Suicide Risk, Assessment Considerations, and Patient Safety

Taking a Closer Look

Dr. Smith explores the patient's thoughts about suicide, including whether the thoughts have become more frequent or intense, whether there has been any planning or preparation, and whether the patient has experienced similar thoughts or behaviors in the past.

The conversation also covers factors that may increase concern, including the recent breakup, academic difficulties, feelings of hopelessness, access to potentially lethal means, substance use, and changes in sleep or functioning.

Just as importantly, Dr. Smith asks about factors that may help protect the patient. What has helped them get through difficult periods before? Who would they reach out to if things became worse? Are there people they trust? What are they looking forward to, even if those things feel difficult to access right now?

These questions give Dr. Smith a more complete picture than a simple yes-or-no answer about whether the patient has a suicide plan.

Building a Plan Together

Based on the conversation and clinical assessment, Dr. Smith discusses with the patient whether a personalized safety plan would be helpful. When clinically appropriate, they work together to develop a plan for managing periods of increased distress.

Together, they may identify:

• Warning signs that may indicate the patient's distress is increasing

• Coping strategies the patient can try on their own

• People and places that can provide distraction or support

• Individuals the patient can contact for help during a crisis

• Professional and crisis resources to contact if additional help is needed

• Steps to make the patient's environment safer, including discussing access to potentially lethal means

Dr. Smith also discusses whether someone in the patient's support system could be involved. With the patient's permission, a trusted family member, roommate, or other support person may be included when clinically appropriate. The goal is to identify sources of support that the patient understands and agrees to use.

Planning the Next Contact

Because the patient has disclosed suicidal thoughts and is experiencing significant stressors, Dr. Smith considers whether a four-week follow-up interval provides enough contact.

Rather than relying on a routine follow-up schedule, the timing of the next appointment is based on the patient's current clinical picture, the safety plan, available supports, and any changes that could increase concern.

Before the patient leaves, Dr. Smith makes sure the patient understands what to do if suicidal thoughts intensify or circumstances change. The plan, clinical assessment, and follow-up arrangements are documented in the medical record.

Consider the clinical approach:

• What additional questions could help provide a fuller picture of the patient's current suicide risk?

• What factors in this scenario may increase concern?

• What protective factors and sources of support could be explored?

• How can a psychiatrist distinguish a patient's denial of a specific plan from the broader question of suicide risk?

• What might an individualized safety plan include?

• When might it be appropriate to involve a family member, roommate, or other support person, and how can the patient's permission and preferences be incorporated?

• How might the patient's circumstances influence the timing of the next appointment?

• What information from the assessment and plan would be useful to document for continuity of care?

Putting It Into Practice

Suicide risk assessment is more than a checklist . . . it's a clinical commitment to understanding, supporting, and safeguarding each individual. A conversation about suicide does not always follow a predictable path, and each patient's circumstances are different. The value of a thoughtful assessment is in taking the time to understand the individual patient, consider the factors that may affect their safety, and involve the patient in determining appropriate next steps.

For Dr. Smith, the Friday afternoon appointment provides an opportunity to look beyond the patient's denial of a specific plan and explore the broader clinical picture. By asking direct questions, listening carefully, discussing available supports, and considering what additional steps may be appropriate, the conversation can become an important part of the patient's care.

The next step is not necessarily the same for every patient. What matters is making space for the conversation and using the information gathered to guide individualized clinical decisions.

Asking directly, listening carefully, and involving the patient in decisions abut next steps can help create a thoughtful, individualized approach to care.

The information provided in this case study is intended for educational purposes and should not be considered legal, clinical, or professional advice. Clinicians should exercise their own professional judgment and follow applicable standards, regulations, and practice requirements.

About American Professional Agency

American Professional Agency provides professional liability insurance and risk management resources for mental health professionals.

For more information on this topic and for potential CME/CEU credits, American Professional Agency invites you to attend their Webinar, Stanford Course on Suicide-Focused Assessment and Treatment. For more information and to register, click here.