NIMH Adult Brief Suicide Safety Assessment

A positive suicide screen calls for a focused clinical interview, not an automatic risk label. The National Institute of Mental Health (NIMH) Adult Brief Suicide Safety Assessment (BSSA) guides a trained clinician through the information needed to choose an appropriate disposition after a positive Ask Suicide-Screening Questions (ASQ) result.

The interview addresses recent and current suicidal thoughts, a plan and access to means, past self-harm or attempts, current symptoms, supports and stressors, reasons for living, safety planning, coping strategies, means restriction, and follow-up resources. The clinician may stop once enough information has been gathered to determine disposition.

• Current safety takes priority. Current thoughts of suicide require an urgent or STAT mental-health evaluation and the patient must not be left alone.
• A request for help is actionable. Saying help is needed to remain safe calls for immediate safety action. Saying no does not establish that the patient is safe.
• Disposition is a clinical decision. The BSSA prompts inform judgment, but the findings are not added into a suicide-risk score.

The guide is for adults age 18 and older in an emergency department, inpatient medical or surgical unit, or outpatient primary or specialty setting. It belongs inside the relevant NIMH ASQ clinical pathway and local safety policy.

This is not a self-assessment, diagnosis, treatment plan, or emergency-clearance test. A patient or untrained person should not use it to decide whether urgent help is needed.

How to Use This Tool:

Use the checklist only after a positive adult ASQ screen and only as the trained clinician conducting the BSSA interview.

1. Begin the clinician checklist and choose the applicable care setting. The setting changes the handoff language, not the recorded disposition or safety rules.
2. Complete each checkpoint from the interview and authorized clinical record. Keep names, narrative notes, and other patient identifiers out of the browser checklist.
3. Act immediately if Current suicidal thoughts is Yes or the patient says they need help to remain safe. Follow the safety notice before continuing to any general disposition.
   Do not wait for the result summary when an urgent safety rule appears. Notify the medical team, keep the patient supervised, and follow the setting's immediate protocol.
4. Record the clinician's disposition after enough information has been gathered. The four choices run from No further intervention necessary at this time through Emergency psychiatric evaluation.
5. Review the Clinician-selected disposition, active safety notice, and setting-specific next action together. Correct any inaccurate checkpoint before using the answer review as documentation support.

Interpreting Results:

The main result records the disposition selected by the trained clinician. It does not estimate a probability of suicide, infer a diagnosis, or calculate urgency from the preceding checkpoints. A higher display level means only that the selected NIMH disposition is more urgent.

Read any immediate safety notice before the disposition. A current-thoughts or needs-help response can require immediate action even if the clinician later records a less urgent general disposition. The safety rule is deliberately independent of the ordinal display.

Use the setting-specific handoff as a reminder alongside local policy, direct clinical judgment, and the authorized record. A completed checklist is not evidence that every relevant concern is absent, particularly when a finding remains undetermined or the patient's condition changes.

Technical Details:

The adult checklist contains 14 structured entries. Thirteen document the setting and interview findings; the final entry stores the clinician-selected disposition. Item codes support an auditable answer review, but only the disposition entry feeds the displayed disposition level.

Rule Core

No Formula Core is appropriate because the BSSA does not compute a risk score. The disposition map is a one-to-one record of the clinician's choice.

Two safety rules have higher precedence than ordinary interpretation. A Yes response to current suicidal thoughts activates the urgent evaluation notice. A Yes response to needing help to remain safe activates an immediate support notice. Neither rule is cancelled by the selected disposition.

Every checkpoint must contain a legal response before the result is finalized. Not yet determined and Review incomplete remain documentation states rather than negative findings, and the checklist does not convert them into reassurance.

Safety, Limitations, and Privacy:

For current suicidal thoughts, imminent danger, or inability to remain safe, arrange immediate in-person help under the clinical setting's protocol. In the United States, call or text 988 for the Suicide & Crisis Lifeline; use emergency services when there is immediate danger.

• The BSSA is a guide for trained clinical professionals after a positive ASQ screen. It does not replace a full mental-health evaluation or local policy.
• Responses and care setting remain in the current browser tab and are not written to the URL or sent to a service.
• Starting over or reloading clears the in-memory checklist. Downloaded or copied records must be handled under the clinical setting's privacy rules.
• Keep patient names, narrative history, and identifiers in the authorized clinical record, not in this structured checklist.

References:

• Adults ASQ Toolkit, National Institute of Mental Health.
• Adult Emergency Department Brief Suicide Safety Assessment Guide, National Institute of Mental Health.