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Risk Assessment Tools — MRCPsych Paper B MCQ

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EasyLiaison PsychiatryRisk Assessment ToolsMRCPsych Paper B

A 22-year-old woman is assessed in the emergency department after taking an overdose of 30 paracetamol tablets 2 hours earlier. Urgent physical management is underway, and she says that she immediately regretted the overdose. The liaison practitioner proposes calculating a risk score and using its category to decide whether she should receive ongoing psychiatric treatment or be discharged from mental health follow-up. According to NICE NG225, is this approach recommended?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — No—do not use scales to predict future self-harm or decide treatment or discharge

Explanation lettering: B = shown as A · C = shown as B · A = shown as C · E = shown as D · D = shown as E

B is correct. NICE NG225 states that risk assessment tools, scales and global risk categories should not be used to predict future suicide or repetition of self-harm, or to decide who receives treatment or is discharged. Her immediate regret does not make a risk score suitable for these decisions. Assessment should instead focus on her needs and immediate and longer-term psychological and physical safety, with a risk formulation completed as part of the psychosocial assessment. Validation or routine use does not make A or D correct. NICE recommends neither SAD PERSONS specifically nor an exception for actuarial tools, excluding C and E.

Reference: National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence (NG225), section 1.6, Risk assessment tools and scales. 2022, updated 2024. https://www.nice.org.uk/guidance/ng225/chapter/recommendations