Table 5.

Illustration of levels of suicide risk.

Acute Risk Level	Characteristics of Level			Recommended Response
	Protective Factors	Acute Risk Factors	Suicidal Evaluation
Mild	Easily identifiable, multiple protective factors.	Few risk factors, mild mood symptoms, evidence of self-control	Ideation limited in frequency, intensity, or duration. No plan or intent	Frequent outpatient follow-up, monitoring for any change in risk. Further evaluation of mood symptoms. Consider psychiatric referral.
Moderate	Some identifiable protective factors.	Baseline chronic risk factors. Minimal mood symptoms. Maintained self-control. Rare acute risk factors.	Frequent suicidal ideation, still limited in intensity and duration. May have plan, but no intent.	Increase frequency/duration of visits. Repeated evaluation of need for hospitalization. Involve family and support system. Means restriction. Review emergency protocols, such as emergency rooms and crisis services. Control mood symptoms with medications and/or psychotherapy. Frequent follow-up with phone calls or nursing visits (if available). Consider psychiatric referral and/or hospitalization, especially if risk increasing with re-evaluation.
Severe	Minimal protective factors endorsed.	Multiple acute risk factors or high acuity risk factor. Poor self-control, either at baseline or due to substances.	Frequent, intense, persistent suicidal ideation with plans. May discuss intent, but has no gathered means or had rehearsal behaviors	Evaluation for inpatient hospitalization, either by on-site psychiatric professional or through an emergency room. Do not leave patient alone in the office during assessment. Hospitalization may be indicated even if involuntarily. Means restriction for acute period following hospitalization.