What role does formulation play in suicide risk assessment, and what is the relationship between formulation and suicide prevention?
In this episode, host Dr Mary Emeleus; general practitioner and psychiatry trainee, and her guest, Associate Professor Christopher Ryan; psychiatrist, discuss the complex, charged and challenging topic of managing risk of suicide using the text, ‘Reformulating Suicide Risk Formulation: From Prediction to Prevention’ (2015, Pisani, A.R, Murrie, D.C, Morton, M.S) as the foundation to their conversation.
The text promotes a framework which encourages a focus on prevention rather than on prediction – listen in as Mary and Chris explore the merits, challenges, and limitations of this position. In so doing, Mary and Chris share their mutual regard of the ‘art of’ formulation in psychiatry; their views on the utility of suicide risk assessments; and the key distinction, as they see it, between suicide prediction and suicide prevention.
In drawing on their combined professional experiences in mental health across both clinical and academic contexts; Mary and Chris offer a rich, accessible, and thought-provoking pathway for listeners to ponder more deeply about the challenges of responding to and managing risk in clinical work.
In this episode
Mary is currently a Stage 3 psychiatry trainee in Queensland, with prior background as a GP and medical educator. She completed her GP training in FNQ and worked as a GP in Ravenshoe and Townsville. Having always held a strong interest in mental health, she completed a Masters in Psychotherapy in 2004. Mary later spent nine years working in youth mental health at headspace sites in Townsville and Cairns, and commenced Psychiatry training in 2017.
Mary has been active in teaching mental health skills to medical students, psychiatry registrar colleagues, GP registrars and GPs, through the Australian Society for Psychological Medicine and JCU-GP Training. She is passionate about interdisciplinary collaboration and supporting rural and remote practitioners, and has been involved with the Mental Health Professionals’ Network (MHPN) as a facilitator of their webinars for some years.
Chris is the Director of Consultation-Liaison Psychiatry at Sydney’s Westmead Hospital and Clinical Associate Professor at the University of Sydney. Though his work is primarily clinical, Chris maintains an active research programme and has numerous publications on a range of topics in psychiatry, law and ethics, including a focus on the assessment and management of people who raise concerns about possible suicide.
All resources were accurate at the time of publication.
Access ‘Reformulating Suicide Risk Formulation: From Prediction to Prevention’ (2015) here.
“I came across the article ‘Reformulating Suicide Risk Formulation: From Prediction to Prevention’ (2015) by Anthony R Pisani, because it is part of the framework for suicide prevention pathways being introduced in Queensland where I work. I attended a training co-facilitated by Tony Pisani with a consumer representative from Grow NZ, in Cairns in 2019. I enjoyed the training and I found him a warm presence and a good teacher. The framework is easy to understand and to remember, and I believe that Pisani and team developed it largely for these qualities: it is practical, it makes sense, and it can be readily taught and applied in practice.
Pisani encourages us to focus on Prevention rather than Prediction (the latter of which he acknowledges in the article is not possible).There is a broader question for me, about the “lenses” we look through: even with a focus on prevention instead of prediction, could we still be looking too intently through the “risk” lens, perhaps missing other lenses which might also help us understand and connect with people?
I invited Dr Chris Ryan to join me in this episode of Book Club to help me address this broader question of mine, after making a connection with him on a MHPN webinar and having long been aware of his work in the field.”
— Dr Mary Emeleus, on her chosen text for Book Club
Enjoyed this episode? To learn more…
‘The validity and utility of risk assessment for inpatient suicide’ (2011) here.
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