Health justice, resource allocation and age in suicide risk assessment

Suicide risk assessment tools and prediction models aim to assess individual suicide risk to assist clinical decision-making and improve health outcomes. While these tools have proliferated in recent years, concerns and criticisms of them have also increased and NICE recommended against their use. In this Perspective, we discuss these tools from the perspective of health justice. First, we argue that, in the context of limited resources, having tools to assist in identifying the highest-risk individuals may help us to prioritize the worst-off and distribute resources more fairly. Second, we argue that, where there are known inequalities in suicide risk and related outcomes between groups, not prioritizing according to risk threatens to indirectly discriminate against higher-risk groups. Particularly salient is the case of older populations who have much higher risks of suicide after self-harm than younger populations, and who already experience inequalities in access to mental healthcare. We conclude by making some recommendations for future research.