Tolerating Risk: Professional Judgment in Suicide Risk Assessment

As a leading cause of death among those suffering from mental health problems, suicide is an issue that challenges policy makers, organizations, and practitioners alike. One outcome has been the implementation of standardized decision-making tools, developed through actuarial methods and aimed at limiting risks inherent in professional judgments. However, despite legislative and policy attempts to standardize the outcomes of risk assessment, professional judgments in specific client scenarios remain highly divergent. This article presents an exploration of the practice-level implementation of policies related to suicide risk assessment and decision-making. Findings suggest that once a judgment regarding risk has been made, ultimately organizational dynamics and resource availability determine disposition. Although attempts to improve outcomes for suicidal clients should include ongoing professional development for practitioners, the findings point to the requirement for community-based and hospital-based services that provide the greatest range of options for addressing client needs and facilitating safety.