5: Suicide Risk Stratification - MIRECC / CoE
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5: Suicide Risk Stratification

Screening and Evaluation » Evaluation
5: Suicide Risk Stratification

While it is an expected standard of care, there is insufficient evidence to recommend for or against the use of risk stratification to determine the level of suicide risk.

Strength:

Neither for nor against

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Although there remains no valid and reliable tool to predict who will (or will not) go on to attempt or die by suicide, the standard of care still mandates efforts to stratify risk in a manner that informs safety needs and clinical care. Completing comprehensive assessments to determine level of risk and appropriate risk mitigation strategies is essential. Risk stratification, when completed as part of a comprehensive evaluation, facilitates clinical impressions regarding suicide risk, and identifies appropriate risk mitigation strategies and treatment decisions. It is useful to have a consistent lexicon for identifying and communicating a patient's level of risk (i.e., high, intermediate, or low acute or chronic risk).

Training Resources

This section includes links to recommended training resources about suicide risk stratification.

Logo forThe Suicide Risk Management (SRM) Consultation Program The Suicide Risk Management (SRM) Consultation Program provides free consultation, support, and resources that promote therapeutic best practices for providers working with Veterans at risk of suicide.
Thumbnail of the Therapeutic Risk Management (TRM) Risk Stratification Table Therapeutic Risk Management — Risk Stratification Table helps providers make determinations regarding suicide risk levels with respect to severity and temporality and to aid in suicide risk management clinical decision making.
Learn about the Therapeutic Risk Management model for supporting patients at risk for suicide
VISN19 Therapeutic Risk Management (TRM) of the Suicidal Patient
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Webinars

This section includes links to recommended webinars about suicide risk stratification.

CPG Webinar Suicide Risk Stratification and Documentation Presented by Dr. Hal Wortzel
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Books

This section includes links to recommended books about suicide risk stratification.

The American Psychiatric Association Publishing Textbook of Suicide Risk Assessment and Management, Third Edition
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Articles

This section includes links to recommended articles about suicide risk stratification.

Grant, C. L., & Lusk, J. L. (2015). A multidisciplinary approach to therapeutic risk management of the suicidal patient. Journal of multidisciplinary healthcare, 8. 291-298. https://doi.org/10.2147/JMDH.S50529
Wortzel, H.S., Homaifar, B., & Matarazzo, B. (2019). Suicide Risk Assessment and Management: Tips for Improving Care and Outcomes. Psychiatric Times, Vol 36, Vol 1. https://www.psychiatrictimes.com/view/suicide-risk-assessment-and-management-tips-improving-care-and-outcomes
Wortzel, H. S., Homaifar, B., Matarazzo, B., & Brenner, L. A. (2014). Therapeutic risk management of the suicidal patient: stratifying risk in terms of severity and temporality. Journal of Psychiatric Practice, 20(1). 63-67. https://doi.org/10.1097/01.pra.0000442940.46328.63
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Podcasts

This section includes links to recommended podcasts about suicide risk stratification.

Rocky Mountain MIRECC Short Takes on Suicide Prevention
Short Takes podcast icon Craig Bryan on Fluid Vulnerability Theory — a way to Understand Acute and Chronic Suicide Risk with Craig Bryan
Short Takes podcast icon A new take on Zero Suicide and Risk Formulation with Tony Pisani, Ph.D.
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