This is for therapists to learn how to talk about suicide with your patients, primarily the assessment.

There are different types of assessments that one can use for suicide risk. The best scale for suicide ideation that is very well researched is Columbia suicide severity rating scale. The full version of this is about four pages, there’s also a triage version a quick to gage where your client is at and get a lot of detail.

So, the triage is just where things are right now, it lets the therapist asses the risk if you don’t have a lot of time. Otherwise, you go through, and you can have a really in-depth conversation about your patient’s suicidality.

The triage version is basically just doing the first half of the first page, questions like have you wished you were dead? Do you wish you could go to sleep and not wake up? Have you had any thoughts about killing yourself? Have you thought about how you might do this? Do you have any intention of acting on these thoughts, as opposed to having the thoughts but definitely would not do it? Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan? Have you done anything, started to do anything, or are prepared to do anything to end your life?

This is the quick triage version, this is looking at thoughts, plans, and means. This helps you determine whether or not they’re an immediate risk, medium risk, and where to go from there.

Let’s talk about the more in-depth version. If someone says they’ve wished to be dead and never to wake up, you get your client to express their emotions. You want them to bring this up and then you just immediately react. You want to understand them that in itself is helpful, that’s why crisis lines can be helpful.

You do that with each of these types of clients, and for some there might be some more things to ask. For example, frequency, how many times have they had these thoughts. Can they stop thinking about killing themselves if they wanted to. When they have these thoughts how long do they last?

That’s very telling if someone says, “oh you know it comes up a lot, but it’s gone within a few seconds”. That’s much different than “I was lying in bed for eight hours and I knew if I got out of bed I would overdose, so I laid in bed for eight hours until I could get out of bed and not”. That is a different type of risk.

In this assessment these are some of the questions. It has the frequency, the duration, the controllability, and deterrence. Are there things that have stopped them in the past or can stop them now? Do they have children or certain beliefs? Also, working out the reasons for the ideation. What sort of reasons did you have for thinking about wanting to die? Was it to end the pain, or to stop the way you were feeling? A lot of times it’s just to stop the pain, so this is the intensity of the ideation portion. Then there’s asking about past behaviors. Have you made suicide attempts? Have you done anything to harm yourself? What did you do? Did you do it for other reasons?

That’s an important thing to talk about whether they’ve had attempts, or aborted attempts. This assessment is in public domain, so do you do afterwards because you’re going to go through all this. You’re going to get a lot of details but it’s not going to tell you what to do.

There is something else you can get from this; you can learn how to score it, and then how to make meaning from it. It will refer you to something else and then you go look at that something else. Once you read that it says to make a clinical judgment, so ultimately it comes down to your clinical judgment. What risk someone is, and if someone is immediate risk, you’re going to need to do something.

Someone can have thoughts and they won’t be high risk. I kind of have my rule of thumb if they answer four questions as yes and are an immediate risk you should act. If they just answer two with yes, they have thoughts about a plan, but they don’t intend to do it. They haven’t done it in the past and it’s something they fantasize about, that’s a risk, but it’s not immediate.

You’re going to want to become familiar with this assessment to determine if someone is as high risk.

If you want to watch this video visit Preston Walker Guides Therapists in Assessing Suicidality | Signs of Suicide | Suicide Assessment | – YouTube