Ambiguity Uncertainty and Risk: Reframing the task of suicide risk assessment and prevention in acute in-patient mental health

Abstract

The work of the National Confidential Inquiry into Suicide by People with Mental Illness has served to draw attention to the issue of suicide amongst users of mental health services including inpatient and provided the basis for a series of recommendations aimed at improving practice (Appleby et al., 2001, NIMHE 2003). Such recommendations include further training on risk assessment for practitioners. However, representing the problem of suicide as one which can be 'managed' by risk assessment particularly quantitative actuarial approaches implicitly misrepresents the phenomena of suicidality as something which can predicted and therefore managed may be inherently unpredictable at the level of the individual over the short term. We need instead to acknowledge that our work with service users who may be contemplating suicide embraces and acknowledges both uncertainty and ambiguity and seeks to assess risk phenomenologically at the level of the individual such that by understanding their reasons for living and dying we can work in partnership with them to find hope.