Suicide risk assessment and safety planning

Structured interview

1. 01

   Screen

   Ask about wishes to be dead and thoughts of suicide in the past month and lifetime.

2. 02

   Define ideation

   Ask frequency, intensity, and whether there is intent to act.

3. 03

   Ask about a plan

   Method, timing, preparation, and any rehearsal.

4. 04

   Assess means

   Access to firearms, medications, and other methods. Ask about alcohol and other drugs.

5. 05

   Review history

   Prior attempts, self-harm, hospitalizations, and family history of suicide.

6. 06

   Identify protective factors

   Reasons for living, family, engagement in treatment, future orientation, faith and responsibilities.

Risk modifiers

Level of care

• ·Imminent risk with intent or a plan, or inability to commit to safety: inpatient admission, voluntary or involuntary as the law allows.
• ·Ideation without intent, good supports, and a feasible safety plan: outpatient care with close follow-up.
• ·Increase contact in the weeks after discharge, a period of high risk.
• ·Document the assessment, the reasoning behind the level of care, and the plan.

Parts of a safety plan

• ·Personal warning signs.
• ·Internal coping strategies.
• ·People and places that offer distraction.
• ·People to ask for help.
• ·Professional and crisis contacts, including 988 in the United States.
• ·Steps to make the environment safe.