Suicide Risk Screening Indicated
Patient presents with concern for suicide risk
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PsychiatryEmergency
Suicide Risk Assessment & Management (C-SSRS)
Suicide Risk Assessment & Management (C-SSRS): Suicide Risk Screening Indicated → Wish to be Dead or Suicidal Thoughts? → No Current Ideation → Recent S...
Pathway Overview
16 steps
Algorithm Steps
16 total
01Start 02Decision Wish to be Dead or Suicidal Thoughts?
C-SSRS Questions 1-2: In the past month...
- Q1: Have you wished you were dead or wished you could go to sleep and not wake up?
- Q2: Have you actually had any thoughts of killing yourself?
03Action No Current Ideation
Screen negative for current suicidal ideation
- Document negative screen
- Consider protective factors
- Address presenting concerns
- Provide crisis resources (988 Suicide & Crisis Lifeline)
04Decision Recent Suicidal Behavior?
C-SSRS Behavior Questions (Lifetime/Past 3 months)
- Actual attempt: Did you do anything to hurt yourself?
- Interrupted attempt: Started to do something but were stopped?
- Aborted attempt: Took steps but stopped yourself?
- Preparatory behavior: Took steps toward making an attempt?
05Action Assess Risk & Protective Factors
Comprehensive risk assessment
- RISK: Prior attempts, psychiatric diagnosis, substance use, hopelessness, isolation, access to means, recent loss, chronic pain
- PROTECTIVE: Social support, reasons for living, children, religious beliefs, treatment engagement, future orientation
06Decision Determine Risk Level
Integrate all assessment findings
07Warning HIGH RISK
Psychiatric hospitalization indicated
- Active suicidal ideation with plan AND intent
- Recent attempt (especially high-lethality)
- Unable to commit to safety
- Severe psychiatric symptoms
- Intoxication with suicidal ideation
08Action Psychiatric Hospitalization
Inpatient admission for safety
- Continuous observation (1:1 if needed)
- Remove access to means
- Voluntary vs. involuntary hold
- Consult psychiatry for admission
- Document capacity if refusing
09Outcome Disposition & Follow-up
Ensure continuity of care
- Schedule follow-up within 24-72 hours
- Provide 988 Lifeline number
- Confirm crisis resources understood
- Communicate with outpatient providers
10Action MODERATE RISK
Intensive outpatient or partial hospitalization
- Suicidal ideation without imminent plan/intent
- Chronic ideation with current stressor
- Able to commit to safety plan
- Social support available
- Engaged with treatment
11Action Create Safety Plan
Stanley-Brown Safety Planning Intervention
- 1. Warning signs (thoughts, images, mood, situation, behavior)
- 2. Internal coping strategies
- 3. People/social settings for distraction
- 4. People to ask for help
- 5. Professionals/agencies to contact
- 6. Making the environment safe (means restriction)
12Warning ⚠️ Means Restriction Counseling
CRITICAL for all risk levels
- Firearms: Temporarily store outside home
- Medications: Lock up, limit quantities
- Other means: Individualized plan
- Involve family/support person
- Document counseling provided
- Path rejoins step 09Shared downstream outcome
13Action LOW RISK
Outpatient management with safety plan
- Passive ideation only
- No prior attempts
- Strong protective factors
- Good social support
- Engaged in treatment
- Path rejoins step 11Shared downstream outcome
14Decision Suicidal Thoughts with Method, Intent, or Plan?
C-SSRS Questions 3-5
- Q3: Have you been thinking about how you might do this?
- Q4: Have you had these thoughts and had some intention of acting on them?
- Q5: Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
15Action Passive Ideation Only
Thoughts without method, intent, or plan
- Lower acute risk but requires assessment
- Assess chronicity and frequency
- Evaluate protective factors
- Consider outpatient management if safe
- Path rejoins step 04Shared downstream outcome
16Warning ⚠️ Active Ideation with Plan/Intent
HIGH RISK - Immediate intervention required
- Method identified
- Intent to act
- Specific plan formulated
- Means access present
- Path rejoins step 04Shared downstream outcome
Guideline Source
Columbia-Suicide Severity Rating Scale (C-SSRS) and APA Practice Guideline for Assessment and Treatment of Patients with Suicidal Behaviors
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Clinical judgment essential - algorithm supports but does not replace assessment
- Patient may minimize or deny suicidal ideation
- Cultural factors may influence disclosure
- Collateral information critical when available
- Acute risk can change rapidly
- Local commitment/hold laws vary by jurisdiction
Applicable Regions
USEUGlobal
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Suicide Risk Assessment & Management (C-SSRS)?
The Suicide Risk Assessment & Management (C-SSRS) is a emergency clinical algorithm for Psychiatry. It provides a structured decision tree to guide clinical decision-making, based on Columbia-Suicide Severity Rating Scale (C-SSRS) and APA Practice Guideline for Assessment and Treatment of Patients with Suicidal Behaviors.
What guideline is the Suicide Risk Assessment & Management (C-SSRS) based on?
This algorithm is based on Columbia-Suicide Severity Rating Scale (C-SSRS) and APA Practice Guideline for Assessment and Treatment of Patients with Suicidal Behaviors (DOI: 10.1176/appi.ajp.2010.10020256).
What are the limitations of the Suicide Risk Assessment & Management (C-SSRS)?
Known limitations include: Clinical judgment essential - algorithm supports but does not replace assessment; Patient may minimize or deny suicidal ideation; Cultural factors may influence disclosure; Collateral information critical when available; Acute risk can change rapidly; Local commitment/hold laws vary by jurisdiction. Individual patient factors may require deviation from these recommendations.
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