Suicide Potential

Treating the Potentially Suicidal Individual

Clinicians are urged to consider the issue of the interpersonal context of the assessment of suicide potential even before they complete the assessment of risk factors and potential indicators, as recent work in this area has suggested that suicidal clients often perceive the assessment process as impersonal and dehumanizing. Moreover, both theory and research suggest that the validity of assessment information is related to the quality of the interpersonal relationship from the client's perspective. Thus, clinicians working with suicidal individuals should acknowledge the importance of considering the assessment process from the client's point of view. Adherents to this perspective consider the suicidal individuals—not the counselor—as the experts in their suicidality. Additionally, suicidality is viewed as the central clinical problem in these models, as opposed to being addressed as a symptom of some underlying psychopathology. Regardless of the approach to the assessment of suicide potential (e.g., standardized assessment measures, clinical interview, or a combination), a greater focus on collaboration and a therapeutic assessment approach to suicide risk assessment will serve to increase the reliability and validity of information accrued through the process.

With the importance of the therapeutic relationship in mind as the backdrop for identifying information relevant to the assessment of suicidal potential, there are two different approaches for identifying risk factors and clinical indicators. The first approach is the top-down or clinician-focused model embedded in the Suicide Assessment Checklist (SAC) developed by James Rogers and his colleagues, and the second is the horizontal model reflected in the Collaborative Assessment and Management of Suicidality (CAMS) protocol developed by David A. Jobes and his colleagues.

Suicide Assessment Checklist (SAC)

In this model, the clinician prompts for information and completes the assessment protocol from what is typically an “expert” position. The SAC identifies a number of status and clinical variables that have been shown in the literature to be related to increased suicide potential. The status variables include the following:

• Previous psychiatric history (implying a psychiatric diagnosis) Diagnoses specifically linked to greater suicide potential include:
  • i.
    Depression
  • ii.
    Bipolar depression (especially with psychotic features)
  • iii.
    Anxiety disorders
  • iv.
    Schizophrenia
  • v.
    Post-Traumatic Stress Disorder
  • vi.
    Personality disorders (especially borderline personality disorder)
• Drug and alcohol use
• Prior suicide attempts
• Sex Males at higher risk
• Age Ages 15 to 35 and 65 and older at higher risk
• Suicide survivor status
• Marital status Divorced, separated, or widowed at higher risk
• Presence of a suicide plan including: An identified method Method access
• Making final plans
• The presence of a suicide note
• Dependent children in the home Serving as a protective factor

Similarly, clinical risk factors identified in the SAC model include the

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