre for Suicide Prevention ending Anna Vidot’s report.
This article first appeared ‘ABC’ on 13 August 2014.