Step 1 — Risk Factors

Static / Historical:

Prior suicide attempt(s)

Family history of suicide

History of trauma / abuse

Chronic pain / Medical illness

Access to lethal means

Male sex / Older age

Dynamic / Modifiable:

Acute suicidal ideation

Hopelessness

Agitation / Psychic pain

Substance intoxication / Withdrawal

Recent loss / Stressor

Sleep disturbance

Command hallucinations

Additional risk factors:

Step 2 — Protective Factors

Reasons for living identified

Children / Dependents

Religious / Moral beliefs against suicide

Therapeutic alliance / Engaged in treatment

Social supports

Positive coping skills

Fear of death / Pain

Additional protective factors:

Step 3 — Suicide Inquiry

Ideation (passive / active):

Plan (yes / no — details):

Intent:

Lethality of plan / Access to means:

Timeframe:

1. Ideation Level

0 — None 1 — Wish Dead 2 — Nonspecific Thoughts 3 — With Method 4 — With Intent 5 — With Plan

1. Actual Attempt

Self-Injurious Behavior with Intent to Die

2. Interrupted Attempt

3. Aborted/Self-Interrupted Attempt

4. Preparatory Acts or Behaviors

5. Non-Suicidal Self-Injury (NSSI)

Most Recent Behavior

yyyy-mm-dd

Lethality (0-10)

Clinician Risk Override

No Override

Step 4 — Risk Level & Intervention

Risk level:

High — imminent danger

Moderate — plan without imminent intent

Low — ideation without plan or intent

Intervention:

Hospitalize (voluntary / involuntary)

Mobile crisis / Crisis stabilization

Safety plan developed / updated

Increase session frequency

Means restriction counseling

No change — continue monitoring

Rationale:

Step 5 — Documentation & Follow-Up

Safety plan completed and given to client

Means-safety counseling provided

Crisis line documented (988 Suicide & Crisis Lifeline)

Collateral contacted

PCP / Supervisor notified

Follow-up interval:

Responsible party:

Contingency plan:

Plan and Follow-Up

Plan area	Details
Next visit
Orders & referrals
Patient instructions
Monitoring & safety

Step 1 — Risk Factors

Step 2 — Protective Factors

Step 3 — Suicide Inquiry

C-SSRS

Suicidal Ideation Severity ⓘ

Suicidal behavior (lifetime; most recent date below)

Risk Details

Step 4 — Risk Level & Intervention

Step 5 — Documentation & Follow-Up

Plan and Follow-Up

Counseling - SAFE-T Suicide Risk Protocol

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