More accurate prediction of self-harm and suicidal behaviour is extremely important given the many and unfortunate consequences these behaviours have for the individual, the family and the society (Pitman et al., 2014; Tsiachristas et al., 2017). The prediction paradox concerns the fact that it is widely believed that clinicians should be capable of predicting episodes of harm and suicide. However, this is actually not evidence based and assessment of self-harm and suicide risk in individuals is not precise (Large, Ryan, Carter & Kapur, 2017;
Morris et al., 2013). The belief that clinicians are able to predict risk of suicidal behaviour with accuracy may put an unrealistic pressure on those working with self-harm and suicidal behaviour. One of the worst things that can happen to the clinician is losing a patient due to suicide. Yet, it happens. Is it aspirational to have a vision of zero suicide? However, it is hard and perhaps frightening to recognize the fact that clinicians are not able to predict self-harm and suicidal behaviour with adequate accuracy. The clinical practice of assessment and prediction in the field of suicidology is currently not evidenced based (Large et al., 2017).
Traditional research on epidemiological risk factors has gained important knowledge.
However, there is a need to move beyond general risk factors in order to better understand the complexities of the suicidal mind (Gjelsvik, 2014). The ideation-to-action framework is hopefully a valuable new perspective in this respect (Klonsky & May, 2014). One has to acknowledge that the factors and processes that lead to suicidal thoughts most likely are different from the factors and processes that lead to suicidal behaviours (Nock et al., 2016), and both researches and clinicians seriously need to understand this gap. However, so far little is known about what distinguishes ideators from actors. There is also reason to question whether the different theories in the ideation-to-action framework actually succeed in separating the two hypothesized distinct processes of development of thought versus development of action.
It is unfortunate that there is no unifying way of defining and understanding the basic concepts in the field of suicidology. One would probably be better off if the different research communities agreed on the definition and operationalization of the distinct concepts
(Silverman et al., 2007a, 2007b).
Recognizing the challenges in the field of suicidology is the first step towards improving the assessment and prediction of self-harm and suicide, and hence, being capable
50
of preventing suicidal behaviour. Importantly, one also needs to address these issues in research and clinical practice. Suicidology – although developing – currently provides a fragmented picture, and the mechanisms proposed to be involved in the transition from suicidal thought to suicidal behaviour awaits further scrutiny.
51
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