Sign Up
Login
Try for Free
Login
A suicide risk assessment is the clinical documentation of how a clinician evaluated a client's suicide risk: the inquiry into ideation, plan, intent, and access to means, the risk and protective factors weighed, a risk formulation, and the actions taken. Mental health professionals document one at intake, when risk indicators emerge, and after a crisis. Most run 200 to 800 words, and the formulation must support the disposition.
Therapists, psychologists, counselors, clinical social workers, psychiatrists, psychiatric NPs, crisis clinicians
Treating team, supervisors, crisis and emergency services, auditors, licensing boards, legal reviewers
200 to 800 words · 10 to 25 minutes by hand (clinical team estimate)
Risk assessment documentation (compare: safety plan, crisis note, self-harm assessment)
At intake, when ideation or other risk indicators emerge, after a crisis or attempt, and at transitions in care
No mandated format; Joint Commission standards define the assessment domains in accredited settings, the clinical standard of care everywhere else
A suicide risk assessment is the clinical record of a suicide-specific evaluation: what the clinician asked and observed, how the findings were weighed, the risk formulation that resulted, and the actions taken in response. It is a younger document family than most note formats, and its structure comes from clinical frameworks rather than a single inventor. SAMHSA published SAFE-T, the five-step evaluation-and-triage framework conceived by Douglas Jacobs, in 2009, and documentation is its express fifth step (SAMHSA, updated December 2024). The Columbia Protocol, or C-SSRS, was developed by teams at Columbia, the University of Pennsylvania, and the University of Pittsburgh with NIMH support, with its multisite validation published by Posner and colleagues in 2011 (Columbia Lighthouse Project). Clinicians and payers also say SRA, suicide assessment, suicide inquiry, brief suicide safety assessment, and suicide risk formulation. Whatever the name, the instrument is not the note: a completed screener can sit in the chart, but a score does not explain a disposition.
Three distinctions carry most of the compliance weight. Screening is a brief case-finding step; assessment is the suicide-specific clinical inquiry a positive screen or disclosure triggers; formulation is the clinician's synthesis that connects the findings to the plan. No statute in the US, Canada, or Australia prescribes a universal template for any of them. The strongest explicit documentation requirements are accreditor standards, and the citation changed in 2026: Joint Commission's hospital requirements moved into National Performance Goal NPG.08.01.01 on January 1, 2026, while behavioral health organizations remain under NPSG.15.01.01, so guidance citing one number for every setting is out of date. In covered settings the assessment must directly address suicidal ideation, plan, intent, suicidal or self-harm behaviors, risk factors, and protective factors, with the overall risk level and mitigation plan documented; a validated tool is encouraged but no tool is mandated by name (Joint Commission FAQ, updated April 2026). Outside accredited organizations, licensing-board record standards and the clinical standard of care expect the same reconstruction, which is why this page treats the structure as one document type. It records the evaluation; the crisis note records an urgent encounter, and a safety plan is a separate intervention document the assessment often produces.
Every licensed mental health discipline documents them: therapists, psychologists, counselors, clinical social workers, psychiatrists, and psychiatric NPs, along with ED and primary care teams that screen. In outpatient practice the trigger is usually a positive screen (an elevated PHQ-9 item 9, a C-SSRS screen) or an in-session disclosure; in hospitals and EDs, accreditation requirements build the assessment into the workflow for behavioral health presentations. The document also anchors specific moments in care: intake, a crisis encounter, a return from hospitalization, and other transitions. A risk assessment is the evaluation record; when the encounter itself was crisis psychotherapy, the crisis note carries the service, and the risk assessment reasoning lives inside or alongside it.
No statute prescribes these headings. They mirror what reviewers, accreditors, and courts look for afterward: what prompted the assessment, what was asked and learned, how the clinician weighed it, and what was done about it. The through-line is that the formulation must explain the disposition.
Reason for assessment and context. What triggered the assessment (a screening result, a disclosure, an intake, a transition in care) and the clinical context around it: precipitants, symptom course, substance use. Pitfall: a positive screen with no documented follow-up. An elevated PHQ-9 item 9 sitting in the chart with nothing after it is the single most indefensible gap in a later review.
Suicide inquiry. Direct questioning documented in the client's own terms: ideation and its frequency, duration, and recency; any contemplated method; plan; intent; and the behavior history (prior attempts, aborted or interrupted attempts, preparatory acts, self-harm). Method, plan, and intent are separate findings, so record each rather than one collapsed "SI" line. Pitfall: "denies SI" standing alone. Record what was asked and what was endorsed, not only the denial; a later reader should see the inquiry, not just its bottom line.
Access to means. The conversation about access to lethal means, asked about directly (firearms by name, plus anything this client's situation makes relevant), the restriction steps agreed, who will carry each step out, and what was actually verified. Pitfall: conclusions with no conversation shown. "No access to means," "means removed," and "means counseling provided" all read as unsupported unless the note records what was discussed, what was agreed, and what was confirmed.
Risk and protective factors. Acute and chronic risk factors, and protective factors that are specific and current for this client, not a generic list. Pitfall: protective factors copied forward ("family support, future oriented") that appear in every note unchanged. Reviewers read that as boilerplate, and boilerplate cuts both ways in a courtroom.
Instruments and scores. Any screener or scale used (C-SSRS, PHQ-9, ASQ) with the result and its date. Pitfall: treating the score as the assessment. An instrument structures the inquiry and triggers clinical judgment; it does not replace the formulation, and no score by itself supports a disposition.
Risk formulation. The clinical synthesis: a risk characterization (many settings use low, moderate, or high for acute and chronic risk) with the rationale that connects the findings above to it. Pitfall: a level with no reasoning, or prediction language ("client will not act on thoughts"). The standard the note is held to is a reasonable assessment process, documented, never an accurate prediction.
Interventions. What was done in response to the formulation: safety planning (documented as completed, with the client's copy noted), means-safety steps, supports involved with consent recorded, treatment changes, crisis resources provided. Pitfall: a "no-suicide contract" documented as the intervention. Contracts have no evidence of protective effect and read poorly in any later review; a collaborative safety plan is the defensible artifact.
Disposition, follow-up, and consultation. The level of care decided, the dated next contact, escalation instructions given, any consultation or supervision obtained, and when risk will be reassessed. Pitfall: "will monitor" with no date, and no reassessment plan. Elevated risk documented once and never revisited reads as abandoned, not managed.
Client: [initials] Date: Setting/context: Reason for assessment (screen result, disclosure, intake, transition): Suicide inquiry (ideation: frequency/duration/recency; plan; intent; behavior history: attempts, preparatory acts, self-harm): Access to means & means-safety steps agreed: Risk factors (acute / chronic): Protective factors (specific to this client, today): Instruments & scores (C-SSRS, PHQ-9, ASQ), with dates: Risk formulation (level + rationale connecting findings to disposition): Interventions (safety plan completed, means counseling, supports w/ consent, treatment changes, crisis resources given): Disposition & follow-up (level of care, dated next contact, escalation instructions): Consultation / supervision (who, when, outcome): Reassessment plan: Clinician signature/credentials: Date signed:
Free to use and share, no signup. The PDF includes a one-page cheat sheet with section-by-section pitfalls and a pre-sign checklist; the DOCX is the blank template, ready to adapt.
Scenario: adult client in weekly outpatient therapy for depression discloses new suicidal ideation during a scheduled session, and the clinician completes and documents a full risk assessment in the same visit. All details are fictional, and the risk content is deliberately generalized: it shows what a defensible note records, not how risk presents.
Client: M.T., 29 · Date: 07/21/2026 · Setting: Outpatient office, scheduled session · Reason for assessment: PHQ-9 item 9 positive at check-in; ideation disclosed in session
Context and precipitant: Client is in week 11 of weekly CBT for major depressive disorder. A four-year relationship ended three weeks ago. Since then client reports worsening sleep, social withdrawal, and drinking above baseline several evenings a week. PHQ-9 today 17 (moderately severe), up from 12 two weeks ago; item 9 scored 1.
Suicide inquiry: Asked directly. Client reports wishing they "would not wake up" most evenings for about two weeks, and thoughts of ending their life on three or four occasions in the past week, lasting minutes, without method, plan, or intent. Most recent episode two days ago. Denies ideation in session today. Denies prior attempts, preparatory or rehearsal behavior, and any history of self-harm. C-SSRS screen: ideation level 2 (nonspecific active thoughts, past month); levels 3 to 5 negative; behavior scale negative.
Access to means: Reviewed directly with client. No firearms in the home. One category of concern was identified, and a specific plan to restrict access was agreed with the client and recorded in the safety plan. Client agreed to a follow-up conversation about means safety at the next session.
Risk factors: Acute: recent relationship loss, moderately severe depressive symptoms, disrupted sleep, increased alcohol use, new-onset ideation. Chronic: one prior depressive episode in early twenties, resolved with treatment; no attempt history; no family history of suicide reported.
Protective factors: Engaged in weekly treatment and open in today's disclosure; close relationship with sister; stable employment; stated reasons for living, including care for their dog and a planned trip with friends in August; expressed clear ambivalence and willingness to plan for safety; no intoxication in session.
Risk formulation: New passive and intermittent nonspecific active ideation without plan, intent, preparatory behavior, or attempt history, in the context of an acute loss, moderately severe depression, and increased alcohol use. Acute risk is judged low to moderate, manageable in outpatient care with the interventions below. Chronic risk is low. Rationale: ideation is recent, brief, and nonspecific; means access is addressed; protective factors are current and specific; the client's account was consistent and openly given; and the client engaged actively in safety planning. Foreseeable destabilizers (an escalation in drinking, renewed contact with the former partner) were named with the client and are covered by the plan below.
Interventions: Collaborative safety plan completed in session (warning signs, internal coping steps, social contacts and settings, professional contacts, means safety), copy to client. 988 saved to client's phone. With client's written consent, sister was called during session and agreed to evening check-ins this week. Alcohol use discussed; client agreed to reduce while symptoms are acute and to review this next session.
Disposition and follow-up: Continue outpatient care at increased frequency: sessions moved to twice weekly for two weeks, next appointment 07/24/2026, phone check-in 07/22/2026 at 5:00 pm. Referral placed for medication evaluation with practice's consulting psychiatric NP; client accepted. Client verbalized the safety plan steps and the instruction to call or text 988 or go to the nearest emergency department if thoughts escalate or intent develops.
Consultation: Case reviewed same day with clinical supervisor, L.R., LCSW; supervisor concurred with formulation and outpatient disposition with increased contact.
Reassessment plan: Ideation, means safety, and safety-plan use reviewed at every contact while ideation is active; full reassessment at the next session or with any change in presentation.
This sample is fictional and for educational purposes. It does not describe a real patient, and it intentionally omits the clinical specifics a real record would contain.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsA suicide risk assessment is written for more readers than any other clinical document: the treating team and supervisor first, then surveyors, auditors, licensing boards, and, after a bad outcome, coroners and courts. In accredited settings the documentation itself is the requirement: Joint Commission expects the overall risk level "clearly documented, with clinical justification, as well as the plans to mitigate" (standards FAQ, April 2026), under NPG.08.01.01 for hospitals and NPSG.15.01.01 for behavioral health organizations. In private practice no accreditor applies, but board record standards and the clinical standard of care ask for the same reconstruction, and the note sits inside the ordinary record: clients generally hold HIPAA access rights to it, and it is reachable by subpoena, so write clinically necessary detail rather than speculation (the separately kept psychotherapy notes category never covers it). After an attempt or death, never revise the original entry. Federal hospital rules require records that are complete, dated, timed, authenticated, and protected from alteration (42 CFR 482.24), and colleges in all three countries expect corrections that preserve the audit trail: anything learned later goes in a clearly dated late entry or addendum. When a death, threat situation, or legal process touches your documentation, consult your attorney or board; state rules vary. If you or a client needs immediate support: call or text 988 (US), 9-8-8 (Canada), or Lifeline 13 11 14 (Australia).
On the payer side there is no suicide-specific code to defend: the assessment is reviewed as part of whatever service carried it, an intake, a psychiatric diagnostic evaluation, psychotherapy, or a crisis encounter, and no reviewed CMS or contractor policy names a required suicide instrument or publishes a suicide-note denial code. Exposure is generic: Medicare's 2024 outpatient psychiatric reporting put improper payments at 16.1 percent ($254.5 million), 78.3 percent of them for insufficient documentation (CMS MLN), so the risk work must be visible inside a note that also supports the billed service. The days after a level-of-care change deserve the most care: of 122 suicide deaths reported to Joint Commission as sentinel events in 2024, 75 percent occurred within seven days of discharge or during intensive behavioral health services (sentinel event annual review), which is why the dated follow-up contact, the escalation instructions, and the handoff you document are the parts most likely to be read again. Elevated risk should also flow into the treatment plan once the immediate response is documented.
The audit numbers for this document come from oversight bodies rather than payers. A 2024 VA Office of Inspector General national review found required suicide risk screening undocumented for 27 percent of sampled inpatients and safety plans missing for 12 percent of discharged patients (VA OIG). Joint Commission's 2024 sentinel event review identified 1,001 contributing factors across the 122 reported suicide deaths, with failure to follow screening, assessment, and reassessment policy among the leading categories. The BastionGPT Clinical Advisory Board sees the same errors most often in suicide risk assessment reviews:
| Aspect | United States | Canada | Australia |
|---|---|---|---|
| Status | No universal statute; Joint Commission defines the assessment domains in accredited settings (NPG.08.01.01 for hospitals since January 2026, NPSG.15.01.01 for behavioral health), while CMS requires safe-setting care and complete, authenticated records rather than named fields | Accreditation Canada and HSO suicide-prevention requirements for participating organizations; college record standards enforceable under provincial law; provincial Mental Health Acts govern involuntary assessment separately | NSQHS Comprehensive Care Standard Actions 5.31 and 5.32 require systems to identify and respond to self-harm and suicide risk; the Psychology Board Code of Conduct (December 2025) makes adequate records mandatory |
| Terminology | Suicide risk assessment, SRA, C-SSRS or Columbia protocol, SAFE-T | Suicide risk assessment, risk formulation; Manitoba's 2026 provincial policy specifies field-level documentation, down to declined screens and the location of assessment | "Risk of self-harm or suicide" in NSQHS wording; suicide risk assessment in practice |
| What changes | Which accreditor citation applies by setting, state training mandates (Washington's RCW 43.70.442 requires suicide assessment training, not a note format), and payer documentation exposure | How specific the documentation expectations are, from general college record rules to Manitoba's itemized policy; involuntary-assessment forms are separate statutory documents | State Mental Health Act forms for compulsory assessment; MBS adequate-and-contemporaneous record rules for billed services |
| Retention | HIPAA sets no clinical-record period; Medicare hospitals keep records at least 5 years, and state law often runs longer (California 7 years, New York 6) | Ontario colleges require 10 years from last contact or from age 18, whichever is later | 7 years from the last entry for adults; until the 25th birthday for clients seen as minors (Board code) |
The assessment itself travels well across all three countries: the same inquiry, formulation, and disposition reasoning is what every reviewer wants to reconstruct. What changes is who defines the fields, an accreditor, a college, a health system, or your own policy, and how long the record must survive.
BastionGPT is specifically trained, tuned, and clinically tested on suicide risk assessments.
See how clinicians use it day to day on the AI therapy notes page.
Many BastionGPT users report saving more than 90 minutes per day on documentation.
HIPAA-compliant with a signed BAA on every plan. Your data is never used to train models. BastionGPT drafts, you review and sign.
No statute in the US, Canada, or Australia prescribes a suicide risk assessment template. The obligations are layered instead: Joint Commission standards define the assessment domains in accredited settings, licensing boards require adequate records everywhere, payers expect the record to support the billed service, and the clinical standard of care fills the rest. Most run 200 to 800 words, and the test any format is held to is whether the formulation supports the disposition.
The citation moved. Joint Commission's National Performance Goals chapter replaced the National Patient Safety Goals chapter for hospitals and critical access hospitals on January 1, 2026, so the hospital suicide requirement is now NPG.08.01.01, while behavioral health organizations keep NPSG.15.01.01. The substance carried over: screen with a validated tool, assess positives with an evidence-based process, and document the overall risk level with the mitigation plan. Guidance citing NPSG.15.01.01 for hospitals is out of date.
No regulation reviewed for this page mandates a specific instrument in any of the three countries. Joint Commission encourages validated tools but accepts another evidence-based process when the organization can name its evidence base, the assessment directly covers ideation, plan, intent, behaviors, risk factors, and protective factors, and the record shows how the risk level was determined (standards FAQ). Your employer or health system can, and often does, require a named tool by policy; that requirement is the policy's, not the law's.
Enough to show the inquiry, not just its bottom line: what you asked, what the client denied (passive thoughts, active thoughts, plan, intent), anything endorsed, and why the account seemed reliable. A routine denial in a stable client needs a sentence or two, not an essay. After a positive screen, a collateral warning, preparatory behavior, or a presentation that contradicts the denial, "denies SI" alone is the least defensible sentence a chart can carry.
A method is the general way a person has thought about dying. A plan adds specifics: place, timing, sequence, or preparation. Intent is the person's expectation or commitment to act, and preparatory behavior is action already taken. Document each separately, in the client's own words, because they carry different weight in the formulation. When the facts are ambiguous, record the ambiguity rather than forcing a label.
No. The risk assessment is the clinician's record of the evaluation and reasoning; a safety plan is a client-facing intervention, the prioritized list of warning signs, coping steps, contacts, and means-safety actions a client uses as risk rises. One documents, the other equips, and the outcome evidence attaches to the intervention with follow-up (Stanley and Brown, JAMA Psychiatry 2018). Document the safety plan as completed with a copy given, and keep the reasoning in the assessment. A crisis note is different again: it records an urgent encounter, which may contain a risk assessment.
Weak as predictions, which is exactly why the reasoning matters more than the label. A 2017 meta-analysis found a pooled positive predictive value of 5.5 percent for suicide among people classified high risk, and the 2024 VA/DoD guideline found insufficient evidence to prefer any stratification method. Accredited settings still require a documented overall level, so give the category your setting expects, pair it with the individualized formulation, and never write prediction language like "client will not act."
Nothing in the original note: preserve the record and its audit trail exactly as they stood. Anything learned or done afterward belongs in a clearly dated late entry, addendum, or your organization's incident process, limited to facts such as notifications received and consultations held. Contact your risk management function, liability carrier, or attorney before writing more, and follow their guidance on what belongs in the chart versus a protected review process. Rewriting history is the one documentation act that makes everything else indefensible.
Yes. Give it bullets or a dictation from the session, and it drafts a structured assessment with the inquiry, risk and protective factors, formulation, interventions, and disposition in the right places for your review. It can also check a finished note for a formulation with no rationale, an undocumented means conversation, or a missing reassessment plan before you sign. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.
The compliance claims on this page trace to these authorities, last verified July 2026:
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.