Suicide Risk

Suicide risk is a clinical formulation, not a permanent label or a diagnosis. It brings together the client’s current suicidal thoughts and behaviour, intent, access to means, recent actions, previous attempts, mental state, stressors, and available protection. The formulation can change rapidly; a client who denied intent in the morning may become unsafe after receiving devastating news, becoming intoxicated, or losing access to a key support. Ask directly and calmly: “Are you thinking about killing yourself?” If the answer is yes, clarify what the client has imagined, whether they intend to act, whether they have access to the method, and when they might act. Direct questioning does not plant the idea. Avoiding the subject can leave the most dangerous information undiscovered. A client who says, “I wish I would not wake up,” has expressed a passive death wish, but that statement is not a sufficient assessment. Ask whether the client has moved from wishing to be dead to thinking about causing death, and then assess intent, method, access, timing, and preparatory steps. The wording matters because risk is determined by...