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Advances in Psychiatric Treatment (2005) 11: 84-91
© 2005 The Royal College of Psychiatrists

Suicide risk: structured professional judgement{dagger}

Joe Bouch and John James Marshall

Joe Bouch is a consultant psychiatrist in general adult psychiatry with Greater Glasgow NHS Primary Care Trust and an honorary senior lecturer at the University of Glasgow (Goldenhill Resource Centre, 199 Dumbarton Road, Clydebank G81 4XJ, UK. e-mail: jbouch{at}glacomen.scot.nhs.uk). His main professional interests are in the fields of postgraduate medical education, the management of severe and enduring mental illness, and suicide prevention. John James Marshall is a consultant in forensic and clinical psychology with Greater Glasgow NHS Primary Care Trust. He is lead clinician of the Forensic Child and Adolescent Mental Health Service, honorary lecturer in legal and criminological psychology at Caledonian University and honorary clinical tutor in clinical psychology at the University of Glasgow. His main research interest is in the field of violence risk assessment and prediction, and he provides expert evidence on risk to the Scottish courts. J.B. and J.J.M. are the authors of the S-RAMM (Suicide-Risk Assessment and Management Manual; Bouch & Marshall, 2003), which utilises a structured professional judgement approach to the assessment and management of patients at risk of suicide.

Patient risk factors for suicide are well known to psychiatrists, yet the availability of clinically useful, routine and systematic methods for risk recognition are limited. This article outlines the structured professional judgement approach to suicide risk assessment and management. This method combines psychiatric assessment and formulation with the evidence base for suicide risk factors. Structured professional judgement is contrasted with actuarial and clinical judgement approaches. A categorisation of risk factors is presented, with four groups described – static, stable, dynamic and future. Case histories illustrate long-term high risk contrasted with sudden and unpredictable onset of suicidality.


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