Screening and Clinical Risk Assessment for Suicide and Self-directed Violence.

Most patients who die by suicide receive care outside mental or behavioral health settings in the year before their deaths. As such, effective suicide prevention efforts require screening and assessment of suicide risk broadly across treatment settings, not just within mental health services. Clinical suicide risk assessment (CSRA) is also a fundamental component of therapeutic risk management. This column provides an approach for suicide risk screening and assessment that is consistent with current best practices and applicable guidelines. Theoretical, empirical, and practical considerations for suicide risk screening and CSRA processes are reviewed. Specific topic areas include therapeutic alliance and goal setting, suicidal ideation and behaviors, risk and protective factors, warning signs, and providing assessment feedback. CSRA is framed as a method for gathering information, as well as a form of brief therapeutic intervention. In doing so, the CSRA can inform future treatment decisions, as well as directly mitigate risk, by helping the patient and provider better understand the patient's suicidal ideation and behaviors.