Headings
Reason for assessment · Current ideation · Plan, intent and means · History of attempts · Risk factors · Protective factors · Risk level · Safety plan · Follow-up
When to use it
Use it whenever a client discloses suicidal thoughts, a screener comes back positive, or you are asked to evaluate safety. It walks through ideation, plan, intent, means and history, then weighs risk against protective factors to set a risk level. It stands apart from a session note so the reasoning behind your safety decisions is easy to find later.
Example
Fictional example
Reason for assessment
W.A., 51, answered “several days” on PHQ-9 item 9 at a regular session, three weeks after losing his job.
Current ideation
Passive thoughts that his family “would be better off” with the life insurance. Fleeting, several times a week.
Plan, intent and means
Denies a plan or intent. Owns a handgun, stored locked in the garage.
History of attempts
No prior attempts. No history of self-harm.
Protective factors
Close to his two daughters. Active in church. Future oriented about job search.
Risk level
Low to moderate, based on new stressors and firearm access, offset by no plan or intent.
Safety plan
Written safety plan completed. Wife agreed to store the handgun at her brother’s home. Crisis line numbers given. Recheck at next session in one week.