Suicide Risk Assessments Understood as Medical Rituals: Functions and Implications from Societal and Medico-Ethical Perspectives.

Abstract

The use of suicide risk assessments in individual psychiatric treatment is widespread and, in many countries, mandatory. However, these assessments exhibit poor predictive accuracy and offer limited clinical value. This raises the question of whether non-medical reasons underpin their continued use. In this paper, suicide risk assessments are interpreted as medical rituals-formalized, repetitive behaviours imbued with symbolic significance that fulfil social functions. Several such functions are proposed, including uniting care providers around shared values in suicide prevention, fostering a sense of safety and control over suicidal behaviour, projecting accountability, and signalling to the public that action is being taken. However, this practice may inadvertently lead to an increase in non-beneficial compulsory admissions, flawed prioritization of patients, and the proliferation of defensive medicine. While the ritualistic use of suicide risk assessments may serve important societal purposes, their potential to harm individual patients renders them indefensible from a medico-ethical standpoint.Instead, evidence-based suicide preventive interventions are recommended. These include implementing general safety measures, equipping psychiatric patients with safety plans, and providing effective mental health treatment according to medical needs.