Suicide risk assessment and safety planning

The key ideas

• Suicide risk assessment

  Assess ideation, plan, intent, access to means and lethality, past attempts, hopelessness, substance use, protective factors and recent stressors; prior attempts and prior psychiatric hospitalization are among the strongest predictors of suicide death. Ask directly; asking does not plant the idea. Use structured tools such as the Columbia (C-SSRS) and document risk level and rationale.^[1][2]

• Stanley-Brown Safety Planning Intervention

  Brief collaborative written plan: 1) warning signs, 2) internal coping strategies, 3) people and places for distraction, 4) people to ask for help, 5) professionals and crisis lines (988), 6) making the environment safe (lethal means). Developed with the patient, kept accessible, and followed up; it is not a no-harm contract.^[4]

• Sequencing: safety before other interventions

  When a client is in danger (abuse, suicide, violence) the ASWB sample key puts safety planning ahead of referral to counseling or other later steps.^[3]

• Antidepressant black box warning (suicidality)

  FDA boxed warning: antidepressants increase the risk of suicidal thinking and behavior in children, adolescents and young adults 24 years of age and younger (under 25), especially early in treatment or after dose changes. Monitor closely, especially in the first weeks.^[5][6]

• Crisis and crisis intervention

  A crisis is an overwhelming event that exceeds coping; crisis intervention is short-term, aims to restore pre-crisis functioning and prevent lasting harm, and focuses on the here and now rather than long-term insight.^[7]

• Roberts seven-stage crisis intervention model

  Assess lethality and safety; establish rapport; identify major problems and precipitants; deal with feelings and emotions; explore alternatives; implement an action plan; follow up. Safety assessment always comes first.^[7]

How the ASWB exam tests it

• A plan with intent and access to means signals high risk; safety planning and means restriction follow. Do not rely on no-suicide contracts.^[1][2]
• Know the order of the steps. Making lethal means less accessible is step 6, and highly lethal means such as firearms are handled by a designated responsible person or police.^[4]
• When a shelter client plans to return to an abuser, the first step is a safety plan, not a referral to counseling.^[3]
• When a teen starts an antidepressant, watch for agitation and suicidal thinking and report them to the prescriber.^[5][6]
• Crisis work is short-term and problem-focused, with an active worker; it is not the time to explore childhood.^[7]
• Safety and lethality come before problem solving. Crisis work is brief, focused, and present-oriented.^[7]

Try a related question

1. LMSW practice · Assessment and Planning

   A 20-year-old client with a history of suicidal attempts reports nausea and headaches while taking fluoxetine (Prozac). During the session, the client states, 'I can’t take this anymore.' What should the social worker do FIRST?

   • A.Assess the client’s current level of suicidal ideation.
   • B.Recommend the client contact their prescribing psychiatrist.
   • C.Explore the client’s reasons for feeling unable to tolerate the medication.
   Show answer

   Answer: A. Assess the client’s current level of suicidal ideation.

   The phrase 'I can’t take this anymore' is a red flag and requires immediate assessment for suicidal ideation, especially given the client’s history of suicide attempts.

More LMSW practice questions with answers

Covered on other pages

• HIPAA serious threat to health or safety

  HIPAA permits (does not require) a provider, in good faith and consistent with applicable law and ethical standards, to disclose PHI believed necessary to prevent a serious and imminent threat, to people able to prevent or lessen it including the target. It also covers aiding law enforcement. Good faith is presumed when based on actual knowledge or credible representation.

Related explainers

• Duty to warn and duty to protect
• Motivational interviewing and stages of change
• Confidentiality and its limits