Suicide risk assessment

Current evidence consistently shows that suicide cannot in fact be reliably predicted using risk factors, scales or categorical risk labels (eg “low/medium/high risk”)⁴⁰, therefore suicide risk assessment is no longer just about trying to predict suicide. In 2026, it is a collaborative, therapeutic process that supports clinical understanding, safety planning and care decisions. For these reasons, a patient experiencing suicidal distress needs an effective care plan that is informed by a comprehensive, person-centred assessment that explores their suicidal thoughts and behaviours openly, directly and compassionately. It’s therefore important to understand that asking about suicide does not increase suicidal ideation or risk, but is, in fact, associated with improved disclosure and engagement in care⁴¹.

A suicide risk assessment is a structured but flexible clinical conversation that collects key information about:

• the patient’s current mental state and level of distress
• the presence, frequency and intensity of suicidal thoughts
• any plans, intent, access to means, or preparatory behaviours on their part
• current and historical risk factors, including previous self-harm or suicide attempts
• precipitating stressors, including health, relationship, financial, legal or occupational pressures
• protective factors, such as reasons for living, relationships, cultural or spiritual supports
• available supports and the patient’s willingness to engage with them.

Risk is understood as dynamic and context-dependent, something that changes with a patient’s circumstances, supports and stressors. This is why best practice emphasises understanding the individual person, right at that time, rather than assigning a static level of risk.

You should consider completing a suicide risk assessment whenever there are concerns about elevated risk, including when a patient:

• expresses hopelessness, feeling like a burden, or feeling trapped
• presents with depression, anxiety, substance use or significant psychological distress
• experiences major life stressors (eg relationship breakdown, bereavement, chronic illness, legal or financial stress)
• has a history of self-harm or suicide attempts
• shows marked changes in mood, behaviour or engagement with care.

Some patients will disclose suicidal thoughts spontaneously, while others may require gentle or explicit enquiry. A helpful, evidence-based opening question could be something like, “With everything that’s been going on, have you had thoughts that life isn’t worth living, or thought about harming yourself?”

Validated tools can support, but must not replace, clinical judgment and therapeutic engagement. These tools are most useful for:

• guiding consistent enquiry
• supporting the documentation of the risk assessment
• facilitating communication across the care team.

In Australia, you can use structured tools to help you organise assessment information and identify areas requiring further exploration. However, no tool can accurately predict suicide, and you should never use scores by themselves to determine risk or make care decisions.

Current best practice recommends that assessment findings can be used to develop a shared understanding of risk and safety, but need to be followed with active patient management, including safety planning and follow-up.

When using tools, build in cultural safety (eg explain the purpose of the tool, offer an opt-out, consider using an interpreter or liaison, and avoid pathologising cultural expressions of distress).

Some risk assessment tools

General mental health assessment tools that might help you to establish a patient’s level of wellbeing include:

• STARS (Screening Tool for Assessing Risk of Suicide - www.griffith.edu.au/griffith-health/australian-institute-suicide-research-prevention/screening-tool-for-assessing-risk-of-suicide)
• PHQ-9 item 9 (as a trigger)
• ASQ (brief screening)
• C-SSRS (brief version)
• STARS (Australia)
• SAFE-T framework
• Risk formulation + safety planning.

Contemporary evidence indicates that suicide risk does not arise from any single factor: rather, it is the interaction of warning signs, long-term and current risk factors, protective factors, and situational stressors, all of which vary over time and context⁴². Therefore, the purpose of a suicide risk assessment is no longer to just assign a fixed level of risk, but to identify and plan timely, proportionate and person-centred action and treatment.

The assessment findings should directly inform decisions about:

• immediate needs to maintain a patient’s safety. Where there is uncertainty about immediate safety, or where suicidal distress is escalating, consultation with local crisis or specialist mental health services is recommended. Shared care and early advice can also help you to make other decisions and plan follow-ups for this patient.
• ongoing supports and interventions that are needed over the coming days and weeks. Depending on the patient’s current presentation, history, supports and preferences, you could consider one or more of the following:
  • urgent referral for specialist or crisis mental health assessment
  • same-day or early GP follow-up
  • collaboratively developing a safety plan
  • involving family, carers or trusted supports (with consent)
  • referral for non-urgent psychological or psychiatric care
  • increased community, peer or cultural supports.

Importantly, risk assessment should be viewed as an intervention in its own right. Open, empathetic discussion of suicidal thoughts can reduce isolation, strengthen the therapeutic relationship, and help patients feel heard and supported. Evidence indicates that such conversations can foster hope, engagement and a sense of safety, particularly when linked to clear next steps and follow-up.

The following table sets out what you need to find out in order to determine a patient’s risk. Typically, you would acquire this information during an open and respectful conversation.