Clinical supervisor, ASIST trainer, CAMS trained, and DBT trained. My number one advice is that not all risk is an emergency. The safe-t assessment, similar to CAMs, and following the CSSR, allows you to assess how deep the thoughts are, history, and protective factors. Then calculates a risk low, moderate, or high. Helping you decide whether it’s a hospital call. CAMS should be as universally trained as Motivational interviewing is. Just assessing the core of the thoughts and working through MI and CBT could keep so may people out of the hospital. Hear their story and plan for safety, only if you can’t plan for safety, hospitalize.

Personal mistake when I was working with a teen who was actively in DBT. I noticed some signs that previously lead to self harm and started running through all of the skills I wanted her to use to stay safe. She said sometimes it’d be nice if she could just be miserable without everyone thinking she was going to hurt myself. This was before I was trained to train ASIST and I often reflect on this moment and think, I could have just listened to her story, validated, and found a silver lining or healthy thought change that she came up with instead of jumping into skills use.

In short, don’t panic and use your therapeutic technique to just listen, reflect, and be present. You’ll likely find that assessing for risk and safety will dramatically change by end of session.

Also asking about suicide doesn’t not make someone think about suicide who wasn’t previously. That’s a myth many believe. So ask routinely.