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New VA study shows risk assessment tools not reliable

May 11, 2012
by James M. Hunt
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The Veterans Affairs (VA) Department of Defense (DoD) suicide prevention Evidence Based Practice Working Group (EBPWG) released a new study in March that reviewed the existing literature regarding the validity of risk assessment tools in use in VA facilities.

The document, titled "Suicide Risk Factors and Risk Assessment Tools: A Systematic Review," starts out as follows:

The objective of this report is to review recent evidence about risk factors and risk assessment tools within Veteran and military populations to provide evidence for clinical practice guideline development specific to these populations.
The key questions addressed in this report were:

Key Question #1. What assessment tools are effective for assessing risk of engaging in suicidal self-directed violence in Veteran and military populations?

Key Question #2. In addition to the risk factors included by current assessment tools, what other risk factors predict suicidal self-directed violence in Veteran and military populations?

This extensive study initially reviewed 16,521 titles and abstracts which were reduced to 778 that received more detailed full-text reviews. Ultimately, 30 observational studies and 14 systematic reviews were selected that addresses at least one of the key questions.

Their conclusions were (page 35) that:

[There is] “Insufficient evidence overall to recommend screening with these [currently used] assessment tools based on this evidence. Future research is warranted, particularly for risk assessment instruments that are already in use within the VA system.”

The full text of this study is available free of charge by clicking here.

As discussed in my previous blogs on this website, I feel that it is very dangerous for hospitals and designers to make important decisions regarding providing suicide resistant features in only certain portions of psychiatric hospital units based on the results of the currently available risk assessment tools.

I strongly recommend that all patient accessible areas of all inpatient behavioral health care units be designed to resist suicide to the extent deemed practical for the patient populations of the facility.

This will reduce the pressure on the staff to make decisions about patients without adequate basis and reduce the need to be constantly moving patients from one room to another.

The increased cost may well be recovered in several ways, not the least of which is the possible saving of a patient’s life.


Jim Hunt

Behavioral Healthcare Design Consultant

Jim Hunt

James M. Hunt, AIA, is a practicing architect and facility management professional with over 40...

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