Risk Assessment Should Include:
- Suicide inquiry - This includes specific questions about the patient’s thoughts about suicide, plans for making an attempt, access to lethal means (such as firearms or pills), past
attempts and preparatory behaviors, and intent to act on these thoughts or plans.
- Risk factors - A patient’s stated lack of intent is insufficient to fully evaluate suicide risk. A person may deny intent but still be judged at high risk based on having thoughts about suicide, a recent history of attempts, or other risk factors. The clinician should ask about current psychiatric disorders; key symptoms such as insomnia, hopelessness, and command hallucinations; family history; interpersonal stressors including loss or humiliation; substance use; and recent changes in treatment.
- Protective factors - Protective factors are important to understand but may not counteract significant risk. Common protective factors include the responsibility to children, grandchildren, or pets; other social supports; good relationships with healthcare providers; and religious beliefs.
Based on these three areas of inquiry, the clinician then makes an assessment of the level of risk and a disposition plan based on that level of risk. The clinician then documents their assessment and determination of risk level. They may also include treatment options they considered and chose not to recommend, along with a rationale for why they made the choices they did.
