Suicide and serious psychiatric risk assessment

Across the manuals, suicide and serious psychiatric risk assessment is treated as a core safety function, with repeated monitoring of suicidal ideation, intent, behaviour, and broader mental state before, during, and after treatment. The sources converge on structured use of the Columbia-Suicide Severity Rating Scale, often alongside clinical judgment, narrative interview, and follow-up contacts. Several manuals also link risk monitoring to concrete escalation routes, including urgent psychiatric assessment, emergency department referral, EMS, hospitalization, withdrawal from study, and documentation or reporting of adverse events. The manuals differ mainly in how they operationalise monitoring and escalation. Some specify frequent scheduled checks, such as screening, baseline, dosing, washout, integration, follow-up, or weekly remote contacts, while others emphasise continuous vigilance during sessions and post-session destabilisation. A few sources add extra safety steps such as daily telephone contact, 24-hour phone availability, emergency contact collection, caregiver or family involvement, or private follow-up by phone or video. They also differ in the exact thresholds for action, with some distinguishing passive ideation from active ideation with plan or intent, and others explicitly naming exclusion criteria, withdrawal, or immediate hospital-level care when risk becomes imminent.