Assessment of suicide risk in people with borderline personality disorder: a qualitative analysis of risk protocols

ObjectiveThe prominence of suicidal ideation, suicide attempts and death by suicide among people diagnosed with Borderline Personality Disorder (BPD) underscores the importance of conducting relevant and informative risk assessment. The purpose of this study was to examine risk assessment protocols used in state public mental health services to assess whether and in what manner they include factors specific to suicidality/self-harm risk in people with BPD.MethodA qualitative evaluation of risk assessment protocols from nine of the thirteen (70%) of Victoria's public mental health was undertaken. Content analysis methodology was utilised to identify themes and compare these to recommendations for risk assessment of BPD as outlined in Australian clinical guidelinesResultsThe risk assessment protocols comprised suicide risk factors generally relevant to psychiatric disorders. Only one protocol incorporated BPD-specific risk assessment principles.ConclusionsFully incorporating BPD-specific risk factors into mental health service risk assessment protocols will better inform service responses and potentially improve clinical outcomes for people with BPD whose presentation includes chronic suicidality and/or high lethality non-suicidal self-injury. What is already known about this topic: Borderline Personality Disorder (BPD) is associated with frequent deliberate self-injury, chronic suicidal ideation, and suicidal behaviour.Specific clinical features of BPD such as chronic suicidality and impulsivity can reduce the applicability of more general psychiatric risk assessments and desensitise clinicians to high-risk situations.BPD-specific risk assessment training enables mental health professionals to differentiate between low versus high risk, chronic versus acute risk, and be alert to changes in the risk profile.What this topic adds: The majority of risk assessment protocols surveyed in public mental health services comprised suicide risk factors related to psychiatric disorders in general.Risk factors specific to chronic suicidality, deliberate self-injury, and changes in the pattern of risky behaviours in people with BPD are not systematically incorporated within public mental health risk assessment protocols.Incorporating existing evidence-based risk assessment protocols that incorporate factors specific to people with BPD may improve the consistency and accuracy with which suicide risk is assessed in public mental health services.