MIRECC / CoE
4: Multiple Method Risk Assessment
Screening and Evaluation » Evaluation
4: Multiple Method Risk Assessment
When evaluating suicide risk, we suggest against the use of a single instrument or method (e.g., structured clinical interview, self-report measures, or predictive analytic models).
Grades and Definitions
- Strong for
- or "We recommend offering this option …"
- Weak for
- or "We suggest offering this option …"
- No recommendation
- or "There is insufficient evidence …"
- Weak against
- or "We suggest not offering this option …"
- Strong against
- or "We recommend against offering this option …"
Categories and Definitions
|New recommendation following review of the evidence
|Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
|Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
|Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
|Recommendation from the previous CPG that has been removed based on review of the evidence
|Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
|Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
|Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
|*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.
Performing suicide risk evaluation is a critical function for clinicians, especially those working in mental health, primary care, and emergency department settings. Though there are many assessment tools and methods available, no single approach is able to address all of the specific needs and circumstances applicable in any given clinical encounter. Hence, risk assessment is best performed using a combination of methods, to include a clinical interview that can be flexibly applied to clinical circumstances, but then augmented with valid and reliable self-report measures.
The combination yields a multifaceted approach to risk assessment, affording multiple opportunities and avenues for identifying thoughts of suicide, and combining the advantages of a flexible and individualized clinical interview with the uniformity and quantifiable data of structed assessment tools. Risk assessment may be further augmented by collateral information from a reliable informant (e.g., family and/or friends familiar with the individual's history).
This section includes links to recommended training resources about multiple method risk assessment.
- From the American Psychiatry Association Quick Reference Guide (p. 282 & 283)
- Learn about the Therapeutic Risk Management model for supporting patients at risk for suicide
- VISN19 Therapeutic Risk Management (TRM) of the Suicidal Patient
This section includes links to recommended webinars about multiple method risk assessment.
- VA Suicide Risk Identification Strategy (Risk ID): Utilizing the CPG to Inform Standardized Suicide Risk Screening and Evaluation Presented by Suzanne McGarity, PhD
- Why Suicide Risk Assessment Matters Presented by Drs. Bridget Matarazzo & Hal Wortzel
This section includes links to recommended books about multiple method risk assessment.
- The American Psychiatric Association Publishing Textbook of Suicide Risk Assessment and Management, Third Edition
This section includes links to recommended articles about multiple method risk assessment.
- A Review of Suicide Assessment Measures for Intervention Research with Adults and Older Adults. https://www.sprc.org/resources-programs/review-suicide-assessment-measures-intervention-research-adults-older-adults .
- 2015). A multidisciplinary approach to therapeutic risk management of the suicidal patient. Journal of multidisciplinary healthcare, 8. 291-298. https://doi.org/10.2147/JMDH.S50529 (
- 2017). Suicide Risk Assessment and Management: Tips for Improving Care and Outcomes. World psychiatry: official journal of the World Psychiatric Association (WPA), 16(1). 28-29. https://doi.org/10.1002/wps.20396 (
- Suicide risk assessment: tools and challenges. Psychiatric Times, Vol 36. Issue 1. https://www.psychiatrictimes.com/view/suicide-risk-assessment-and-management-tips-improving-care-and-outcomes
- 2015). Balancing patient care and confidentiality: considerations in obtaining collateral information. Journal of psychiatric practice, 21(3). 220-224. https://doi.org/10.1097/PRA.0000000000000072 (
This section includes links to recommended podcasts about multiple method risk assessment.
- Rocky Mountain MIRECC Short Takes on Suicide Prevention
- Suicide Risk Assessment: A new look at an old tool and why it remains essential. (with Dr. Peter Gutierrez)