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Suicide assessment checklist (Associate Handbook)

Audience: Associates
Goal: Provide a quick, consistent checklist when suicidal ideation is present or suspected.

This is a practical checklist, not clinical/legal advice. Use professional judgment and follow local laws/standards. When in doubt, escalate early.

1) First: determine immediacy (acute vs non-acute)

Acute / high-immediacy risk (act now)

If you believe there is immediate danger (e.g., active intent with plan/means, imminent timeframe, inability to commit to safety, you cannot ensure safety):

  • Stay with the client (do not abruptly end the contact if avoidable).
  • Call 911 (or local emergency services) if needed.
  • Contact Katherine immediately as soon as it is safe to do so.
  • Document your assessment and actions in JaneApp (see documentation checklist).

Non-acute but concerning (same-day escalation)

If suicidal thoughts are present but not imminent:

  • Complete assessment (below)
  • Develop a safety plan (below)
  • Report to Katherine the same day
  • Document in JaneApp

2) Core assessment questions (minimum)

Use direct, calm language. You can adapt wording to your style.

  • Ideation: “Have you had thoughts about wanting to die or killing yourself?”
  • Frequency / intensity: “How often? How intense are the thoughts?”
  • Plan: “Have you thought about how you would do it?”
  • Intent: “Do you feel you might act on these thoughts?”
  • Timeframe: “When would you do this?” / “Have you set a time?”
  • Means / access: “Do you have access to [means]?” (medications, weapons, etc.)
  • Past behavior: “Have you ever attempted suicide before?” / “Any self-harm history?”
  • Substances / disinhibition: “Any alcohol/drug use recently that affects control?”
  • Protective factors: reasons for living, supports, responsibilities, beliefs, therapeutic alliance
  • Supports: “Who can you contact today?” “Are you alone?” “Who is nearby?”

3) Triage (simple decision support)

Higher risk indicators (not exhaustive):

  • active intent
  • specific plan
  • access to means (means are dangerous or deadly)
  • near-term timeframe
  • escalating hopelessness, agitation, severe symptoms
  • close friend or family member has died by suicide in the past
  • intoxication / impaired judgment
  • inability/unwillingness to use supports or commit to a safety plan

If multiple higher-risk indicators are present, treat as urgent and escalate immediately (see section 1).

4) Safety plan (minimum elements)

If not acute/emergent, create a collaborative plan:

  • Identify warning signs (what cues the spiral)
  • Internal coping strategies (grounding, distraction, self-soothing)
  • People/places for distraction/support (names + numbers)
  • Professional supports (clinic contact, crisis lines per local norms)
  • Reduce access to means (as appropriate)
  • Confirm immediate next steps (e.g., check-in time, next appointment, contact plan)

Safety plan template:

If you use a “Safety and no harm agreement”:

  • Please use it only as an adjunct; do not treat it as a substitute for a safety plan or escalation.
  • Template: No harm contract template

5) Who to contact (clinic)

  • Urgent clinical safety concerns: Katherine
  • Admin/logistics: admin

6) What to document (minimum)

In JaneApp, document (as applicable):

  • what prompted the assessment (client statements, presentation)
  • ideation/plan/intent/timeframe/means (yes/no + brief details)
  • protective factors and supports
  • your clinical judgment of risk level (brief)
  • actions taken (safety plan, emergency services, consult)
  • who you contacted (Katherine/admin/911) + times
  • follow-up plan (next session timing, check-in, referrals/resources)