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As a therapist, those sessions where you sense that a client is holding something heavy (maybe it’s in their body language or hearing a statement that sounds like defeat) can be so subtle and at the same time gut-wrenching. I know that especially in my early years as a therapist it wasn’t always easy to know how to respond or navigate. The topic at hand can feel complex, but through my years of experience I know how important the role of suicide assessment tools is in clinical practice.

Suicide assessment tools offer structure and guidance when clarity is most needed. Let’s talk through how suicide assessment tools can support clinical decision-making in practice and how to use them without losing the human connection…

Why Suicide Assessment Tools Matter

I know there can be some opinions surrounding using suicide assessment tools feeling impersonal or cold at times. But the tools are to give you confidence when walking through some really tough moments. The right tool can help you ask the hard questions more effectively. They offer a framework when your nervous system might be fluttering with a little anxiety, and they ensure you’re not missing key pieces of information that are important for clinical care.

Suicide Assessment Tools aren’t only about liability, either (though let’s be real, they help there too). They’re about safety, clarity, and ensuring that you and your client are on the same page about what’s going on.

Common Suicide Assessment Tools

There are several standardized suicide assessment tools that have become essential in clinical practice. Here’s a brief overview of a few I keep in my toolbox:

#1- Columbia-Suicide Severity Rating Scale (C-SSRS)

This one is widely used and it helps identify whether someone has suicidal ideation, a plan, intent, or previous attempts. The language is straightforward and meant to help assess for risk in those crisis moments.

#2- Beck Scale for Suicide Ideation (BSS)

The Beck Scale is more structured and best used when you have an established relationship with the client. It helps quantify the severity of suicidal thoughts and can be tracked over time.

#3- Patient Health Questionnaire-9 (PHQ-9)

While the PHQ-9 is primarily a depression screening tool, Item 9 specifically asks about suicidal ideation. This makes it a helpful tool for flagging potential risk. I always have incoming clients complete this scale so I’m prepared to safety plan if needed in the intake appointment.

When to Use a Suicide Assessment Tool

There’s no one-size-fits-all rule for when to introduce a suicide assessment tool, but in my practice, here are some instances where it’s warranted:

• When a client expresses suicidal thoughts or hopelessness
• After a significant life stressor or traumatic event
• During intake when reviewing a client’s history
• When something in my gut tells me to check-in a little more intentionally

The tool helps start the conversation, but it’s your clinical judgement that tells you when to use it!

Getting Comfy with Suicide Assessment

When first gaining experience in practice it’s so normal to worry that pulling out a formal suicide assessment tool might make clients feel scrutinized or shut down emotionally. BUT I’ve learned that delivery can make a big impact on how it feels for a client. If you say, “Hey, I care about your safety and I want to ask a few questions to understand how you’re feeling so we can figure out the next steps together,” it lands differently than if you silently check boxes on a form.

In these conversations it’s important to stay connected and let your client know you’re not trying to put them in a box. You’re just trying to get a clearer picture so they don’t have to hold the weight alone.

Incorporating Safety Planning

When done with care, suicide assessment doesn’t end with identifying risk alone. As therapists, we are responsible for creating a plan with the client to ensure safety. Here’s some really important parts of safety planning to consider…

#1 – Warning signs
This could include changes in sleep patterns, withdrawing from loved ones, skipping meals, or losing interest in things typically enjoyed. When safety planning, help the client identify their own personal ‘red flags’ (physical sensations, emotional cues, or thoughts that tend to show up when they’re headed toward a crisis point). You want to make these as specific and observable as possible. The clearer they are, the easier it is for clients to recognize when to put the safety plan into motion.

#2- Internal coping skills
These are tools the client can use on their own before involving others. Think of things like taking a walk, journaling, practicing a breathing exercise, coloring, etc. It’s helpful to identify strategies that are easily accessible and calming. Sometimes a client might not have any identifiable and you may need to help suggest some here! 

#3- Social supports
We want to name specific people here (not just “friends” or “family”). Who is the person they’d feel comfortable texting or calling if they were struggling? It might be a roommate, a sibling, a trusted coworker, or a friend. 

#4- Professional resources
It’s important to include a section is listing the formal supports available to clients in times of crisis, such as therapists (boundaries can look different here depending on the clinical setting!), psychiatrists, 24/7 crisis services, Suicide & Crisis Lifeline, walk-in mental health centers, and the nearest emergency room. You are helping the client to build a reliable and easy-to-follow support system so that in moments of overwhelm they have clear steps to follow rather than scrambling to try and find the information! 

#5- Making a safe environment
This part can feel heavy, but it’s super important. Talk about ways to make the client’s environment safer. That might mean locking up medications, storing firearms outside the home, or giving car keys or sharp objects to someone they trust. This is helpful for creating space between impulse and action.

I have truly found that using a safety plan template helps the client feel empowered. They can safely walk away with a game plan and know you’re in their corner. It also creates documentation that you’re addressing risk collaboratively and thoroughly.

Documentation and the Legal Side

Let’s talk logistics for a minute. Suicide assessment tools help protect you legally. They provide documentation that shows you took reasonable steps to assess and address risk. If you ever find yourself needing to justify your clinical decisions (hopefully you won’t, but it happens), having clear, dated, and thorough notes makes all the difference. When using suicide assessment tools I always ensure I document not just the scores or outcomes, but the context, my impressions, and what actions were taken. This might include:

• Results of the assessment
• Client quotes that display risk or protective factors
• Safety planning steps taken
• Whether the client was referred for higher levels of care/third party involvement

If you’re new to using these tools it’s totally okay to feel unsure! My encouragement would be to start by familiarizing yourself with a couple of the essentials. Practice integrating them into sessions before the moment feels high-stakes…someone doesn’t have to be in crisis for a safety plan or assessment to take place. The more you use them, the more natural it becomes over time.

Suicide Assessment Tools and EMDR Therapy

If you’re an EMDR therapist like me then you might be curious about how these tools fit into the EMDR process. Especially when it comes to the preparation phase, suicide assessment tools are incredibly helpful. Client readiness is so important when it comes to EMDR. When a client is emotionally dysregulated or expressing passive suicidal ideation, you may need to check-in and assess for safety. A solid assessment gives you the confidence to know whether the client is ready for deeper work or if you need to shift focus to stabilization and safety planning.

Final Thoughts

Suicide assessment tools are NOT a substitute for your therapeutic presence. However, hopefully after reading this post you will agree that they absolutely can enhance it. They give you stabilization when the conversation gets heavy, and they show your clients that their life matters enough to talk about the hard stuff openly!

In my experience clients appreciate the clarity and structure these tools bring…especially when paired with warmth, curiosity, and compassion. You don’t have to choose between being human and being clinical. The best therapists are both. 

I’m passionate about equipping therapists with the most effective tools for clinical work. If you’re looking for tools to help you build your confidence when working with risk in session, I’ve put together a curated collection of risk and safety resources. These resources streamline your workflow while ensuring your documentation is both thorough and compliant.

Explore them here: mindemics.co/risk-and-safety-tools. Let’s keep doing the brave work!