How to Perform a Suicide Risk Assessment

More documented suicides occur now than in the last 80 years. Starting in the late 1990s, suicide rates have steadily ticked upward, driven by a cocktail of world events and social media usage. Now, nearly 50,000 people lose their lives to suicide every year, a number not seen since 1941, when World War 2 was impacting people’s lives. Preteens, adolescents, and older people are especially at-risk, as are Indigenous people. So, knowing how to perform a suicide risk assessment is essential, even if you’re not a mental health professional.

In this article, you’ll learn:

• What a suicide risk assessment is
• Who needs a suicide risk assessment
• How to perform a suicide risk assessment
• What actions to take if someone is suicidal
• What are some commonly-used suicide risk assessments

What Is a Suicide Risk Assessment?

Suicide risk assessments include any evaluation that determines whether someone is at-risk for attempting to take their own life.

These assessments usually include several components that ask crucial questions in different ways. For example, the person may ask both “Do you have a plan to kill yourself?” and “Have you ever wished you could go to bed and not wake up in the morning?” Asking a variety of questions in different ways helps you gain more information on the specifics of the person’s suicidal thoughts. That way, you can determine what type of treatment they need (more on this later).

In addition, a suicide risk assessment usually asks the person if they self-harm (cutting, hair-pulling, burning, punching something in order to inflict self-harm, etc.). Self-harm is not always indicative of suicide risk, but it can be. If the person indicates they self-harm, ask them whether they self-harmed with the intent to die or to distract themselves from emotional pain.

Who Needs a Suicide Risk Assessment

A suicide risk assessment should be performed any time someone does any of the following:

• Makes a statement indicating they want to die (including, but not limited to, “I just want to kill myself”, “I don’t want to be here any more”, “What’s the point of going on?”, etc.). All statements should be taken seriously, even if the person has a history of lying or attention-seeking behaviors
• Says they feel hopeless
• Self-harms
• Starts showing signs of suicide (such as saying goodbye to friends and family, writing notes, parting with possessions, making arrangements for the care of pets and children, etc.)
• States they feel like a burden
• Has a history of suicidal ideations or attempts, especially if the ideations or attempts were recent.
• Starts obtaining lethal means, including, but not limited to, pills or weapons

How to Perform a Suicide Risk Assessment

For the purposes of this article, we’ll talk about two different types of suicide risk assessments: ones you can give any time, anywhere, and ones you need a form to be able to complete.

In general, we recommend everyone learn how to perform the former assessment, while mental health professionals will more commonly use the latter.

Performing an Assessment for Non-Therapists

1. Ask the Person If They’re Suicidal 

The first and most important part of any suicide assessment involves asking the person outright if they’re suicidal. When you do this, be direct in your language. Say something like, “Are you wanting to kill yourself?” or “Do you have suicidal thoughts?”

Some people mistakenly believe bringing up suicide will cause the person to think about it and then maybe act on it. However, research shows people aren’t more likely to attempt to take their lives in these situations. In fact, asking directly actually saves lives because it leaves little room for misinterpretation. So, you’re more likely to get an accurate answer.

After asking this question, ask these follow-ups:

• Have you ever thought you or your family would be better off if you were dead?
• Have you ever thought you were a burden to those around you?
• Do you ever go to sleep and hope you don’t wake up in the morning?

If they say, “No” to all of these questions skip to step 3. If they say, “Yes” to even one, move to the next section.

Asking someone if they have a plan to kill themselves can prove intimidating. So, practice saying it out loud a few times so you can say it when you need to. Remember that even though the words are uncomfortable, they’re part of a life-saving, emergency procedure.

2. Ask If They Have a Plan

Once someone confirms they have suicidal thoughts, you’ll want to ask them whether they have a plan to kill themselves. Plans can include a variety of things, including taking pills, using a weapon, jumping off a high place, etc.

If they do have a plan, take action immediately. Remove any dangerous items from their person and/or their surroundings. Do not let them out of your sight and take them to the nearest mental health hospital or emergency room. If they resist going to the hospital, call 911 or 988 if you’re in the U.S.

3. Get Help and Create a Safety Plan

If they don’t have a plan, you still need to take action as quickly as possible. Set them up with an appointment with a therapist and remove all dangerous items from their home or immediate vicinity. Help them come up with a safety plan, which consists of written down things they can do and people they can call (including emergency numbers) if their thoughts become more intense.

You’ll want to create a safety plan with someone who has a plan as well, even if you need to wait until after they’re discharged from the hospital. Often, hospitals help their patients create safety plans, too.

If you’re worried about remembering all of this, keeps the SAFE-T Pocket Card with you! It provides brief but thorough instructions on providing the assessment.

Therapist-Used Assessments

If you’re a therapist or someone curious about learning to do official suicide assessments, you’ll want to familiarize yourself with the following assessments:

• The Suicide Risk Screening Tool (ASQ)
• Columbia Suicide Severity Rating Scale (C-SSRS)

Suicide Risk Screening Tool (ASQ)

The Suicide Risk Screening Tool is used in many therapeutic practices and is useful for both its brevity and its clear and direct instructions.

It consists of 5 quick questions, each of which is designed to determine suicide risk level. Answering “no” to all the questions will yield a negative screening result, meaning the person is not likely to be an immediate risk. Responding “yes” to questions 1-4 indicates a positive test result, and the immediacy of the risk must then be determined.

The 5th question asks whether the person is currently experiencing suicidal thoughts. If the person replies “Yes,” they’re considered an acute positive screen and need to be further assessed. If the person responds “Yes” to questions 1-4 but responds “No” to the 5th question, they’re still a positive screen but are not likely to be in immediate danger. However, they should still receive non-emergency treatment.

Columbia Suicide Severity Rating Scale (C-SSRS)

The Columbia Suicide Severity Rating Scale is a longer, more in-depth suicide assessment that delves into the person’s history of suicidal ideation and self-harm. The C-SSRS identifies current suicidal thoughts and asks whether the person has a plan.

In addition, the C-SSRS asks whether the person has a history of suicide attempts. If the person says that they have attempted in the past, they may be more likely to attempt in the future.

Getting Mental Health Care

Because of rising suicide rates, we all probably know someone who needs a suicide risk assessment. So, knowing how to do one is crucial.

Regardless of whether someone goes to the hospital for suicidal thoughts, procuring mental health care for them is absolutely essential. Learn more about how to find a good mental health professional!