Assessing Risk

Full risk assessment involves assessment of a number of aspects of safety of the patient or others, including suicide risk, violence risk, physical safety (for example, self-care, risk of accidental injury), child care, driving and workplace safety. Detailed considerations of full risk assessment are beyond the scope of these guidelines. In many cases, intervention to help the patient abstain from alcohol will substantially reduce many risks. However, where concern about safety of the patient or others remains, consultation should be obtained from the relevant specialist or agency. 

While deaths by suicide are rare, suicidal ideation and attempts are less rare. Data from the United States indicates that 38% of adults who go on to die by suicide have had contact with a primary care provider within the preceding month. A meta-analysis of existing data determined that screening in primary care may be able to identify adults at increased risk of suicide. It is, therefore, desirable to screen for suicide as part of standard risk assessment. Clinical assessment regarding thoughts of self-harm is valuable with psychiatric referral where responses are troubling. A large number of standardised screeners exist for this purpose, including Adult Suicidal Ideation Questionnaire, Beck Scale for Suicide Ideation, Hamilton Rating Scale for Depression, and Positive and Negative Suicide Ideation Inventory. These tests have been tested in various populations and have favourable psychometric characteristics.