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Barriers to Effective Suicide Risk Assessment – Part 2

Article in Review: Berman, N. C., Sullivan, A., Wilhelm, S., & Cohen, I. G. (2016). Effect of a legal prime on clinician’s assessment of suicide risk. Death Studies, 40(1), 61-67.

Summary: Clinicians with limited experience or training in suicide risk assessment are more likely to be influenced by legal priming, with paradoxical results of underestimating the treatment needs of simulated clients at risk of suicide. 

Another recent study (Berman et al., 2016), yielded results advocating for a more considered approach to suicide risk assessment and the need for practitioners to increase their training and skill in working with suicidal clients.

This study evaluated the impact of reminding clinicians about their potential liability (i.e. medico-legal responsibilities and potential outcomes associated with suicide risk assessment), prior to being presented with a case example, against those that were presented with a case example alone. The clinicians were asked to conducting a suicide risk assessment, being rated on how likely they are to recommend hospitalisation and perceptions of suicide risk of the client. As such, the aim of the research was to determine how legal priming may affect decision making and assessment outcomes on the clinicians.


Somewhat unexpectedly, results demonstrated that priming/reminding participants of the legal standard prior to conducting the suicide risk assessment led to significantly lower ratings of suicide risk, but had no impact on the decision as to whether or not the patient required a hospital admission. Interestingly, however, clinicians’ training level was a moderating factor. Trainees were found to be susceptible to the priming and unexpectedly provided lower evaluations of risk, while experienced clinicians were not. Berman et al (2016) questioned as to whether the training of legal principles associated with assessing and responding to suicidality, actually led to better quality assessment, given the lower risk ratings they attributed to the cases. What was proposed is that clinicians that have had greater experience and exposure to applied practice appeared to dilute the potential impact of the legal priming. Further, they noted that an important aspect to the research was the active review of the assessment process and the adjustments that could and should be made to a risk assessment, as guided by an ‘accurate’ assessment process.

Implications for Clinicians

Overall, Berman et al.’s (2016) findings suggest that it is not sufficient or effective for clinicians to merely be aware of their liability and associated legal precedents. Rather, the results highlight the need for in-depth training and knowledge regarding the medico-legal aspects of suicide risk assessment which includes not only simulation of risk assessment in the context of various priming, but interactive review and reappraisal of the assessment, according to an ‘accurate’ protocol. This would appear likely to facilitate an effective and accurate decision-making and suicide risk appraisal process.

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