About this resource
Research shows that risk scales and low, medium or high categories cannot reliably predict suicide, and NICE advises against using them for that purpose. What helps is a compassionate conversation that builds a shared understanding of what is happening and leads to a plan. This record follows that approach: asking directly, recording the person's own words, noting what makes things harder and what keeps them safe, and documenting the plan, who was consulted and when you will follow up.
Purpose
To guide and document a compassionate conversation about suicide, and the plan that follows, without relying on a score.
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
- When a client mentions suicide or you are worried about them
- Documenting a safety conversation in session
- Preparing for supervision or consultation
- Handover to a GP or crisis service
Instructions for practitioners
- Follow your organisation's procedure, and call 000 if there is immediate danger.
- Ask directly and calmly about suicide. Listen more than you talk.
- Record the person's own words, not only your interpretation.
- Build a shared understanding of what is happening, including what helps.
- Agree a safety plan and who will be told, and be honest about the limits of confidentiality.
- Consult your supervisor, record your reasoning and follow up on the agreed date.
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
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. A review of the evidence found that asking about suicide does not increase suicidal thoughts and may help. Careful, non-stigmatising language matters. Safety planning is an evidence-based brief intervention that reduces suicidal behaviour and increases engagement with care.
- 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
- Stanley, B., & Brown, G. K. (2012). Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001
- Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018). Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry, 75(9), 894. https://doi.org/10.1001/jamapsychiatry.2018.1776
What is included
A 4-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.
