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Rocky Mountain MIRECC for Veteran Suicide Prevention

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Therapeutic Risk Management (TRM) with Patients at Risk for Suicide


The Rocky Mountain MIRECC model of Therapeutic Risk Management (TRM) with Patients at Risk for Suicide is a clinically, medically and legally informed model for the assessment and management of suicide risk. It is designed to be used collaboratively with the patients you serve. The model has evolved to include flexible elements to meet clients’ individual needs and clinical presentations, optimizing suicide risk assessment and management.

The original model involved three main components:

  1. Augmentation of clinical risk assessment with structured instruments
  2. Risk stratification with respect to both severity and temporality
  3. Collaborative development of a safety plan

More recent additions to the model include:

  1. Use of chain analysis to further explore the function of Veteran’s suicidal thoughts
  2. Lethal means safety guidance and recommendations
  3. Obtaining collateral data for support persons in the Veteran’s life
  4. Welfare checks as a part of therapeutic risk management
  5. Postvention planning and services for suicide loss survivors

The TRM model and its components are fully described in a series of ten articles published in the Journal of Psychiatric Practice. Read the articles in this series here.

Risk Stratification Tool

The Risk Stratification Table is a tool designed to:

  1. help providers make determinations regarding suicide risk levels with respect to severity and temporality
  2. aid in suicide risk management clinical decision making.

A copy can be downloaded here.  

Order multiple laminated copies for free from our Educational Products page.

Related Webinars

TRM Featured in National Suicide Prevention Guidance

Several national bodies, including VA/DoD and the Joint Commission, recommend therapeutic risk management:

VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide 

Joint Commission National Patient Safety Goals (see NPSG.15.01.01 EP3)

VA Suicide Risk Management (SRM) Consultation Program

Suicide Risk Management Consult

Providing care for Veterans at risk of suicide may feel like a daunting responsibility. Why worry alone? The Rocky Mountain MIRECC offers free, one-on-one consultation for any provider (community as well as VA) who works with Veterans.
Tools + Support + Evidence-based Knowledge = Better Outcomes

Ask for an SRM consult by emailing

Visit the SRM website.

Links to articles about TRM

The visual abstracts below outline findings from some of these articles. Click each image and learn more.

chain analysis chain analysis chain analysis

Looking for Resources for Therapeutic Risk Management of Other-Directed Violence?

TRM also requires attending to risk for violence against others. Fortunately, the TRM approach can be repurposed to address this need, as described in a separate series. The version of the TRM model and its components are fully described in a series of five articles published in the Journal of Psychiatric Practice with links to articles here:


Clinical Risk Structured Instruments Stratifying and Characterizing


Chain Analysis Safety Planning


Last Updated 27 June 2023