back to US directory
us clinical guidance

Suicide-related self-harm assessment and safety planning

VA/DoD-aligned identification, comprehensive suicide-risk assessment, collaborative safety planning and risk-tailored disposition.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adults with suicidal thoughts, a suicide attempt or other potentially suicidal self-directed behavior. The 2024 VA/DoD guideline focuses on suicide risk and does not make all nonsuicidal self-injury equivalent to a suicide attempt. Every episode still needs assessment of intent, function, medical injury and future risk.
sources for this section:VA/DoD suicide risk 2024

The Bottom Line

  • Ask directly and compassionately about thoughts of death, suicidal ideation, intent, plan, preparation, recent behavior, prior attempts, access to lethal means and reasons for living.
  • Use a comprehensive clinical assessment to determine acute and chronic risk; do not let a scale score, a denial of intent or a single protective factor dictate disposition alone.
  • Create a collaborative, personalized safety plan that identifies warning signs, internal coping, supportive people and settings, professional contacts and steps to reduce access to lethal means.
  • Match monitoring and level of care to current risk, ability to use the plan, supports, intoxication, medical severity and environmental safety, with active follow-up after transitions.
sources for this section:VA/DoD suicide risk 2024

Practical clinical workflow

1
First treat injury, poisoning, intoxication, withdrawal or altered mental status; obtain emergency medical support and poison-control input when indicated before completing psychiatric disposition.
2
Establish what happened, expected lethality, intent, ambivalence, rescue circumstances, stressors, psychiatric symptoms, substances, sleep, pain, recent loss, access to firearms or medications and protective connections.
3
Determine whether the patient can collaborate, maintain safety and access follow-up; involve chosen supports with consent or under applicable emergency exceptions and document the rationale for disposition.
4
Before discharge, complete safety and lethal-means counseling, confirm rapid follow-up and crisis access, reconcile medications and communicate the plan across settings rather than relying on a no-harm promise.
sources for this section:VA/DoD suicide risk 2024

Safety boundaries and escalation

  • Current intent, a feasible plan, recent preparatory behavior, inability to maintain safety, severe agitation, psychosis, intoxication or absent support requires immediate secure evaluation and must not be left to routine follow-up.
  • A medically low-lethality act can coexist with high future suicide risk; assess the person and trajectory rather than ranking seriousness from the injury alone.
  • Firearms account for highly lethal attempts in the United States; counsel collaboratively on temporary off-site or otherwise safer storage consistent with federal, state and local law.
  • Risk often changes after emergency or inpatient discharge, medication changes, legal or relationship loss and renewed substance use; use caring contact and active follow-up rather than assuming the crisis has passed.
sources for this section:VA/DoD suicide risk 2024

Localization

Call or text 988 for the US Suicide & Crisis Lifeline and use 911 for immediate danger or medical emergency. State emergency-hold law, firearm-transfer law and crisis-service availability vary.
sources for this section:VA/DoD suicide risk 2024

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. U.S. Department of Veterans Affairs and U.S. Department of Defense Evidence-Based Practice Work GroupVA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide2024 guideline; official guideline page checked 2026-08-20 路 accessed 2026-08-20
    view source
continue the learning

From guidance to deliberate practice and evidence

Choose what happens next. iatroX can carry this page's jurisdiction, source-check date and released version into an editable learning record, support your reflection, or let you browse the regional question bank while keeping this topic visible. No action records completion, starts a session or awards CPD/CME credit automatically.

Add this guidance review to CPD/CMEOpen an editable learning-log record with this page鈥檚 provenance attached. You confirm the activity, time, reflection and mappings.Reflect on this with TutorUse optional prompts to consider what you learned and what鈥攊f anything鈥攜ou may change. Suggestions are never inserted automatically.Browse the US question bankKeep this guidance topic in view, then choose your exam and filters. No session starts automatically.
Found a source update or regional discrepancy? Tell the iatroX editorial team.