About this resource
Many practitioners worry that asking about suicide might make things worse. A review of the evidence found that asking does not increase suicidal thoughts, and it may help. This guide gives plain wording for asking directly, words to use and avoid, how to respond, and what to do next. It complements the Suicide Risk Conversation Record.
Purpose
To build counsellors' confidence in asking directly about suicide and responding well.
Who it is for
Primary profession: Counsellors and therapists. Also relevant for psychologists, social workers, youth workers.
Client or participant group: Adults and young people seeing a counsellor or therapist.
Practice setting: Counselling and therapy services, including private practice, schools and community services.
Suggested uses
- New and provisional counsellors
- Student placements
- Team refreshers
- Supervision discussions
Instructions for practitioners
- Practise the wording aloud, so it feels natural when you need it.
- Ask directly, using the word suicide.
- Listen and stay with the person's experience before moving to plans.
- Follow your organisation's procedure and consult your supervisor.
Accessibility considerations
Use the person's own words. Offer an interpreter, a support person or a different format where it helps.
Scope and limitations
A structured conversation and record. It is not a risk scale, gives no score or rating and cannot predict what someone will do. It does not replace clinical judgement, supervision, your professional code or your organisation's procedures. If someone is in immediate danger, call 000. Lifeline: 13 11 14. Suicide Call Back Service: 1300 659 467. 13YARN: 13 92 76. Kids Helpline: 1800 55 1800.
Higher-risk topic: use only within your training, supervision and organisational procedures.
Research basis
A review of the evidence found that asking about suicide does not increase suicidal thoughts and may help. Careful, non-stigmatising language matters. Research shows that risk scales and low, medium or high categories cannot reliably predict suicide or repeat self-harm. NICE advises against using them for this and recommends a compassionate psychosocial assessment that leads to a plan.
- Carter, G., Milner, A., McGill, K., Pirkis, J., Kapur, N., & Spittal, M. J. (2017). Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales. British Journal of Psychiatry, 210(6), 387–395. https://doi.org/10.1192/bjp.bp.116.182717
- Chan, M. K. Y., Bhatti, H., Meader, N., Stockton, S., Evans, J., O'Connor, R. C., Kapur, N., & Kendall, T. (2016). Predicting suicide following self-harm: systematic review of risk factors and risk scales. British Journal of Psychiatry, 209(4), 277–283. https://doi.org/10.1192/bjp.bp.115.170050
- Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361–3363. https://doi.org/10.1017/s0033291714001299
- Everymind. Mindframe: Language and suicide. https://mindframe.org.au/suicide/communicating-about-suicide/language
- Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time. PLOS ONE, 11(6), e0156322. https://doi.org/10.1371/journal.pone.0156322
- National Institute for Health and Care Excellence. (2022). Self-harm: Assessment, management and preventing recurrence (NICE guideline NG225). https://www.nice.org.uk/guidance/ng225/chapter/Recommendations
What is included
A 3-page printable A4 PDF, including a practitioner notes page with the research basis (version 1.0).
Originality
Original Practitioner Plus content: wording, activity structure, layout and icons were created for this resource. No third-party worksheets, illustrations or text were reproduced. Written for Practitioner Plus from the guidelines and research listed in the research basis; no third-party template was used.
