It is time to dethrone suicidal ideations as a risk predictor

Area of Science:

• Mental Health Services Research
• Clinical Psychology
• Public Health Policy

Background:

• Suicidal ideation (SI) is commonly used as a key predictor for suicide risk and a determinant for accessing mental health services.
• This practice is prevalent across emergency and community mental health settings.

Purpose of the Study:

• To critically evaluate the clinical utility of reported suicidal ideations (SI) as a primary predictor of suicide.
• To assess the role of SI in determining eligibility and priority for mental health services.
• To explore the implications of SI's current status within mental health care systems.

Main Methods:

• Review of current practices in triage, screening, and management protocols involving suicidal ideation.
• Analysis of evidence regarding the predictive accuracy of SI for suicide.
• Discussion of potential detrimental effects and systemic downsides.

Main Results:

• Evidence indicates limited utility of SI as a reliable suicide predictor, consistent with broader challenges in suicide prediction.
• Widespread reliance on SI in clinical decision-making is observed.
• Potential negative impacts on clinical encounters and health system efficiency are identified.

Conclusions:

• Suicidal ideation (SI) retains a "canonical" status in mental health risk assessment and triage despite lacking robust evidence.
• The exaggerated importance of SI can lead to detrimental clinical and systemic consequences, particularly in resource-constrained environments.
• Rethinking the role of SI in mental health service delivery is warranted to improve patient care and system functioning.