A Clinical Primer on Evidence-based Suicide Risk Assessment and Intervention

Working with people who experience suicidal thoughts, suicidal behaviors, or suicide risk is one of the most critical responsibilities of mental health professionals (MHPs). Over 80% of people who die by suicide have a diagnosable mental health disorder,¹ one out of three individuals who die by suicide comes into contact with mental health services within one year of death, and one out of five within one month of death.² MHPs are in an important position to prevent suicide deaths, yet many providers feel ill-equipped to assess and respond to patients at risk. The purpose of this article is to provide an overview of evidence-based suicide risk assessment and intervention methods, along with guidance on how to use these tools in practice. Recommendations are geared towards MHPs (psychiatrists, psychologists, social workers, psychiatric nurses, etc.) working in hospital-based settings.

This practitioner-oriented review focuses on direct assessment and intervention of suicidal thoughts and behaviors (STBs). However, comprehensive risk assessment should include consideration of risk and protective factors beyond STBs (eg, demographics, diagnoses, recent life events, social connectedness, etc.; a comprehensive list is provided in Franklin et al³), and interventions that target interrelated problems should be included in the treatment plan (eg, treatment for comorbid conditions). Additionally, this review is intended to be brief, with the busy practicing MHP in mind. More in-depth descriptions of suicide risk assessment instruments and interventions can be found elsewhere.^4,5

Assessment

Importance of Evidence-based Assessment

In practice, many providers do not routinely assess suicide risk using standardized, evidence-based methods, and some avoid asking about suicide altogether. First, it is a common misconception that talking about suicide increases risk. This idea has been thoroughly debunked,⁶ and asking directly about suicide normalizes disclosure. Second, many providers do not conduct follow-up assessment for patients initially presenting as low risk. However, research using intensive assessment methods demonstrates that STBs fluctuate substantially, even over minutes to hours.⁷ It is therefore crucial to repeatedly assess risk, regardless of past risk determinations. Third, even providers who frequently ask about suicide may not use standardized measures due to a lack of familiarity with or appreciation for the importance of evidence-based assessment. Evidence-based assessment tools have undergone the rigorous process of validation, which involves testing...