Balance Beams and Suicide-Risk Screening

This chapter examines how the mental illness model of suicide has led us to place more faith than may be warranted in concepts such as suicide “warning signs” and suicide-risk screening tools. These concepts are notoriously unreliable indicators of emerging suicidal behaviors because they do not sufficiently reflect the inherently dynamic and ever-changing nature of suicide risk. Any given warning sign for suicide will be wrong much, much more often than it will be right. Even when multiple warning signs are experienced or expressed by an individual, this problem persists. One factor limiting the accuracy of suicide-risk screening is that thoughts about death and suicide fluctuate over time. Thus, we should move away from assuming that we must know who will and who will not attempt suicide to prevent these behaviors from occurring.