Assess Severity of Suicidal Ideation

Clinician: "When people are depressed or overwhelmed, they may often feel like life isn't worth living. I will be asking you more questions about this…"

Assess the level of suicidal risk in your patient and consider using the following tools: 

• C-SSRS Risk Assessment-Adult | C-SSRS Risk Assessment-Adult PDF
• C-SSRS Screener | C-SSRS Screener PDF
  • Questions include:
    • Item 4. Suicidal intent: Have you had thoughts of killing yourself? Have you had the intention of acting on these thoughts?"
    • Item 5. Suicidal intent with Specific Plan: Have you started to work out the details, or made plans on how to kill yourself? Do you intend to carry out this plan?
    • Item 6. Suicide Behaviour Question: Have you ever done anything to end your life?
    • If the patient answers "yes" to items 4, 5 or 6 (within the last 3-months), then consider the suicide risk to be high.

• Based on the C-SSRS Screener, or your clinical assessment, patients can be divided into: 
  • Low risk
    • May have thoughts of death, but no active intent
    • No means
    • Able to contract for safety, i.e. patient reports that they are agree to tell someone else if suicidal ideation worsens
  • Medium risk
    • Multiple risk factors, few protective factors
    • Suicidal ideation with plan, but no intent or behaviour
  • Chronic risk
    • Individuals with personality disorders (e.g. borderline personality) often express longstanding suicidal ideation
    • Admission may be indicated if risk is higher than usual (i.e. 'acute on chronic'), but inpatient admission for chronic risk is generally not therapeutic
  • High Risk
    • Active intent
    • Has lethal means of harming self, e.g. firearms, toxic medications, etc.
    • Unable to contract for safety, i.e. patient is unable to agree to tell someone else if suicidal ideation worsens

Reference: Suicide Assessment Five-step Evaluation and Triage (SAFE-T)

Other articles of interest:

1. Determining Suicide Risk.pdf
2. CASE approach.pdf