Suicide Risk Assessment — Clinical Decision Tree
Suicide risk assessment is not a checklist — it is a clinical conversation that generates a formulation. This decision tree covers every domain of the assessment with clinical language, risk stratification, and a safety plan format you can use in session.
What is in this decision tree
Seven assessment domains — suicidal ideation, plan, means, intent, history, protective factors, and current context. For each: what to ask, what the answer tells you, and how it weighs in the overall picture.
Ideation type classification — passive, active non-specific, active with plan, and active with intent. What each level looks like and what it means for the clinical response.
Risk stratification guide — specific criteria for low, moderate, and high risk, with the appropriate clinical response at each level. Includes decision criteria for when hospitalization should be considered.
Means restriction conversation — how to raise means restriction collaboratively with clients, with specific language for firearms and medications. This is an underused direct safety intervention.
Safety plan format — a six-step collaborative safety plan built in session: warning signs, internal coping, social distraction, who to tell, professional contacts, means restriction.
Documentation language — example note language that reflects clinical reasoning, not just conclusions. What your documentation needs to include and why.
Columbia Protocol (C-SSRS) overview — the gold-standard clinical screen at a glance, with the specific ideation items that constitute high-risk indicators.