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K12: KEYNOTE: Re-evaluating the 'high-risk' approach to suicide prevention
Time:
Friday, 28/Aug/2026:
9:30am - 10:00am
Location:ALPHA
Presentations
Re-evaluating the 'high-risk' approach to suicide prevention
Matthew Large
UNSW, Australia
In 1985, Rose articulated that causation in epidemiology encompasses two distinct issues: the determinants of incidence rates and the determinants of individual cases. Rose suggested two complementary strategies: the population approach, which seeks to control the causes of incidence, and the 'high-risk’ approach, which seeks to identify and protect individuals.
This became psychiatric and suicide prevention orthodoxy. By 2014, the WHO generalised and publicised a more refined version, advocating for a broad-based preventive strategy based on Universal measures directed at the entire population (for example, by restricting access to lethal means and responsible media reporting), Selective strategies based on directing resources to vulnerable subpopulations (for example, people exposed to trauma, conflict, or social disadvantage) and Indicated measures directed at particular people.
However, the high-risk approach, which began as a sensible clinical impulse to recognise and protect a suicidal person, was transformed by epidemiology and managerial systems into an attempted method of predicting and sorting patients. In recent years, this has been re-appraised in the light of knowledge of the weakness of suicide prediction.
This plenary will consider what suicide risk assessment can—and cannot—tell us, how the designation of “high risk” influences clinical decisions, and whether concentrating attention on a relatively small group may obscure the larger population in which most suicides occur. It will examine the consequences of false reassurance, false-positive classifications, defensive practice, restrictive interventions and the diversion of resources.
Risk is not irrelevant; researchers should not stop researching, and clinicians should continue to consider suicidal thoughts and behaviours. However, risk categorisation has a limited role in compassionate, evidence-informed care. Suicide prevention might be strengthened by moving beyond prediction, but there are major barriers to this change that must be overcome.
