When I was first practicing in this clinic, I avoided asking about suicide because I didn't know how to react. The first time a patient told me he wanted to kill himself, I really freaked out. After that I worked out a definite plan. I made a list of phone numbers to call for acute crises and taped it to my desk. I talked with my mental health collaborators, and we came up with a plan to address these and other problems that feel urgent. Myself and the other clinic staff also reviewed the need to make sure suicidal patients are not left alone.

You should go ahead and make a list of emergency numbers, plan who will stay with your patient in case of an emergency, and form cooperative relationships with mental health practitioners.

It's important to become comfortable asking about suicide, but you'll also need to be prepared to deal with the responses. There are two important aspects to this. The first is to ask follow-up questions to determine how immediate the threat is. Some patients may have occasional thoughts of suicide or may think about it as an abstract concept, but have little likelihood of actually attempting to commit suicide. Others have carefully considered plans, the means to carry them out, and may have practiced them. In addition to asking questions about the immediacy of the threat, some knowledge of the risk factors for completed suicide will help you determine the severity of risk.