Assessment and Management of Suicidal Risk

Despite recent advances in science and practice, suicide remains a leading cause of mortality. Managing patients at risk of suicide is a core competency for mental health practitioners but can be a complex and challenging task. Demographic, psychosocial, and diagnostic risk and protective factors for suicide have been identified, while the impact of the Covid-19 pandemic is starting to be understood. Knowledge of risk and protective factors informs the assessment of suicide risk. Assessing a suicidal patient requires rapport and includes an evaluation of suicidal ideation and behavior as well as psychosocial circumstances that may be contributing to risk. Management of suicide risk requires a comprehensive plan that focuses on immediate safety and addressing the factors driving risk, in the longer term. Evidence-based psychosocial and psychopharmacological treatment approaches that are associated with reductions in suicidal ideation and behavior are available. Safety planning intervention is a brief intervention that provides the patient with a set of coping resources for use leading up to or in a crisis. Psychological interventions including cognitive behavioral therapy for suicide prevention and dialectical behavior therapy are associated with reductions in suicide risk. Of the psychopharmacological approaches, clozapine has demonstrated capacity to reduce suicide risk, while intravenous ketamine and lithium show promise.