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Risk Tools Not Recommended — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatryRisk Tools Not RecommendedMRCPsych Paper B

A 28-year-old woman attends the emergency department after deliberately cutting her forearm. After wound treatment, she denies current suicidal intent and asks to leave. A triage nurse records a low SAD PERSONS score and proposes that she does not require liaison psychiatry assessment solely because the score is low. Which approach is most consistent with NICE NG225?

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

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Correct answer: A — Do not use the score for prediction or discharge; arrange a needs-focused psychosocial assessment.

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

B is correct. NICE NG225 advises against using risk assessment tools or scales to predict future suicide or repetition of self-harm, determine treatment or discharge, or classify people as being at low, medium or high risk. A low SAD PERSONS score therefore cannot justify discharge or omission of specialist assessment, even when current suicidal intent is denied. Following self-harm, the person should be offered referral to liaison psychiatry or another suitably skilled mental health professional for a psychosocial assessment focused on their needs, vulnerabilities and immediate and longer-term safety. A, C and D propose exceptions that NICE does not recognise. E is also incorrect: clinical judgement should inform an individualised assessment and risk formulation, not validate score-based global risk stratification.

Reference: National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence (NG225), recommendations 1.5.1, 1.6.1–1.6.6 and 1.7.13–1.7.14. 2022. https://www.nice.org.uk/guidance/ng225/chapter/recommendations