Advances in our attempts to assess critical areas in our field continue to lag. A major problem is the multidimensionality of suicide and violence potential, as well as the transient nature of the individuals potential. There is also the difficulty of trying to quantify the degree of potential danger, due to the very nature of these behaviors.
I am firmly convinced that self-report questionnaires are not sufficient. If they are included in a battery of assessment techniques, which includes a focused interview, aimed at evaluating potential, plus some subjective methods, such as projective techniques, then and only then, will we achieve some degree of a comprehensive assessment process.
Assessment measures should include evaluations of the degree of ambivalence in prior attempts, as well as the stated intentionality, of the overt act. Such measures would help assess immediate vs. longer term risk, and might even help us distinguish self-destructive potential from self-harm intent (such as the need to punish oneself, but not to die), or violence to destroy others, vs. getting even.
Ideally, I would envision a serial assessment with three or four assessment techniques serving to screen for potential, to be followed, if needed, a few more assessment procedures to evaluate degree of risk, or to gain more depth, as to dynamics (situational vs. chronic anger, despair, hopelessness, etc), for the purpose of disposition and treatment of the person.
I believe we already have some good tools, but we need to create more of a focus, on both strengths and weaknesses of the personi.e. how violent, what are the controls if impulsivity exists, is anger directed towards oneself or to others, etc?
Among mental health professionals, assessment is unique to psychologyother disciplines, such as psychiatry and social work, do not have the background or training, to develop this assessment area to a higher level of validity and reliability.
With the increase of violence in the world, especially in the school, and elsewhere, and with more stress in daily life, creating more feelings of hopelessness, especially among vulnerable persons, we need to do more. The assessment task is difficult, but it is not impossible.
I welcome your comments, ideas based on your professional experiences, and even your resistances, about what is feared, in the challenge we face.
While human behavior in these areas may be too complex to predict with certainty, we certainly can do more in the clinical assessment of potential, and risk, of violence and suicide.