Can we usefully stratify patients according to suicide risk?

In the UK, one in five adults have considered suicide at some time, and one in fifteen have attempted suicide.1 Half of those who attempt suicide seek help afterwards, a quarter from a GP, a quarter from a hospital or specialist medical or psychiatric service.1 Suicidal patients, those who do present to health services, with suicidal ideas, self-harm, suicide attempts and those who present as significantly distressed or mentally ill can be challenging to manage. Doctors are often advised to use suicide risk assessment to help them decide management plans. A wide variety of risk factors have been implicated in the stratification of potentially suicidal patients. 2 This stratification is often expressed in terms of high, medium or low-risk. 3 4 In practice, doctors commonly give the most importance to suicidal ideation. 5 6 In some specialist mental health settings these judgments are aided by local risk assessment pro formas comprised of lists of clinical and demographic factors while other centres use risk strata derived from validated questionnaires or scales.7 However, there is little consensus over their use and virtually no evidence that any of the method of suicide risk stratification can contribute to suicide prevention.