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Despair to Aspire

Introduction to the PROTECT Frameworks

PROTECT Week One: Assess Individual Distress

How to use the distress map to gather information?

Evolving distress has generic patterns that can provide a template for collecting individualised information. Enquire, explore and estimate using the DESPAIR Map.

Key Concept: DESPAIR Map

O Assessment has a dual role, explore distress and capture hope

o Integrate multisource perspective on psychache

o Establish distress patterns and imminence of action

Key Principles

Gain Knowledge:

• What are the different aspects of a comprehensive assessment?
• What are the signs and symptoms of relevant mental illnesses?
• What are the warning signs and fixed and fluid risk factors for suicide?
• What is acute risk, chronic risk and acute on chronic risk?

Develop Understanding:

• What are risk assessments trying to achieve?
• What are the problems and how to avoid them?
• How does distress evolve and why is it important to understand its evolution?
• Why is it important to break down the drivers of distress into bite size chunks?
• Where and when to call in more support?

Refresh Skills:

• How to transform internal distress discourse into external distress dialogue?
• How to develop common understanding of distress?
• How to make reliable judgement calls on intent, motivation and immediacy?
• How to engage family and friends in the assessment process?
• How to gain an understanding of the balance between reasons for living and dying?

A comprehensive meta-analysis of risk predicting clinical instruments by Carter et al (2017) showed the futility of risk stratification. Pooled positive predictive value for completed suicide was only 5.5%, so 94.5% of people classified as high risk were false positives. So from a care allocation perspective, most will receive unnecessary treatment. Large et al (2016), in a meta-analysis of longitudinal cohort studies showed pooled sensitivity of a high-risk categorization of 56%, indicating that only over half of the suicides occurred in the high-risk groups so false negatives, classified as low risk will be denied necessary treatment.  

FUTILITY OF RISK STRATIFICATION