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Suicide Risk Assessment

Suicide risk assessment helps us distinguish people who have thoughts of ending their lives from those who are in danger of attempting or completing suicide.  Most people who have suicidal thoughts do not have a plan to attempt suicide, and most people who attempt do not die.  Risk assessment helps us identify those most at risk, and focus emergency intervention efforts on those individuals, and focus on providing emotional support and community connection to those with suicidal thoughts.

All San Francisco Suicide Prevention operators are trained on Thomas Joiner’s Interpersonal Model of Suicide Risk, which is translated into a ‘DCI’ assessment method.  There are three components of the DCI method:

  • DESIRE – Does the person say they want to end their own life?
    • Characteristics of suicidal desire: 
      • Do they have a desire to end pain (physical or emotional)?
      • Feel trapped with no way out?
    • How to identify suicidal desire:
      • Ask directly!
      • “Are you feeling suicidal?”
      • “Are you thinking of ending your own life?
      • “Do you want to be alive right now?”
  • CAPABILITY – (both physical and emotional) Does the person have access to, and the ability to use a lethal method of ending their own life?
    • Characteristics of suicidal capability:
      • Do they have a plan?
      • Is the plan lethal?
      • Do they have access to the means?
      • History of attempt?
      • Loss?
      • Lack of emotional support?
    • How to identify suicidal capability:
      • “Do you have a plan for how you would attempt suicide?”
      • “What is your plan for how you would attempt suicide?”
      • “What would you use?”
      • “Do you have the thing you plan on using?”
      • “Have you ever attempted suicide before? How did you do it?
  • INTENT– Does the person disclose a commitment to end one’s life?
    • Characteristics of suicidal intent:
      • Is there a plan in place?
      • Are there preparatory actions for the plan?
      • Is there a timeframe for the attempt?
    • How to identify suicidal intent:
      • “Do you plan on carrying out this method?”
      • “When were you planning on attempting suicide?”
      • “Have you done anything else in preparation for attempting suicide?”

In order to evaluate what to do given specific answers to these questions, call our operators at 415-781-0500.  If the person-at-risk says they are going to attempt with a lethal accessible plan in the immediate future, call 911 to intervene.

If a person who is at risk of suicide says they’d like help staying safe from a plan they may have in place, consider organizing means removal.  Read more information about means removal here.