This resource page includes tools, trainings, and apps that may help you strengthen your understanding of suicide risk assessment and safety planning. These resources can support learning, but they do not replace your preceptor’s guidance, institutional policy, state law, clinical judgment, or emergency procedures.

As a PMHNP student or new clinician, you should use these tools to become more structured, more confident, and more consistent in how you assess and document risk. When risk is present or unclear, involve your preceptor promptly.

Columbia Lighthouse Project / Columbia-Suicide Severity Rating Scale

The Columbia Lighthouse Project provides resources related to the Columbia-Suicide Severity Rating Scale, commonly called the C-SSRS or Columbia Protocol. The C-SSRS uses plain-language questions to help assess suicidal ideation and behavior. The Columbia Lighthouse Project describes the tool as a simple series of questions that can be used across many settings. It also offers training options and versions of the tool for different populations and clinical contexts.

Useful for learning:

• How to ask direct suicide risk questions

• How to distinguish passive suicidal ideation from active suicidal ideation

• How to ask about method, plan, intent, and behavior

• How to structure suicide screening more consistently

• How to improve risk-related documentation

How to use it in clinical learning:

• Review the question structure before clinical.

• Practice saying suicide risk questions out loud so they feel less awkward.

• Ask your preceptor whether your site uses the C-SSRS or another risk tool.

• Follow your site’s required screening and documentation process.

• Do not use the tool as a substitute for full clinical assessment, supervision, or escalation when risk is present.

Clinical reminder:

A screening tool can help structure the assessment, but it does not replace clinical reasoning. You still need to assess context, risk factors, protective factors, access to means, mental status, substance use, psychosis, mania, collateral information when appropriate, and ability to engage in safety planning.

Stanley-Brown Safety Planning Intervention

The Stanley-Brown Safety Planning Intervention is a brief, collaborative intervention designed to help people experiencing suicidal thoughts or self-harm risk identify concrete steps to reduce danger during a crisis. The official Stanley-Brown Safety Planning resource describes the intervention as collaborative and focused on mitigating acute risk.

A safety plan commonly includes:

• Warning signs

• Internal coping strategies

• People and social settings for distraction

• People to ask for help

• Professional and crisis resources

• Means safety

• Follow-up steps

Useful for learning:

• How to make safety planning specific and practical

• How to help patients identify early warning signs

• How to include coping strategies and supports

• How to address means safety

• How to avoid relying on vague “contracting for safety”

How to use it in clinical learning:

• Review the structure before clinical.

• Ask your preceptor how your site completes safety plans.

• Practice turning vague coping ideas into specific steps.

• Use patient-centered language.

• Document the actual safety plan, not just “safety plan completed.”

Clinical reminder:

Safety planning is not the same as a no-suicide contract. A patient promising not to harm themselves is not a complete safety intervention. A safety plan should be concrete, individualized, and reviewed with your preceptor when risk is present.

VA Safety Plan App

The VA Safety Plan app is designed for people who have experienced suicidal thoughts or self-harm thoughts. The VA describes the app as a tool to help users identify coping strategies, sources of support, and ways to manage distress. The VA also notes that the safety plan is best created when the person is not in acute distress so they can think clearly.

Useful for learning:

• How a safety plan can be organized in a patient-friendly format

• How patients can carry their plan on a phone

• How coping strategies and support contacts can be personalized

• How safety planning can extend beyond the clinic visit

How to use it in clinical learning:

• Review the app yourself so you understand its structure.

• Ask your preceptor whether recommending safety planning apps is appropriate at your site.

• Do not assume all patients can or should use an app.

• Consider patient preference, privacy, phone access, digital literacy, and safety.

• Document app discussion only if it is clinically relevant and consistent with site policy.

Clinical reminder:

An app is not a replacement for clinical assessment, crisis care, emergency evaluation, or higher level of care when needed. It may be a supportive tool for some patients, but it should not be used to minimize risk.

988 Suicide & Crisis Lifeline

The 988 Suicide & Crisis Lifeline provides 24/7 crisis support in the United States by call, text, or chat for people experiencing suicidal crisis, mental health crisis, substance use crisis, or emotional distress. SAMHSA provides 988 implementation and professional resources, and 988 is intended as an accessible national crisis support number.

Useful for learning:

• What crisis resource patients may be instructed to use

• How crisis support fits into safety planning

• How to discuss emergency options clearly

• How to document crisis resource education

How to use it in clinical learning:

• Know whether your site uses 988, local crisis lines, mobile crisis, or other crisis pathways.

• Include crisis resources in safety planning when appropriate.

• Clarify that patients should use emergency services or go to the emergency department if they cannot remain safe.

• Ask your preceptor how your site phrases crisis instructions.

Clinical reminder:

988 is a crisis resource, not a substitute for emergency evaluation when the patient has imminent risk, active intent, inability to safety plan, severe psychosis, severe mania, intoxication/withdrawal, or other high-risk concerns requiring immediate intervention.

Veterans Crisis Line

The Veterans Crisis Line provides 24/7 confidential crisis support for Veterans and their loved ones. Veterans can dial 988 and press 1, text 838255, or chat online. The Veterans Crisis Line states that a person does not have to be enrolled in VA benefits or VA healthcare to use the service.

Useful for learning:

• Veteran-specific crisis support options

• How to include population-specific resources in safety planning

• How to ask about military service when clinically relevant

How to use it in clinical learning:

• Consider Veteran-specific resources when working with Veterans or military-connected patients.

• Ask your preceptor how the site handles VA coordination.

• Document crisis resource education when relevant.

Site-Specific Suicide Risk Tools

Many clinical sites have their own required suicide screening tools, risk assessment forms, safety plan templates, or EHR workflows.

Your site may use:

• C-SSRS

• PHQ-9 item 9 follow-up workflow

• SAFE-T-style risk formulation

• Internal suicide risk assessment template

• Safety plan template

• Crisis protocol checklist

• Telehealth emergency workflow

• Higher level of care referral process

• Firearm or lethal means counseling workflow

You must follow your site’s required process. If a course resource differs from the clinical site workflow, use the site workflow and ask your preceptor for clarification.

What These Tools Can Help You Do

These tools can help you:

• Ask more direct questions

• Reduce avoidance of uncomfortable topics

• Distinguish passive ideation, active ideation, plan, intent, and behavior

• Structure safety planning

• Address access to lethal means

• Improve documentation

• Communicate risk more clearly to your preceptor

• Recognize when more assessment or escalation is needed

What These Tools Cannot Do

These tools cannot:

• Predict suicide perfectly

• Replace clinical judgment

• Replace preceptor consultation

• Replace emergency evaluation when needed

• Replace institutional policy

• Replace state law

• Replace a complete psychiatric assessment

• Make an unsafe outpatient plan safe

• Eliminate the need for documentation

Use tools as supports, not as shortcuts.

Questions to Ask Your Preceptor

Ask your preceptor:

• “What suicide screening tool does this site use?”

• “Do you use the C-SSRS or another structured tool?”

• “How do you document passive suicidal ideation?”

• “When do you require a formal safety plan?”

• “How do you document means safety?”

• “When do you involve mobile crisis or emergency services?”

• “How do you handle suicidal ideation during telehealth?”

• “What should I do if a patient endorses plan or intent?”

• “How do you document preceptor consultation for risk?”

• “What crisis resources should patients receive?”

Red flags

Do not rely only on a resource, app, or form if the patient has:

• Active suicidal ideation

• Plan

• Intent

• Access to lethal means

• Preparatory behavior

• Recent suicide attempt

• Escalating self-harm

• Command hallucinations

• Severe psychosis

• Severe mania

• Severe intoxication or withdrawal

• Severe agitation

• Inability to safety plan

• Unsafe home environment

• Homicidal ideation with target, plan, intent, or weapon access

• Any concern that outpatient care is not safe

In these situations, involve your preceptor immediately and follow site policy.

Final Note

Structured tools can make you a better, safer clinician when you use them correctly. They help you ask direct questions, organize risk information, and create more concrete safety plans.

Do not let a tool replace your clinical responsibility. Risk assessment still requires careful listening, direct questioning, attention to red flags, preceptor consultation, clear documentation, and appropriate escalation when safety cannot be maintained.