Suicide Risk Screening & Assessment
A Resource Guide for Mental Health & Helping Professionals
Suicide prevention requires more than documenting whether a client answered “yes” or “no” to suicidal ideation.
Effective suicide-risk care involves recognizing changes in presentation, asking directly about suicidal thoughts and behaviors, differentiating levels of risk, identifying protective and vulnerability factors, assessing access to lethal means, developing an appropriate safety response, documenting clinical reasoning, and reassessing risk as circumstances change.
Screening Is Not the Same as Assessment
A brief suicide-risk screener helps identify individuals who may require additional assessment.
A positive screen should generally prompt further clinical assessment rather than automatically determining someone's level of risk or disposition.
Likewise, a negative screening result should not replace clinical judgment when other aspects of the person's presentation raise concern.
Evidence-Informed Screening Resources
Ask Suicide-Screening Questions (ASQ)
Developed by the National Institute of Mental Health, the ASQ consists of four brief screening questions and can be used with youth and adults. NIMH also provides clinical pathways and Brief Suicide Safety Assessment resources for individuals who screen positive.
Columbia-Suicide Severity Rating Scale (C-SSRS)
The Columbia Protocol provides structured questions for identifying and characterizing suicidal ideation and suicidal behavior. Versions and supporting materials are available for healthcare, behavioral health, schools, first responders, community settings, and other environments.
Following a Positive Screen
Depending upon your setting, population, scope of practice, and the individual's presentation, further assessment may include exploration of:
Passive thoughts of death versus active suicidal ideation
Frequency of suicidal thoughts
Duration
Intensity
Controllability
Suicidal method
Access to the identified method
Development of a plan
Suicidal intent
Preparatory behaviors
Previous suicide attempts
History of nonsuicidal self-injury
Recent changes in symptoms or functioning
Hopelessness
Agitation or impulsivity
Substance use or intoxication
Significant losses, trauma, pain, medical concerns, or other acute stressors
Access to lethal means
Reasons for living
Protective factors and supports
Willingness and ability to engage in safety planning
Ability to maintain safety at the current level of care
Risk assessment should integrate the person's current presentation, history, clinical context, and professional judgment rather than relying solely upon a numerical score or risk label.
From Assessment to Clinical Risk Formulation
Suicide risk formulation involves integrating the information gathered during assessment rather than relying on a single response, screening result, or numerical score.
Clinicians may consider the individual's current/acute risk, as well as factors contributing to longer-term or chronic vulnerability.
A clinical formulation should help answer:
• What is occurring right now that increases or decreases risk?
• How does the person's current presentation compare with their baseline?
• What historical factors contribute to longer-term vulnerability?
• What protective factors and reasons for living are currently present?
• Is the person able and willing to participate in safety planning?
• Can risk reasonably be managed at the current level of care?
• What follow-up, consultation, intervention, or escalation is indicated?
Risk formulation should inform the clinical response rather than functioning solely as a label such as “low,” “moderate,” or “high.”
Safety Planning
When clinically appropriate, collaborative safety planning may include:
Identifying personal warning signs.
Identifying internal coping strategies.
Identifying people or environments that provide distraction or connection.
Identifying people the individual can directly ask for help.
Identifying professional and crisis resources.
Reducing access to lethal means.
A safety plan should be individualized and practically usable during periods of increased distress.
Lethal-Means Safety
When suicide risk is present, clinicians should consider whether the individual has access to firearms, medications, or other potentially lethal means.
Means-safety conversations should be direct, collaborative, and focused on creating additional time and distance between a suicidal crisis and access to a lethal method.
Documentation
Clinical documentation should reflect what was actually assessed and the reasoning supporting the treatment/disposition decision.
Depending upon the encounter, documentation may include:
Suicidal ideation and behavior assessed
Passive versus active ideation
Method, plan, intent, and preparatory behavior
Frequency, duration, intensity, and controllability when clinically relevant
Previous attempts/NSSI
Acute and chronic risk factors
Protective factors/reasons for living
Access to lethal means
Means-safety interventions
Safety planning
Crisis resources provided
Client's engagement and ability/willingness to follow the plan
Clinical risk formulation
Rationale for outpatient treatment or escalation to a higher level of care
Follow-up and reassessment plan
Avoid documenting assessments that were not actually completed.
Free Professional Resources
National Institute of Mental Health – ASQ Toolkit
Free screening tools, adult and youth materials, Brief Suicide Safety Assessment guides, clinical pathways, translations, and training resources.
Columbia Lighthouse Project – C-SSRS
Free Columbia Protocol screening and assessment resources, training materials, and versions adapted to multiple professional and community settings.
Zero Suicide Toolkit
A systems-level resource addressing identification, engagement, treatment, transitions, workforce training, and continuous quality improvement in suicide-safe care.
988 Suicide & Crisis Lifeline
Crisis support is available 24/7 by calling or texting 988 in the United States. Professionals and loved ones can also contact 988 when seeking assistance for someone else.
A Note for Professionals
A screening instrument can support clinical practice.
It cannot replace clinical judgment, an individualized assessment, appropriate consultation, or emergency intervention when indicated.
When someone's presentation falls outside your competence, scope, or available level of care, consultation and appropriate escalation are part of responsible suicide-prevention practice.
Larson North Point Counseling
Trauma-informed mental health services, clinical evaluations, consultation, and professional resources.
This resource is provided for educational purposes and is not a substitute for individualized clinical assessment, supervision, legal advice, emergency services, or an organization's policies and procedures.
Prepared by Carmen Larson, LCSW, MSW
Licensed Clinical Social Worker | Larson North Point Counseling
Last reviewed: September 2026
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