At a recent workshop I presented, a senior colleague commented that our clinical vernacular needs a more apt phrase than “high risk” to describe individuals whose clinical and historical presentation suggests risk for suicide. “High risk for suicide,” he pointed out, sounds like suicide is probable, when in fact the likelihood of suicide in any given “high risk” case is still low in absolute terms. So, I’ve been struggling to think about an alternative. “Elevated risk?” “Multiple indicators of risk?” I don’t know. This is not the only area in clinical suicidology with nomenclature problems, but it’s the one I need to figure out right now in order to make some recommendations for documentation standards in our department. If you have any ideas, please leave them in the comment section or use the contact page to email me.
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Here is an excerpt from an email sent to me by a senior colleague who, though not a suicide expert, is a master clinician and has helped me many times gain clinical, conceptual, and semantic clarity:
it’s a wrong question, trying to fix a problem that doesn’t need fixing. I think “high risk” is perfect and the question is a misguided one. the fact that they technically aren’t really at high risk in statistical terms is irrelevant, I propose. subjectively, for the clinician, they are at risk, and it’s high enough to be called high, and calling it high is useful on a number of levels…
I would disagree that High risk implies that suicide is probable. It doesn’t. It implies that the risk is high. Which means that this individual is at higher risk than someone who is at lower risk. And that is true. There by definition must be an ability to mark even a low probability risk as high some of the time or for certain people.
You could go with elevated risk, but that sounds a bit precious. This patient is at elevated risk for suicide. Well, elevated relative to what? You could say the same about High (high relative to what), but high at least implies absolute vs. elevated which implies relative to something else, so it becomes more confusing.
that’s my off the cuff opinion, and i’m sticking too it, at least till i have another.