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 | PDF
  • 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 and 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