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-Ask Suicide-Screening uestions
•	Use after a patient (18+ years) screens positive for suicide risk on the asQ
•	Assessment guide for mental health clinicians, MDs, NPs, or PAs
•	Prompts help determine disposition
What to do when an adult patient
screens positive for suicide risk:
for discussing their thoughts
“I’m here to follow up on your responses to the suicide risk screening questions. These can be hard things to
talk about. Thank you for telling us. I need to ask you a few more questions.”
Praise patient1
Provide resources to all patients
•	 24/7 National Suicide Prevention Lifeline: 1-800-273-TALK (8255), En Español: 1-888-628-9454
•	 24/7 Crisis Text Line: Text “HOME” to 741-741
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Assess the patient2
Determine if and how often the patient is having suicidal thoughts.
Ask the patient: “In the past few weeks, have you been thinking
about killing yourself?” If yes, ask: “How often?” (once or twice a
day, several times a day, a couple times a week, etc.) “When was the
last time you had these thoughts?”
Frequency of suicidal thoughts
Review patient’s responses from the asQ
Evaluate past self-injury and history of suicide attempts (method,
estimated date, intent). Ask the patient: “Have you ever tried
to hurt yourself?” “Have you ever tried to kill yourself?” If yes, ask:
“How? When? Why?” and assess intent: “Did you think [method]
would kill you?” “Did you want to die?” Ask: “Did you receive
medical/psychiatric treatment?”
Past behavior
(Strongest predictor of future attempts)
Interview the patient alone; ask any visitors to leave the room
Assess if the patient has a suicide plan, regardless of how they
responded to any other questions (ask about method and access to
means). Ask the patient: “Do you have a plan to kill yourself?
Please describe.” If no plan, ask: “If you were going to kill yourself,
how would you do it?”
Suicide plan
Note: If the patient has a very detailed plan, this is more
concerning than if they haven’t thought it through in great detail.
If the plan is feasible (e.g., if they are planning to use pills and have
access to pills), this is a reason for greater concern and removing
or securing dangerous items (medications, guns, ropes, etc.).
“Are you having thoughts of killing yourself right now?”
(If “yes,” patient requires an urgent/STAT mental health
evaluation and cannot be left alone. A positive response indicates
imminent risk.)
NIMH TOOLKIT: ADULT EMERGENCY DEPARTMENT
Brief Suicide Safety Assessment
asQ Suicide Risk Screening Toolkit NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 7/1/2020
Determine disposition
q 	 Emergency psychiatric evaluation: Patient is at imminent
risk for suicide (current suicidal thoughts). Urgent/STAT page
psychiatry; keep patient safe in ED
q Further evaluation of risk is necessary: Request full mental
health/safety evaluation in the ED
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Depression: “In the past few weeks, have you felt so sad or
depressed that it makes it hard to do the things you would like
to do?”
Anxiety: “In the past few weeks, have you felt so worried that
it makes it hard to do the things you would like to do or that you
feel constantly agitated/on-edge?”
Impulsivity/Recklessness: “Do you often act without
thinking?”
Hopelessness: “In the past few weeks, have you felt
hopeless, like things would never get better?”
Isolation: “Have you been keeping yourself more than usual?”
Irritability: “In the past few weeks, have you been feeling
more irritable or grouchier than usual?”
Substance and alcohol use: “In the past few weeks,
have you used drugs or alcohol?” If yes, ask: “What? How
much?”
Other concerns: “Recently, have there been any
concerning changes in how you are thinking or feeling?”
Symptoms
Support & Safety
Support network: “Is there a trusted person you can talk
to? Who? Have you ever seen a therapist/counselor?” If yes, ask:
“When and for what purpose?”
Safety question: “Do you think you need help to keep
yourself safe?” (A “no” response does not indicate that the
patient is safe, but a “yes” is a reason to act immediately to
ensure safety.)
Reasons for living: “What are some of the reasons you would
NOT kill yourself?”
q No further evaluation in the ED:
	 Create safety plan for managing potential future suicidal
thoughts and discuss securing or removing potentially
dangerous items (medications, guns, ropes, etc.)
m Send home with mental health referrals, or
m	No further intervention is necessary at this time
After completing the assessment, choose the appropriate disposition.