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The Suicide Risk Assessment and Management Manual (S-RAMM) Validation Study II

Published online by Cambridge University Press:  13 June 2014

John Fagan ,
Atif Ijaz ,
Alexia Papaconstantinou ,
Aideen Lynch ,
Helen O'Neill  and
Harry G Kennedy
John Fagan
Affiliation:
Central Mental Hospital, Dundrum
Atif Ijaz
Affiliation:
Central Mental Hospital, Dundrum
Alexia Papaconstantinou
Affiliation:
Central Mental Hospital, Dundrum
Aideen Lynch
Affiliation:
Central Mental Hospital, Dundrum
Helen O'Neill
Affiliation:
University of Dublin, Trinity College
Harry G Kennedy*
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14 University of Dublin, Trinity College, Ireland.
*
*Correspondence E-mail: [email protected]
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Abstract

Objectives: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument.

Methods: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records.

Results: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF).

Conclusions: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.

Keywords

SuicideStructured professional judgementClinical risk assessment
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 26 , Issue 3 , September 2009 , pp. 107 - 113
Copyright
Copyright © Cambridge University Press 2009

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References

1.Bloom, H, Webster, CD (Editors). Essential Writings in Violence Risk Assessment and Management. Toronto; Centre for Addictions and Mental Health 2007.Google Scholar
2.Nicholls, TL, Brink, J, Desmarais, SL, Webster, CD, Martin, ML. The short-term assessment of risk and treatability (START): a prospective validation study in a forensic psychiatric population. Assessment 2006; 13: 313–327.CrossRefGoogle Scholar
3.Webster, CD, Hucker, SJ. Violence Risk Assessment and Management. Chichester, Wiley 2007.Google Scholar
4.Bouch, J, Marshall, JJ. Suicide risk: structured professional judgement. Advances in Psychiatric Treatment 2005; 11: 84–91.CrossRefGoogle Scholar
5.Hawton, K, van Heeringen, K (editors). The International Handbook of Suicide and Attempted Suicide. Chichester: Wiley 2000.CrossRefGoogle Scholar
6.Kennedy, HG. Risk assessment is inseparable from risk management: Comment on Szmuckler. Psychiatric Bulletin 2001; 25: 208–211.CrossRefGoogle Scholar
7.Douglas, KS, Webster, CD, Hart, SD, Eaves, D, Ogloff, JRP. HCR-2- violence risk management companion guide. Burnaby, British Columbia: Mental Health, Law and Policy Institute, Simon Fraser University, 2001.Google Scholar
8.Appleby, L. Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Department of Health 2001.Google Scholar
9.Bouch, J, Marshall, JJ. S-RAMM Suicide Risk Assessment and Management Manual (Research Edition) Cardiff: The Cognitive Centre Foundation 2003.Google Scholar
10.Ijaz, A, Papaconstantinou, A, O'Neill, H, Kennedy, HG. The Suicide Risk Assessment and Management Manual (S-RAMM) Validation Study I; Inter-Rater Reliability, Internal Consistency, and Discriminatory Capacity. Irish Journal of Psychological Medicine 2009; 26(2):54–58.CrossRefGoogle Scholar
11.Webster, CD, Douglas, KS, Eaves, D, Hart, SD. HCR-20: Assessing risk for violence, version 2. Burnaby, British Colombia: Simon Fraser University 1997.Google Scholar
12.Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 1987; 13: 261–277.CrossRefGoogle ScholarPubMed
13.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edition). Washington DC: American Psychiatric Association 1994.Google Scholar
14.Ogloff, JRP, Daffern, M. The Dynamic Appraisal of Situational Aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioural Sciences and the Law 2006; 24: 799–813.CrossRefGoogle ScholarPubMed
15.SPSS Inc. SPSS for Windows version 1 2.0.1 (11 November 2003). Chicago: SPSS Inc 2004.Google Scholar
16.Pillay, SM, Oliver, B, Butler, L, Kennedy, HG. 2008. Risk stratification and the care pathway Irish Journal of Psychological Medicine 2008; 25(4): 123–127.CrossRefGoogle ScholarPubMed
17.Pokorny, AD. Prediction of suicide in psychiatric patients: report of a prospective study. Archives of General Psychiatry 1983; 40: 249–257.CrossRefGoogle ScholarPubMed
18.Goldstein, RB, Black, TW, Nasrallah, A, Winokur, G. The prediction of suicide. Archives of General Psychiatry 1991; 48: 418–422.CrossRefGoogle ScholarPubMed
19.Altman, DG, Bland, JM. Statistics notes: diagnostic tests 1: sensitivity and specificity. British Medical Journal 1994; 308: 1152.CrossRefGoogle Scholar
20. Healy -v- The North Western Health Board, High Court, Flood J, January 31, 1996.Google Scholar
21.Webb, M, O'Leary, D. What is a “firm remission”? Medico-Legal Journal of Ireland 1999; 4–7.Google Scholar
22.Patterson, WL, Dohn, HH, Bird, J, Patterson, GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics 1983; 24: 343–349.CrossRefGoogle Scholar
23.Risk Management Authority of Scotland. Risk Assessment Tools Evaluation Directory (RATED) version 1. Scotland: Astron.2006. http://www.rmascotland.gov.ukGoogle Scholar
24.Geddes, J. Suicide and homicide by people with mental illness. British Medical Journal 1999; 318: 1125–1126.CrossRefGoogle ScholarPubMed
25.Szmuckler, G. Homicide inquiries, what sense do they make? Psychiatric Bulletin 2000;24:6–10.CrossRefGoogle Scholar
26.Szmuckler, G. Violence risk prediction in practice. British Medical Journal 2001; 17: 884–85.Google Scholar
27.Szmuckler, G. Risk assessment: ‘numbers’ and ‘values’. Psychiatric Bulletin 2003; 27: 205–207.CrossRefGoogle Scholar
28.Kennedy, H. Risk assessment is inseparable from risk management: comment on Szmuckler. Psychiatric Bulletin 2001; 25: 205–207.Google Scholar
29.Webster, CD, Hucker, SJ. Violence risk: assessment and management. Chichester; John Wiley & Sons, 2007.Google Scholar
30.Maden, T. Treating violence: a guide to risk management in mental health. Oxford: Oxford University Press, 2007.CrossRefGoogle Scholar
31.American Psychiatric Association. Practice guideline for the assessment and treatment of patients with suicidal behaviours. Washington DC: American Psychiatric Association, 2003.Google Scholar
32.Maden, A. Violence risk assessment: the question is not whether but how. Psychiatric Bulletin 2005; 29: 121–122.CrossRefGoogle Scholar
33.Moris, R, Gask, L, Webb, R, Dixon, C, Appleby, L. The effects on suicide rates of an educational intervention for frontline health professionals with suicidal patients (the STORM project). Psychological Medicine 2005; 35: 957–960.CrossRefGoogle Scholar
34.Green, G, Gask, L. The development, research and implementation of STORM (Skills-based Training on Risk Management). Primary Care Mental Health 2005; 3: 207–213.Google Scholar