Which elements are essential in a suicide risk assessment during an MSE?

• A. Only assess current mood.
• B. Only assess for prior attempts in past year.
• C. Assess ideation, intent, plan, means, prior attempts, protective factors, substance use, mental state, and imminence; ensure safety planning.
• D. Only assess whether patient denies thoughts.

Answer: (C)

During the mental status exam, a comprehensive suicide risk assessment looks at more than mood. The crucial elements include current thoughts of self-harm (ideation), whether there is intent to act, whether there is a concrete plan, and whether the patient has access to means. Past attempts inform risk but must be interpreted in light of present factors. Protective factors like supportive relationships and coping skills can lessen risk. Substance use can heighten impulsivity and lethality, so its impact is important to evaluate. The patient’s mental state—mood, hopelessness, judgment, and cognitive clarity—helps gauge current risk and reliability of reported information. Imminence asks how soon harm might occur, guiding the urgency of intervention. Finally, safety planning brings together concrete steps to reduce risk: removing means, locating supports, and determining the appropriate level of care. This full approach identifies the current risk level and informs immediate safety actions, whereas mood alone, recent attempts alone, or simply noting denial do not capture the full, dynamic risk profile.