MIRECC / CoE
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.
Neither for nor against
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.|
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).
This section includes links to recommended training resources about suicide risk stratification.
- 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.
- 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
This section includes links to recommended webinars about suicide risk stratification.Return to Resource Options
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
This section includes links to recommended articles about suicide risk stratification.
- 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 (
- 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 (
- 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 (
This section includes links to recommended podcasts about suicide risk stratification.
- Rocky Mountain MIRECC Short Takes on Suicide Prevention
- Craig Bryan on Fluid Vulnerability Theory — a way to Understand Acute and Chronic Suicide Risk with Craig Bryan
- A new take on Zero Suicide and Risk Formulation with Tony Pisani, Ph.D.