Standards
1. Ethics and Values
Social workers shall adhere to the values and ethics of the profession using the NASW (2021) Code of Ethics when interacting with clients who are at risk for or currently experiencing suicidal thoughts or behaviors.
Interpretation
Service
Social workers are called on to use their training, skills, and knowledge to address social problems and provide ethically informed service to people in need. Given the extent of suicide across the lifespan and the many individual and social determinants that contribute to risk, clients in both generalist and clinical settings may experience suicidal thoughts and behaviors. Because social work prioritizes service to others and places clients’ needs above self-interest, social workers should examine their personal attitudes and values about suicide (Rudd et al., 2008; Suicide Prevention Resource Center [SPRC], 2006). Being aware of one’s views, biases, and values facilitates the introspection that is needed for providing responses to clients at risk of suicide that prioritize their needs and values.
Social Justice
Another requirement for social workers is to improve the lives of others by challenging social injustices. Social workers’ social change efforts are focused primarily on issues of poverty, respect for social and ethnic diversity, and addressing forms of injustice—including the stigma associated with suicide. To honor the value of social justice, social workers should recognize suicide risk among populations that experience not only mental health challenges but also social determinants of health that are harmful. These include individuals who are vulnerable due to discrimination, oppression, housing insecurity, food insecurity, unemployment, and limited or no access to healthcare and education. Social workers should also consider populations that experience higher rates of suicide, such as LGBTQIA+ individuals; military-affiliated and veteran populations; American Indian, Alaska Native, and Native Hawaiian individuals; and older adults (66 years and over) whose needs may be complicated by intergenerational trauma, social inequities, and intersecting identities. Social workers have opportunities for suicide prevention activities beyond the micro-level responses by embracing mezzo- and macro-level interventions and reforms and by advocating for improved awareness, knowledge, and approaches to suicide prevention for individuals, families, and communities.
Dignity and Worth of the Person
Social workers must also give every individual client the respect and decency they deserve as a human being. This value is reflected in respect for the client’s autonomy and self-determination. When working with a person at higher risk for suicide, someone who is experiencing a suicide crisis or living with chronic thoughts of suicide, it is imperative that the social worker seeks services in the least restrictive environment. If a more restrictive environment, such as hospitalization, is the optimal course of action to ensure client safety, the social worker should proactively address client concerns by transparently explaining the reasoning for this course of treatment. Beyond these immediate safety measures, when a client’s persistent pain and suffering lead to a desire to die, the social worker should work to understand the underlying reasons for their wish to die while adhering to established standards of care for suicide prevention. In some jurisdictions, this exploration may involve legal options like MAID as part of end-of-life care or Psychiatric (or Mental Health) Advanced Directives (or PAD), documenting mental health treatment preferences before a crisis. While a client’s interest in MAID can challenge social work values of personal autonomy and self-determination, it is legally and ethically distinct from suicide. Although MAID-related decisions fall outside the scope of these standards, social workers are still expected to follow the standards of care for suicide to support the client through their emotional pain and suffering. Social workers must follow applicable laws and should refer to NASW’s recently updated Practice Standards for Serious Illness Care: Hospice and Palliative Social Work for guidance (NASW, 2026).
Importance of Human Relationships
Another focus for social workers is to build relationships with individuals and the community they are part of and to provide support and healing in the wake of societal, interpersonal, and economic hardships. Relationships are a core vehicle for change (NASW, 2021). The ability to build rapport and engage clients empathically is a fundamental social work skill that enables a trusting and meaningful connection with a client while maintaining professional boundaries. This connection creates the space for the client narrative and the assessment narrative to emerge.
Social work recognizes that interpersonal relationships and support systems (i.e., family, peer, tribal, or community-based) engagement can either exacerbate suicide risk or strengthen protective factors. It is important for social workers not to assume family engagement is a positive support for the client. Clients who report isolation or a lack of formal or informal supports may experience increased suicide risk and would benefit from connections to self-help groups or community resources such as faith-based organizations and crisis helplines (e.g., 988 Suicide and Crisis Lifeline, the Crisis Text Line, and local crisis helplines). Relationships are also central to the development of a collaborative safety plan and during follow-up.
In tribal contexts, relationships may extend beyond the individual and family to include connections with ancestors, future generations, culture, the natural world, and the community as a whole. Among other populations, social workers should consider the importance of chosen family, especially among LGBTQIA+ clients. When combined with a standardized assessment instrument, engagement with the client’s support system is essential to developing an effective suicide risk intervention strategy.
Many social workers find the professional and emotional demands of working with clients who experience suicidal thoughts or behaviors as challenging and fear inducing. Therefore, all social workers, regardless of education level or practice setting, need support from trusted colleagues and, when applicable, their employers. Supervision and consultation are critical components of effective practice with clients at risk for suicide and reflects social work’s collaborative and interdisciplinary foundation. If a social worker does not have access to an appropriate supervisor or colleagues for consultation, they should seek support from their organization administrators.
Integrity
An important goal for social workers is to build trust in relationships with clients by adhering to a strong set of moral and ethical principles, being honest and transparent in all interactions, and consistently acting in the best interests of the client and the profession. Social workers fulfill the core value of integrity before, during, and after their interactions with clients at risk for suicide or who experience suicidal thoughts or behaviors. Integrity begins with understanding and seeking out the skill set required to effectively intervene with a client experiencing suicidal ideation or behavior. It continues in interactions with the client through the process of informed consent regarding expectations and boundaries of interactions and interventions, including discussions of confidentiality and implementation of safety strategies. Finally, it continues in follow-up contacts related to treatment recommendations and in the process of documentation, which serves as a record describing the integrity and ethical nature of all practice decisions.
Competence
Social workers should also apply their knowledge and skills to effectively support the well-being of the community and its commitment to social justice, and to know when and how to apply ethics and advocacy for social change. Acknowledging one’s personal values and attitudes about suicide is the first step toward professional competence (SPRC, 2006). Competence then requires training and ongoing enhancement of suicide-related knowledge and skills necessary for prevention and intervention. These standards outline the minimum level of competence that all social workers should possess regardless of degree, specialization, or setting.
Competent social workers understand the risks of overestimating or underestimating a client’s suicide risk, either of which may compromise the client’s rights and safety or increase provider liability. Consistent with the NASW (2021) Code of Ethics, which states that “social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience” (1.03a), social workers must commit to continuing professional development, especially in field suicide prevention. Social workers should utilize additional training, education, supervision, and consultation to improve their knowledge and competence in suicide prevention, intervention, and postvention, both overall and with special populations.
Suicide-Related Knowledge
Social workers shall remain current in their knowledge of suicide-related statistics, epidemiology, risk factors (including social determinants and >exposure to death or suicide), protective factors, screening and assessment resources, safety planning, referral resources, and, if relevant—based on their licensing—intervention and treatment strategies. Social workers should be knowledgeable about suicide-related resources and community services and make appropriate referrals as needed. Social workers in administrative or leadership roles should be aware of safe messaging guidelines (best practice for communication about suicide) as well as variables associated with the risk of suicide contagion and the components of postvention strategies as they work with suicide loss survivors or communities.
Interpretation
While most undergraduate and graduate social work programs and state licensing boards currently do not require education in suicide prevention, intervention, or postvention, these standards encourage social workers to receive and maintain current knowledge on all these topics by attending trainings and being aware of new developments in the field (see the Resources section for more information).
Specific Knowledge of Screening, Assessment, and Intervention Strategies
There are currently a variety of evidence-based screening, assessment, and intervention strategies for suicide prevention and many hospital and clinical settings have these tools embedded in their protocols and electronic health records. There is also a selection of brief interventions and therapeutic treatment models that have evidence of effectiveness with clients at risk for or currently experiencing suicidal thoughts or behaviors. The SPRC (n.d.-a) has an updated list of treatment models in their Best Practices Registry.
There are, however, some limitations in these tools that social workers should consider. First, most standardized screening tools fail to include social determinants or systemic risks. Second, the effectiveness of intervention strategies may be compromised because many of them were piloted in White, middle-class populations. Cultural, linguistic, and developmental adaptations may be necessary to fully capture risk or protective factors relevant to specialized populations such as American Indian or Alaska Native populations and children or youth. Practitioners should consider supplementing standardized measures with narrative assessment, community consultation, and culturally congruent approaches that recognize the importance of family, relationships, spirituality, and cultural strengths of the community.
Use of Resources and Referral
Social workers should maintain continuity of care by ensuring that clients receive coordinated psychosocial services and advocacy across service delivery systems, in collaboration with caregivers, school personnel, and community providers. Knowledge of local, state, and national suicide-related resources is essential when referral to other services is necessary. 988 Suicide and Crisis Lifeline is a national resource provided in various languages (including supports for the deaf and hard-of-hearing community) that assists with crisis stabilization and connection to resources; talk, text, and chat options are available.
The social worker should maintain collaborative contacts with other social workers or relevant professionals and know how to make appropriate referrals that include clear protocols for documentation and follow-up assessment of referral efficacy. Given that suicidal urges can fluctuate over time, clients who are currently stable but demonstrate risk factors for suicide should be provided with suicide resources as part of a safety plan, empowering them to take proactive steps if those feelings resurface.
Specialized Practice Standards
Six standards of care for suicide screening and assessment have been promulgated for use by all clinical and professional practices by NAASP (2018). These standards recognize these steps as feasible and practical actions that can be applied in both clinical and generalist social work settings, especially when they are integrated with social work values, ethics, and skills. All social workers in a professional pathway that affords them the opportunity to work directly with clients (in clinical or generalist practice) are expected to adhere to Standard 3. As espoused by NASW, these steps incorporate the person-in-environment perspective, which is more comprehensive and inclusive than the more typical, individual-focused medical model interpretation of care. Standard 3 comprises successive actions that social workers engage in to identify and respond to potential suicide risk.
It is understood that macro-level social workers who do not interact directly with clients are expected to adhere to their professional pathway and will not be required to practice outside of their competence as it relates to assessment, safety planning, and counseling on access to lethal means. However, not unlike mandated reporters for child abuse or other conditions, they are expected to know the risk and protective factors for suicide, screen for suicide risk, make a proper connection to an appropriate care provider via an immediate warm handoff and/or implementation of crisis protocol, document, and follow up.
The following sections outline the six NAASP standards of care for suicide incorporating social work values and ethics.
3.1 Initial Screening
Social workers shall ask all clients in a clear and direct manner about thoughts of suicide (e.g., “Are you thinking about killing yourself?”; “Do you wish to be dead?”) and suicidal behavior (e.g., “Have you ever tried to hurt yourself to end your life?”).
Interpretation
Screening for suicide is a brief, initial check to determine if a client might be at risk for suicide. It was adapted from public health approaches in physical health promotion to identify individuals who may need further assessment, support, and interventions or treatment. Initial screening is warranted in social work settings, whether generalist or clinical, independent of whether a client is demonstrating signs of suicide risk. Broaching the topic provides clients who may be reluctant to bring up their personal concerns about discussing suicidal thoughts or behaviors a safe environment to address the subject.
To ask all clients directly through a standardized screening instrument or in narrative questioning if they are experiencing thoughts of suicide or killing themselves is the fundamental approach. For example, a social worker can add the following question to their repertoire of questions: “Have things in your life ever been so bad that you thought about taking your life?” (Underwood et al., 2018). Approaching the question about suicidal thoughts or behaviors from the perspective of “taking your life” can open the door to conversation with a client who is personally struggling with acknowledging that they are thinking about suicide. Starting the conversation with a question about “wishing you did not wake up” has also been suggested as a way to ease into the conversation. If this approach is used and the response is affirmative or if there is hesitation, it is imperative that the question be followed by more direct questions about specific thoughts of killing oneself.
Standardized Screening Instruments
There are multiple standardized suicide screening instruments that are used in social work. Some of these are the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011), Ask Suicide Screening Questions (ASQ; Horowitz et al., 2012), the Patient Health Questionnaire–9 (PHQ-9; Kroenke et al., 1999), and the Patient Health Questionnaire modified for Adolescents (Johnson et al., 2002). These tools are free and publicly accessible, and free training in their use is available online and should be completed prior to usage (see Resources). Some of these measures have been tested with special populations and have adaptations available. A measure that incorporates the sociocultural determinants of risk is the Culturally Responsive Assessment of Suicide (CARS; Chu et al., 2013; Molock et al., 2023) and it can be easily integrated into a suicide assessment intervention. NASW does not endorse any specific instrument and assumes no responsibility for the validity or outcomes of third-party tools. Selection of an appropriate instrument remains the professional judgment of the social worker in the context of their practice setting, the client’s background, and applicable organizational protocols.
Dynamic Nature of Suicidality and Risk Stratification
Some screening measures introduce risk stratification (i.e., low, medium, and high), which can provide a false sense of security for the provider or organization if the client identifies as low risk (Large et al., 2016; Large et al., 2017). Insurance and organizational policy may require the use and documentation of risk stratification but given the dynamic state of suicide (Kleiman et al., 2017), a client may screen as low risk at one point in time and then escalate in risk outside of the time captured by the initial screen; thus, the social workers should clearly document the dynamic, point-in-time nature of that risk in the event a client’s status rapidly changes hours after an assessment. What can make the screening process more effective is including additional narrative questions that provide more details and lead to more clarity. Engaging clients more fully in their own treatment by helping them identify the situations that may increase their risk for suicide in the future as well as the supports and resources to utilize if this happens (i.e., collaborative safety planning) introduces the process of clinical intervention during the assessment process.
Concern Can Remain Even if Client Denies Suicidal Thoughts or Behaviors
It is important to recognize that some clients may be reluctant to acknowledge suicidal thoughts or behaviors during the screening process. Utilizing the social work values and skills of rapport building and human connection may create a safe environment that helps a client have an honest discussion about their suicidal thoughts or behaviors. But if, within the context of a safe therapeutic relationship, the client continues to report no suicidal thoughts or plans, social workers need to look beyond the screening data to identify risk and protective factors that may escalate or mitigate a suicidal crisis in the future and provide appropriate care (i.e., safety plan), referral, and/or resources.
3.2 Formal Assessment, As Indicated
To inform service delivery, social workers who interact with clients in
generalist or clinical direct practice shall gather information about suicide
risk and protective factors, ideation, intent, and plans of an individual
who indicates thoughts of suicide or suicidal behaviors. It is imperative
that when social workers in generalist practice suspect or observe
potential suicide risk, they refer clients to a clinician for a comprehensive
assessment. Social workers’ assessment should reflect the person-in-environment
perspective by including individual, interpersonal, historical,
community, and societal influences on suicide risk and protection.
Interpretation
The purpose of suicide assessment is to confirm risk, determine severity,
and guide the treatment plan. Its main goal is to evaluate risk
factors (especially those that may be modifiable), the client’s psychosocial
history, social determinants that may be associated with suicide
risk, and the client’s protective factors to inform clinical decisions. If a
client expresses thoughts of suicide during screening, or risk is identified through the presentation of risk factors, additional questions and a detailed clinical evaluation or assessment are required to determine the severity and immediacy of the risk. If a suicide risk assessment is not within the social worker’s professional responsibilities, they must follow these standards within the context of their agency or organization regulations and protocols to ensure the client is connected to additional care (i.e., a warm handoff) and document the concerns and referral in the appropriate records.
There are a range of standardized assessment instruments available which provide lists of questions related to risk factors and protective factors. SPRC provides additional information on assessments that are widely used and/or at no cost and are applicable across a broad range of ages.
Just as it does in the screening process, risk stratification may also appear in assessment and the same rules (discussed in “Dynamic Nature of Suicidality and Risk Stratification”) apply. Even if your organization requires risk stratification, the provider should recognize that risk stratification is not a determination that can predict suicidal outcome. Instead, the social worker should draw on their social work skills to complete a thorough assessment based on the person-in-environment approach and use the information collected to inform suicide prevention intervention strategies and protocols to support the client.
Social Work Values in Assessment
Like in the screening process, social workers should conduct all assessments within the context of the social work values and skill set of being nonjudgmental, collaborative, supportive, and respectful while building rapport and a strong therapeutic alliance (Praetorius, 2021). When a client is overwhelmed by isolation and hopelessness, social workers can “lend hope” (Clark & Hoffler, 2014) through the use of a possessive pronoun (e.g., “we,” “us”) or incorporate the suggestion of collaboration (e.g., “Let’s put our heads together”). When social workers employ these joining techniques rather than use outdated models of diagnoses and deficits, the risk factors of isolation and hopelessness can transform into feelings of connection and hope, which are protective factors for suicide (Bird et al., 2014; Heller, 2015). These simple techniques reinforce to the client that they are not alone and the social worker is joining them in problem solving (Underwood et al., 2018).
Person-in-Environment Risk and Protective Factors
Competent assessment of suicide risk should be greater than the individual
level of risk and protective factors and more broadly incorporate
person-in-environment considerations. This approach acknowledges
the relevance of a social constructionist assessment by considering
the impact of the environment and other sociocultural influences
(e.g., structural racism [Alvarez et al., 2022] as well as discrimination,
oppression, structural inequities, and intergenerational trauma [Button,
2016]) as risk and protective factors (including reasons for living,
supportive relationships, access to health and mental health resources,
and identity-based/culturally grounded strengths such as family, community
connection, and spirituality). Because of this, social workers
should also embrace cultural humility by acknowledging the various
individual and social determinants of risk and protective factors that
are present and with which they may be unfamiliar (i.e., Structural
Racism and Suicide Prevention Systems Framework [Alvarez et al.,
2022] and CARS [Chu et al., 2013; Molock et al., 2023]). Regardless
of cultural context, certain core components of suicide risk assessment
remain constant (Rudd, 2006). These include assessing history of suicidal
thoughts and behavior, access to lethal means, and support system
availability.
Frequency of Assessment
Given the transient and, at times, reoccurring nature of suicidal thoughts
and behavior, risk assessment should be ongoing throughout the course
of treatment. How this is conducted may vary based on the situation and
client. With clients who exhibit some degree of risk in outpatient care,
it is important to ask questions about suicidal ideation at each session
to check in and determine if more focus on reviewing and updating the
safety plan is necessary or if additional assessment and/or a more intensive
level of intervention is needed. This is especially critical for clients
who experience chronic or persistent thoughts of suicide. Social workers
should explain to clients that talking with them about suicidal thoughts
and changes in their intensity over time is an important focus of treatment
and that safety plans should be reviewed and adapted as stressors
and challenges change in life. For individuals with suicidal thoughts,
events that trigger thoughts of suicide should be explored and specific
and accessible coping mechanisms identified that the client could use
outside of the treatment setting.
3.3 Development of a Collaborative Safety Plan
Social workers shall complete a collaborative safety plan with clients who are at risk for suicide or experiencing suicidal thoughts or behaviors.
Interpretation
Safety planning reflects collaboratively identified information by the
social worker and client, including distress triggers and a hierarchy of
coping techniques about what to do to distract from distress triggers,
where to go for help, and with whom (i.e., personal and professional
networks) to talk to in order to minimize suicide risk (see Stanley–
Brown Safety Planning Intervention, https://suicidesafetyplan.com;
B. Stanley & Brown, 2012). Developing the plan reinforces the client’s
agency and highlights the importance of including human relationships
in their coping repertoire. A collaborative safety plan promotes client
safety with respect for client dignity, worth, and self-determination, emphasizing
what the client will do to stay safe rather than focusing solely
on reactions to distress.
After the written safety plan is completed, two additional areas
should be explored. The first is discussing reasons for living. Social
workers can shift the focus from the “deficits” of triggering events to
the “strengths” in the client’s reasons for living by saying, “You’ve told
me your reasons for dying; now I’d like you to hear about your reasons
for living.” This reflection of self-determination and dignity focuses on
positive, protective factors.
The second additional step, also grounded in self-determination
and personal autonomy, is asking the client how likely they are to use
the plan and identify potential barriers to implementation. The plan can
then be revised to better reflect the client’s perceptions of its utility. Social
workers must obtain training and competence in the development
of collaborative safety plans (see Resources).
It is important to note that safety plans are different from “no harm” or “no suicide” contracts. Historically, “no harm” or “no suicide”
contracts—an agreement in which a person promised not to engage
in suicidal behavior or self-harm and to contact a designated person
or service if they experienced thoughts of suicide—were used in clinical
settings. There is no evidence, however, that they effectively mitigated
suicidal behavior, and their use may have provided clinicians with a false
sense of security that the client was safer after signing the contract. In
addition, they are not legally binding (Rudd et al., 2006) and do not reflect
social work values (Sanders et al., 2006). Rather than being collaborative,
they are directive and authority-based, and do not consider the
environmental factors that could contribute to distress or support safety;
thus, “no harm” or “no suicide” contracts should not be used.
3.4. Counseling about Access to Lethal Means
Social workers shall understand the role of access to lethal means in death by suicide and ask questions about access to and safe storage of such lethal means.
Interpretation
Having access to lethal means can increase the possibility of a death
by suicide. Social workers should recognize that the category of lethal
means is broad and includes not just firearms and medications but encompasses
environmental means such as access to bridges or other high
places, trains, or sharp objects (Pollock, 2019). Once the range of methods
of suicide is considered, the second key component of this standard
is counseling regarding safe storage or access to these means. This requires
discussion with the client and their support system (i.e., family or
community-based support) about strategies to monitor and limit that
access, especially for the period of time that the client remains at risk
for suicide. Engaging the support system in this process speaks to the
social work perspective of acknowledging the influence of person-in-environment
and the importance of human relationships. Social workers
should educate the client’s support system about the critical role
they can play in limiting the at-risk client’s access to lethal means for as
long as the risk remains (Harvard Injury Control Research Center, n.d.).
The CALM training is evidence-based and available at no charge on
the Counseling on Access to Lethal Means website (https://www.calmamerica.org) as well as on multiple other sites.
3.5. Documentation of Care Plan
Social workers shall document adherence to the standards of care for
suicide including care processes, decision making, consultation and supervision,
and the rationale for care provided and care considered but
ruled out.
Interpretation
While documentation is important in the legal context, it is also an
important part of reflective and ethically grounded practice serving to
demonstrate best practice and the suicide care pathway in service of our
clients. Documentation related to the standards of care for suicide prevention
should be concise, complete, logical, and purposeful in demonstrating
the guidance of care and practice provided (Reamer, 2005);
more information does not provide more protection against liability if
the right information is not included (Reamer, 2013). According to the
NASW (2021)
Code of Ethics, “Social workers’ documentation should
protect client’s privacy to the extent that is possible and appropriate and
should include only information that is directly relevant to the delivery
of services” (3.04[c]). Information overload in records can lead to decreased
accuracy in the quality of decision making. It has been found
that weaker documentation is the result of weaker suicide assessment
and intervention knowledge (O’Connor et al., 2004).
There are several important purposes for documentation:
- To provide a history of interventions
- To provide a rationale for decisions made in care planning
- To demonstrate awareness of state or tribal-specific laws regarding
mental health and gun possession
State/tribal-specific laws are relevant in states that use Extreme Risk
Firearm Protection Orders (ERFPOs)—colloquially referred to as red
flag laws. ERFPOs require certain people to petition the court to potentially
remove firearms from someone who is determined to be at risk to
their self or others; these certain people may include social work clinicians.
Furthermore, since petitioning a court may involve breaking
client confidentiality, social workers must adhere to the following section
of the
Code of Ethics: “Clinicians need explicit ethical backing in the
text to disclose confidential information without consent for ‘compelling
professional reasons’ to prevent ‘serious, foreseeable, and imminent
harm’ ” (NASW, 2021, 1.07[c]).
Relevant documentation should detail the risk factors for suicide
at the time of interaction with the client and the actions taken as part
of care planning to address those risks, with the rationale underlying
those treatment decisions. The contemporaneous records of the suicidal
impulses present at the time of initial screening and assessment
are essential information, especially if a referral is made for subsequent
services. Because suicidal impulses may be transient, the documented
history provides evidence of suicidal thoughts and/or behaviors that
were present at the time of the initial interview but may not be present
or disclosed by the client at a later point in time or after a referral (Kalafat
& Underwood, 2004). What is often missing in documentation but
is required to meet this care standard is a description of the disposition
options considered but not taken. For example, if a treatment decision
is made to recommend hospitalization, documentation should include
not only the reasons for this recommendation but also the reasons why
outpatient care was not considered appropriate. Timely documentation
should also include the names of screens and assessments administered
(including dates and scores) and, when possible, the client’s own words
indicated by quotation marks. Written communication, including text
messages, are part of the documented record.
Additionally, documentation is important from a legal perspective.
It should demonstrate that the actions taken by the social worker are
aligned with what a “reasonable person of ordinary prudence” (Reamer,
2003) would have done in a comparable situation and, as such, it can
offer protection from malpractice liability. If clinical decisions and their
rationale are not documented, it may be presumed that standards of care
were not met and the provider may be found liable if a death by suicide
occurs (Bongar & Stolberg, 2009; Knapp, 2024; Simpson et al., 2016;
I. H. Stanley et al., 2019).
There are multiple documentation models in social work, each with
the purpose of providing accountability, corroborating the delivery of
appropriate services, and supporting clinical decisions (Hepworth et al.,
2016). Some organizations will have electronic health/medical records
(EHR/EMR) that provide fields to include this information. If the
EHR/EMR does not include specific fields for relevant content related
to the standard of care for suicide, efforts should be made to include it
as attachments, open text fields, or professional documentation notes. If
an organization does not have a required mental health documentation
protocol, social workers should use the mechanisms available (i.e., incident
reports, personal files) to record their actions. Further guidance for
documentation can be found in NASW’s (2025a)
Practice Standards for
Clinical Social Workers.
3.6. Follow-Up
Social workers shall conduct follow-up with clients who are at risk for or experiencing suicidal thoughts or behaviors.
Interpretation
Follow-up reflects social work values as well as NAASP (2018) standards
of care by mitigating client isolation through case management and care
coordination (Hepworth et al., 2016). Care coordination includes the
use of warm handoffs, proactive outreach after acute crises, and coordination
across service systems (e.g., schools, emergency departments,
outpatient settings, and community-based services). Case management
and care coordination not only facilitate client connections to resources
but also provide human connection and embody the social work values
of human relationships and social support, which can provide stability
for the client and protection against suicide risk (Hepworth et al., 2016).
Scheduled follow-up visits should be supplemented with brief, intermittent,
and repeated check-ins at shorter intervals, like the first 24 hours or
daily, when the social worker is concerned about an exacerbation of the
client’s risk factors. Follow-up check-ins or contacts may include phone
contacts, voicemails, text messages, postcards, or letters, and should be
included in documentation. This is a simple and low-cost strategy, often
referred to as caring contact, which has been shown to be especially
effective in preventing repeat suicide attempts during the six months
following discharge of the client from the emergency department. In
addition, these contacts can serve to decrease loneliness, which is a risk
factor for suicide (Inagaki et al., 2019).
4. Diverse Populations: Developmental, Cultural, Historical, and Contextual Consideration
Social workers shall understand the cultural, historical, developmental,
and contextual factors, and their intersections, that shape the experiences
of diverse communities across the United States as they relate to the
provision of effective and equitable suicide-related care.
Interpretation
Standard 4 acknowledges that diversity in its broadest sense, incorporating
people of different gender identities, social classes, cultures, occupations,
religious and spiritual beliefs, ages, and physical and cognitive
abilities, requires additional interventions that are both culturally sensitive
and culturally competent. Social workers must recognize how intersecting
identities (e.g., age, race, ethnicity, immigration status, disability,
LGBTQIA+ identity) compound risk through systematic barriers that
can create limited access to both care and relevant resources for suicide
prevention. It is also important to recognize that certain medical and
physical limitations or disabilities, including those that may be invisible
(e.g., chronic pain), can lead to increased risk for suicide due to
minimization of symptoms, heightened social stigma, loss of status, and
exclusion or isolation.
While the steps in Standard 3 are required to be completed with
all community members, Standard 4 provides information on unique
risk and protective factors to be considered when implementing the
standards with subpopulations at risk for suicide. This section does not
address all subpopulations, and those groups identified represent heterogeneous
communities that can span dozens or more ethnicities, languages,
religions, trauma history, socioeconomic status, immigration/
generation status, and relationships to mental health services, each requiring
a different approach. Social workers are encouraged to seek
additional knowledge and support when working with clients so that
unique characteristics and circumstances are not overlooked during
assessment and care. Furthermore, social workers should continue to
advocate for additional research, policy changes, and adaptations of
suicide-specific
interventions to address the unique needs of various
populations and the structural inequities driving mental health disparities.
See NASW’s (2015)
Standards and Indicators for Cultural Competence
in Social Work Practice.
Developmental Considerations
Suicide impacts individuals of all ages; however, there are specific considerations
needed when working with different age cohorts in the population.
Social workers must be aware of the intersectionality of age with
race, ethnicity, immigration status, disability, LGBTQIA+ identity, and
others, as they compound risks and impact the implementation of Standard
3. Social workers should ensure that the standardized screening and
assessment instruments used are validated with the age group of interest.
Youth (24 and Under). Youth have unique developmental, social (including
social media), and environmental vulnerabilities that shape suicide risk.
Their emotional regulation, identity formation, and reliance on family
and peer systems make them particularly sensitive to relational stressors,
school dynamics, and feelings of isolation or burdensomeness. As
youth age, life changes (e.g., grades, schools, friends) in the transition to
independence can become risk factors for suicide. Contact with caring
adults, peer support, and social connections are strong protective factors
for youth. Social workers who work with the school-age population
should be familiar with navigating confidentiality, family engagement,
and procedures for reentry following hospitalization. School social
workers should be familiar with the NASW (2025b)
Practice Standards
for School Social Workers.
Emerging Adulthood (Ages 25–44). Emerging adulthood is a distinct developmental
period with individuals navigating critical life transitions, including
entering college or the workforce; developing an identity; and gaining
responsibilities and independence regarding housing, finances, careers,
relationships, and families. From a clinical perspective, this age group is
highly vulnerable to the emergence of co-occurring mental health and
substance use disorders. During these transitions to adulthood, new risk
factors for suicide may emerge, including relationship dissolution (separation/
divorce), parenting stress, infertility, postpartum depression/
psychosis, and housing or economic instability. Furthermore, untreated
trauma or the escalation or onset of substance use or severe persistent
mental illness (e.g., bipolar disorder, schizophrenia) may emerge. At the
same time, this period may lead to developing strong protective factors/
reasons for living such as meaningful employment, stable partnerships/
marriage, child-rearing responsibilities, access to employee assistance
programs or employer-sponsored healthcare, and active community or
religious engagement.
Working Adults (Ages 45–65). Working adults, and men in particular in this
age group, have the highest relative risk for suicide, which is often
related to occupation (e.g., construction, farming/ranching, forestry,
transportation, manufacturing, military, police, first responders), as
well as access to lethal means. Additional risk factors for this population
can include increased isolation; physical health challenges, especially
pain; alcohol or drug use; financial challenges; barriers to help
seeking due to a stigma that it is a sign of weakness; and living in areas
with a shortage in healthcare professionals. Rural settings can also play
a role in risk as it can be related to increased access to lethal means
and lack of access to healthcare professionals. Protective factors may
include close connection to friends and family, including peers at the
workplace; religion and spirituality; and positive environmental factors,
such as safe and stable housing and financial and employment
security (Tiesman et al., 2023).
Older Adults (66 and Older). Older adulthood can be a profound period of
transition and identity status changes (e.g., moving from active
employment into retirement, experiencing aging-related challenges).
Adults ages 75 and older have the highest rate of death by suicide and
the lowest ratio of suicide attempts to death (Garnett et al., 2023).
Older adults face elevated suicide risk through cumulative losses due
to the convergence of physical decline (chronic illness, pain, cognitive
changes; Fässberg et al., 2016), financial vulnerability (Comans
et al., 2013), and losses in relationships, which can lead to loneliness
and isolation. Suicide risk in this group may be underassessed, particularly
in regard to access to lethal means. Also relevant is the role
of late-onset alcohol, substance, or prescription medication misuse to
cope with grief or physical pain. Social determinants of risk include
financial, housing, and food insecurity and lack of access to care. Protective
factors include redefined identity and purpose, social connection,
physical activities, learning new activities, increased spirituality,
and connection to religion.
Diverse Population Considerations
American Indian and Alaska Native Populations. American Indian and Alaska Native
communities represent more than 574 federally recognized tribes, each
with its distinct culture, language, governance structure, and spiritual
traditions. Tribes are sovereign nations and maintain government-to-government
relationships with the U.S. government; therefore, social
workers should avoid generalizations and ensure their practice aligns
with each tribe’s laws, local customs, and culturally grounded approaches
to intervention and healing.
American Indian and Alaska Native people have resiliently navigated
historical and intergenerational trauma. Colonization, forced relocation,
boarding schools, termination and relocation policies, and the suppression
of language and culture have created cumulative trauma and
unresolved grief carried across generations. Today, over half of Native
people live in urban areas due to the federal relocation programs of the
1950s, while many others live in reservation, rural, or frontier communities.
Each context shapes access to resources, cultural connection, and
community support in different ways. Native people are diverse in their
levels of assimilation, cultural expression, community involvement, and
lived experience, and this diversity must be honored in practice. Profound
strengths and protective factors come from relational respect,
cultural identity, spiritual practices, and healing through connection
with family, elders, community, and cultural lifeways.
Asian Community. The Asian American community is a diverse population
within itself. Understanding cultural and identity-level factors (e.g., discrimination,
acculturation, stress between generations navigating different
expectations at home and in school/work environment, “saving face”
by suppressing emotions to protect the family, and dealing with the
“model minority” stereotype; Lee et al., 2009) are important within the
Asian American community. These factors may lead to stigma regarding
disclosing mental health distress and seeking services resulting in isolation,
loneliness, and undertreatment of mental health conditions (Lee
et al., 2009; Renehan, 2022). The stigma of disclosing mental health
distress may lead to increased disclosure of physical symptoms (i.e., the
somatization of emotional distress) and seeking medical help in an effort
to mitigate the shame of admitting anxiety or depression (Choi et al.,
2016). Protective factors include an active problem-focused coping strategy,
strong ethnic identity and cultural connectedness, family cohesion,
and social support from faith communities and cultural organizations.
As with other populations, it is critical that social workers acknowledge
their own cultural humility and limitations reading the dynamics that
relate to this specific population and seek to educate themselves.
Black Community. Black youth and adults are at increased risk for suicide
due to multiple environmental factors. Social determinants of risk for
suicide include racism; discrimination; exposure to violence; lack of
access to health and mental health services; and cultural stigma regarding
mental health and mental health services, partly rooted in historical
practices of medical and psychological abuse toward Black individuals.
Protective factors include having healthy relationships and connections
with family and community, strong sense of racial/ethnic identity and
spiritual beliefs, sense of control, and willingness to seek physical and
mental health treatment.
Immigrants, Refugees, Asylum Seekers, and International Communities. This population may
present with significant historical or current trauma and displacement.
Systemic inequities that lead to marginalization and increased suicide
risk include racism, poverty, language inequity, and legal precarity. The
current sociopolitical context, cultural norms or stigma around mental
health and help seeking, and mistrust of culturally insensitive services
further increase risk. Risk may be compounded by lack of familiarity
with systems, insurance limitations, and limited or nonexistent interpretation
services. Family dynamics of acculturation stress, role shifts,
intergenerational conflicts, and survivor’s guilt should be considered as
potential contributors to risk. Protective factors include strong cultural
or ethnic identity and spiritual values, family and community support
(i.e., elders, faith leaders, mentors), stable living conditions, meaningful
social engagement, and cultural and community beliefs that support life
and facilitate coping with adversity.
Hispanic/Latine Community. “Hispanic” is a U.S. Census term used to describe
people who descend from Spain and Latin American countries, including
Mexico, Central and South America, and the countries in the Caribbean
where Spanish language is spoken. “Latina/Latino” (and gender-neutral
“Latine”) refers to geography (people from Latin America who share
similar values and may share the Spanish language, although Brazilians
are considered Latines). This section focuses on the Latine population
living in the United States.
Rates of death by suicide have increased among the Hispanic adolescent
and adult populations, and suicide ideation and attempts continue
to increase, particularly among female adolescents and nonelderly
adults (Gaylor, 2023; Polanco-Roman et al., 2025; Verlenden, 2024).
While clinical issues like depression and trauma are significant, risk is
compounded by community-level trauma (e.g., violence, victimization)
and structural inequalities, including acculturative and immigration
stress, discrimination, acculturation gaps, underemployment, poverty,
food insecurity, unsafe schools, and rising firearm access (Fortuna et
al., 2016; Hall et al., 2021; Khubchandani & Price, 2022; Martínez et
al., 2025; Silva & Van Orden, 2018). Protective factors cluster around
strong, supportive relationships, school and community connectedness,
and positive cultural identity and engagement. Responsive care
addresses both individual and structural factors.
LGBTQIA+ Communities. LGBTQIA+ individuals are not inherently at higher
risk for suicide due to their sexual orientation or gender identity.
Rather, their risk increases due to disparities associated with racism,
oppression, and other structural inequities, which contribute to higher
rates of suicide among this group. Culturally responsive care must
address these layered experiences to support LGBTQIA+ individuals
effectively.
Suicide risk is often highest just before and just after the coming-out
process for LGBTQIA+ individuals. Relevant risk factors include
ongoing discrimination, bullying, harassment, hate-based violence creating
chronic stress, family rejection, limited access to affirming mental
health services or gender-affirming care, and identity-specific stressors.
Protective factors include access to gender-affirming resources and services,
pronoun respect, and supportive adults and allies.
Military and Veteran Communities. This population’s risk comes from the military’s
unique cultural, occupational, and psychological factors (i.e., stoicism,
resilience, and fear of career impact) and its associated risks of elevated
exposure to trauma, moral injury, frequent transitions and relocations,
reintegration challenges, and a culture of access to lethal means. Protective
factors are also present, including purpose and a strong identity
(e.g., camaraderie, mission focus, spirituality, and family). It is important
to recognize and engage with the military community and potential
military-
specific resources, such as the Veterans Crisis Line offered by
988 Suicide and Crisis Lifeline and those offered by the U.S. Department
of Veterans Affairs.
Non-Hispanic White Men. While the populations described earlier face elevated
risk relative to their share of the general population and warrant the
focused, culturally responsive practice this document outlines, White
men consistently represent the single largest cohort of suicide deaths
by total number (Centers for Disease Control and Prevention [CDC],
2025a). This pattern holds across age groups, with the highest suicide
rates among middle-aged and older White men (El Ibrahimi et
al., 2021). A critical prevention priority is their own barriers to help
seeking, including cultural norms around self-reliance and emotional
disclosure, underrepresentation among mental health providers, and
disproportionately high rates of gun ownership. While it is important
that research and prevention frameworks center minority and historically
underrepresented populations given the documented disparities,
this emphasis should not obscure the risk that suicide poses to White
men. Comprehensive, population-aware practice requires holding the
reality that all populations may be at risk for suicide. It is important to
address the specific vulnerabilities of groups facing structural inequities.
5. Supervision and Consultation
Social workers shall maintain access to professional supervision and/
or seek consultation when working with clients who are at risk for or
currently thinking about suicide or have suicidal behavior.
Interpretation
Supervision and consultation augment the core social work values of
integrity and competence of the social worker. They also provide the
social worker with human connection and serve as a reminder that this
is beneficial not only to clients but also to social workers themselves
and is especially important when working with challenging cases involving
suicide.
As per the NASW (2025a) Practice Standards for Clinical Social Workers,
“the purpose of supervision is to provide education, accountability,
and direction to supervisees” (Standard 6, p. 5). This is particularly
critical as many social workers report feeling anxious and fearful when
providing services to clients who are suicidal (Dahl-Jacinto & Hays,
2024). Due to this fear, social workers may be more likely to refer a
client to another professional or recommend hospitalization, both of
which could violate the client’s rights to dignity and personal autonomy
(NASW, 2021), access to care, and the least restrictive treatment
(Dahl-Jacinto & Hays, 2024; Groth & Boccio, 2019; Kumbhare, 2022;
Scott & Underwood, 2025). It is the responsibility of social work supervisors
to be knowledgeable in suicide prevention, intervention, and
postvention as well as in how to guide and support their supervisees
during work with clients at risk for suicide and, if a client dies by suicide,
during postvention.
Consultation can validate the social worker’s observations of suicide
risk, associated risk and protective factors, and actions taken and not
taken. Consultation serves to enhance professional judgment, promotes
critical thinking, and improves decision making to better serve clients.
Because social workers recognize the value of interprofessional and
interdisciplinary work, case consultation may be obtained from qualified
professionals in other related disciplines if a social work supervisor
is not accessible or is not knowledgeable in the field of suicidology
(NASW, 2025a). This holds true in all practice settings and for all social
workers, regardless of education and licensure. Even if a supervisor is
available, collegial support through consultation can help mitigate fear
and protect against malpractice (Knapp, 2024), since consultation can
be a validity check for actions taken or not taken (Bongar & Stolberg,
2009; Scott & Underwood, 2025).
Social workers can be impacted by exposure to trauma, and may
be considered suicide loss survivors following the suicide of a client.
Receiving supervision, consultation, and peer support can be critical
self-care strategies to promote healing (Sanders et al., 2008; Ting et al.,
2006; Ting et al., 2008). The SPRC offers postvention resources for
professionals who have lost a client by suicide.
NASW and the Association of Social Work Boards (2013) offer
Best
Practice Standards in Social Work Supervision
that social workers should
use for guidance on supervision. NASW’s (2025a)
Practice Standards for
Clinical Social Workers
includes a standard on supervision and consultations
that should be used to inform clinical social work practices. In
addition, all social workers should abide by the statutes and regulations
regarding supervision and consultation in their states of practice.
6. Advocacy and Leadership
Social workers should advance the profession’s role in suicide prevention,
intervention, and postvention through advocacy, community
engagement,
and leadership to improve suicidal outcomes and organizational
or social worker liability through the adoption of best practices
and evidence-based strategies. A sample of suggestions for advocacy and
leadership are provided here; however, this list is not fully inclusive, as
other opportunities for advocacy and leadership should be sought as
new challenges and opportunities emerge.
-
Advocate for national public policy challenging myths and stigma
associated with mental health, suicide, and help seeking; access to
mental health services/mental health equity; safe storage of lethal
means; and digital media/artificial intelligence safety.
- Advocate for societal change to address social determinants of
risk (e.g., broader conditions that contribute to suicide distress,
such as housing instability, economic insecurity, systemic racism,
and barriers to healthcare) to prevent suicide.
- Develop, adopt, and implement organizational policies and protocols
related to these standards, including implementation of
effective suicide prevention and suicide-specific intervention
strategies and postvention protocols.
- Implement documentation standards reflecting suicide standards
of care and safer care practices, especially in electronic health and
medical records.
- Support supervision informed by standards of care for suicide.
- Implement organization-based self-care and postvention services,
especially in managing grief and loss following the suicide
of a client through debriefing and support.
- Promote culturally relevant suicide prevention awareness campaign
messages and resources, using safe messaging that promotes
hope, resilience, and help seeking and incorporates the
voices of families and those with lived experience.
- Provide appropriate level of suicide prevention, intervention, and
postvention training and education to social workers in agencies
and organizations, including the minimum standards of care for
all social workers, and advanced suicide-specific interventions
and work with special populations for clinical social workers.
- Advocate for required suicide prevention, intervention, and postvention
training in undergraduate (BSW) and graduate (MSW)
education and in social work licensing requirements.
Finally, if social workers are employed in multi-stakeholder systems
where assessing suicide risk is outside their current professional responsibilities
or organizational function, they must be able to ensure the
minimum standard of care is met if they interact with someone at risk
for suicide. While it may not be a specific job responsibility, it is part
of the expectation of the profession that all social workers know how
to address the standards of care for suicide. Not unlike being a mandated
reported for child abuse, social workers must be knowledgeable
of the risk factors, warning signs, and protective factors; knowing how
to screen for suicide risk, the resources to make a proper referral/warm
handoff, and how to document the interaction and conduct a proper
follow-up.
In workplaces and professional organizations, social workers can
champion upstream, midstream, and downstream approaches to suicide
prevention that focus on the health and safety of an organization (Frey
et al., 2025a, 2025b). One example available to social work leaders is
the National Guidelines for Workplace Suicide Prevention, which help
organizations prevent suicide crises and provide a pathway for supporting
loss with evidence-informed postvention support (see www.workplacesuicideprevention.com). This can serve as an example that suicide
prevention is everyone’s responsibility.
Opportunities
These standards are grounded in research, policy, lived experience, and best practice. Social workers have the unique opportunity to be leaders in suicide prevention, intervention, and postvention with a unique skill set embedded within the framework of social work values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. Social workers will inevitably encounter people at risk for suicide in the diverse settings in which they work due to individual, social, or societal risk factors. Each encounter is an opportunity for social workers to prevent death by suicide. These standards complement the strengths of social work and its emphasis on empathic relationship building. We must be ready to have the conversations that can keep people safe and save lives.
Social workers have the opportunity to not only work on their competency to provide the standards of care of suicide in direct practice (i.e., micro) settings, but to also take the lead in addressing stigma and encouraging preparedness through education, organization, and advocacy (i.e., mezzo and macro) efforts.
The road will not be easy as there are gaps and barriers in the current system. However, these standards can provide the blueprint for future direction.
Glossary
Definitions of terms in this glossary are applicable to this document. Where available, sources are provided for each definition, and a more comprehensive list is provided in the Resources section.
Assessment
The purpose of suicide assessment is to confirm risk, determine severity, and guide the treatment plan. Suicide assessment typically follows a positive screening or clinical concern about suicide risk. Assessment is comprehensive and detailed, whereas screening is brief and surface level (see “Screening” definition). The main goal of a suicide assessment is to evaluate risk factors (including exposure to death), the client’s psychosocial history, social determinants that may be associated with suicide risk, current and prior history of suicidal thoughts and behaviors, and the client’s protective factors to inform clinical decisions (SPRC, 2026). During a suicide assessment, social workers may use an in-depth clinical evaluation that includes structured tools, open-ended interviews, and collateral information from clinical records or family members (Brown et al., 2014). Assessments also require the social worker’s knowledge regarding suicide risk and protective factors.
Client/Patient/Consumer
Social workers generally use the term “client” to refer to the individual, group, family, or community that seeks or receives professional services. The term “patient” is more commonly used by social workers employed in healthcare settings. The term “consumer” is also used in settings that view the client as the end user—that is, the one capable of deciding what is best for them—to encourage self-advocacy and self-judgment in negotiating the social services and welfare system (definitions from Barker, 2014).
Community Helper/Trusted Helper/Gatekeeper
Community helpers/trusted helpers, formerly known as gatekeepers in
suicide prevention literature, are individuals who have face-to-face contact
with many community members and may be in a position to identify
people at risk of suicide and refer them to treatment or supporting
services. These community helpers are not necessarily mental health
professionals—they can be teachers, coaches, clergy, first responders,
supervisors, peers, or others who interact regularly with people in their
communities or organizations. See SPRC’s (n.d.-a) Best Practices Registry
for more information on the various community helper trainings.
Contagion
Suicide risk associated with knowledge of another person’s suicidal
behavior, either firsthand or through the media (CDC, 2024a). Suicide
contagion occurs when the exposure to suicide or suicidal behavior of
one or more people influences others to attempt suicide. Exposure can
be direct by having a personal connection to the person who died by
suicide, or indirect through media reporting or social media posts about
a person who was not a personal connection.
Cultural Competence
The process by which individuals and systems respond respectfully
and effectively to people of all cultures, languages, classes, races, ethnic
backgrounds, genders, sexual orientations, religions, immigration statuses,
and other diversity factors in a manner that recognizes, affirms,
and values the worth of individuals, families, and communities and protects
and preserves the dignity of each.
When working with tribal nations, this includes respecting tribal
sovereignty, historical context, and tribal self-determination through
engaging in culturally grounded, community-defined practices.
Developmental Competence
How children typically grow cognitively, emotionally, and socially,
developmental competence reflects the ability to assess where a child
is in relation to expected developmental milestones (Henderson &
Thompson, 2015). Social workers should tailor assessments to the child’s
developmental stage and integrate developmental theory with practical
assessment techniques. In the NASW (2003)
Standards for the Practice of
Social Work with Adolescents
, adolescent developmental competence is defined
as “the ability to understand and appropriately respond to the developmental
needs and tasks of adolescents, recognizing normal variations
and the influence of social, cultural, and environmental factors” (Introduction,
para. 6). This definition highlights the importance of tailoring
interventions to an adolescent’s developmental stage and context. It is
important to note the intersection of culture and other subgroups along
with the developmental stage of the individual.
Health Disparities
“Systematic, avoidable health differences that adversely affect marginalized
or disadvantaged populations, often due to inequities in social
determinants such as housing, education, income, and access to health
care” (National Institute on Minority Health and Health Disparities,
2025, para. 1). They are largely preventable and linked to intergenerational,
social, economic, and environmental disadvantages.
Lived Experience
A broad term encompassing a range of experiences with suicidal intensity.
This range includes direct, personal, and professional experience of
suicide as well as experience of the personal impact or trauma related to
a suicidal crisis, thoughts, or behaviors within one’s social circle (Zero
Suicide Institute, 2018).
Malpractice
When a social worker deviates from standards or duty to care in their
profession (i.e., by a negligent act or omission), thereby causing injury
or death to a client. Individuals can file a civil action against the provider
in such cases. The provider’s liability is determined by foreseeability and
reasonable care.
Foreseeability refers to whether the clinician could have
anticipated the potential or actual results of what they did or what they
failed to do based on the reasonable care standard.
Means Safety
Strategies to reduce the availability or ease of access to lethal means for
suicidal self-directed injurious behavior.
Medical Assistance in Dying (MAID)
Medical assistance that individuals may receive regarding the timing
and manner of their death. For a detailed description of NASW policy
on this matter, please refer to NASW (2026)
Practice Standards for Serious
Illness Care: Hospice and Palliative Social Work.
Postvention
Activities following a death by suicide to help alleviate the suffering and
emotional distress of the survivors and prevent additional trauma and
contagion encompassing issues such as grief, loss, complicated bereavement,
traumatic stress, posttraumatic growth, and suicide contagion.
Protective Factor
A characteristic at the biological, psychological, family, or community
level that is associated with a lower likelihood of problematic outcomes
(i.e., a buffer) and that may reduce the impact of a risk factor on a suicide-related
outcome. No protective factor is absolute and must be considered
in the context of risk factors, age, and health status/severity of illness.
Risk Factor
A situation or problem that can increase the possibility that a person will
attempt suicide. Risk factors can be found at the biological, individual,
relationship, community, and societal levels.
Safe Messaging
Communication strategies that reduce risk and promote help seeking
(CDC, 2025b; SPRC, n.d.-c). Safe messages are tailored to the audience
and context and are designed to promote behavior change. Studies
show that certain types of media reporting about suicide deaths may
spur replication of suicidal behavior among vulnerable individuals (people
in despair or already thinking about suicide). Thus, it is important
to report on suicide accurately, avoiding graphic descriptions of suicide
methods so as to not negatively impact people at risk.
Werther effect:
In 1974, the sociologist David P. Phillips coined
the term “Werther effect” to describe the mimicry of suicide
after a highly publicized suicide in the media (Walling, 2021).
Papageno effect:
Under certain conditions, exposure to accounts
of suicidal behavior in the media is associated with a lower risk of
suicide attempts and can have a more positive (i.e., educative or
preventive) effect, especially when the media present constructive
strategies to cope with suicidal ideations or emphasize other
solutions to adverse life circumstances (Domaradzki, 2021; Niederkrotenthaler
et al., 2010).
Safety Planning
The Stanley–Brown Safety Planning Intervention is a prioritized written
list of six steps: (1) identify warning signs, (2) list individual coping
strategies, (3) name people and social settings that are distracting,
(4) name people to go to for help, (5) list professionals to go to for help,
and (6) plan how to make the environment safe (i.e., cleansing the environment
of access to lethal means). The plan is brief, in the client’s own
words, easy to read, and accessible in times of crisis. The most important
part of the safety plan is its collaborative development. (See https://suicidesafetyplan.com.)
Screening
Brief and standardized process to identify individuals who may be at
risk for suicide. It is designed to identify individuals who need further
evaluation or support. Screening can be conducted universally with
full populations regardless of risk status or selectively with individuals
from at-risk populations, or indicated with individuals who express risk
factors for suicidal behavior. Screening is typically the first step, and its
purpose is to detect suicide risk early. If someone screens positive for
suicide, an assessment follows (please refer to the “Assessment” definition
for differentiation). The most common suicide screening tools are
ASQ, C-SSRS, and PHQ-9 or PHQ-A (PHQ-9 adaptation for adolescents).
A social worker can also screen with just one or two questions.
Social Determinants of Health
Physical, social, economic, and environmental conditions that influence
individual and community health. These include access to nutritious
food, safe housing, education, income, employment, transportation,
social support, and access to quality healthcare (Magnan, 2017).
Social Worker
In the United States, a social worker is an individual who possesses a
baccalaureate or advanced degree in social work from a school or program
accredited by the Council on Social Work Education. The social
worker must comply with the licensing and certification requirements
of the states or jurisdictions where they practice, and must possess the
skills and professional experience necessary to practice social work.
While the roles and responsibilities of social workers at different degree
levels may vary considerably, some core functions are common to all
social work, such as engagement with clients; assessment of client priorities,
strengths, and challenges; development and implementation of
a care plan; monitoring of service delivery; and evaluation of outcomes
(NASW, 2013).
Standards of Care
The minimum level of acceptable practice expected of a professional
in a given situation. It is often defined by what a reasonably competent
professional would do under similar circumstances and is generally not
flexible or adaptable. Standards of care are legally enforceable and can
be used in court to evaluate negligence or malpractice. The purpose of
a standard of care is to protect the public from substandard or harmful
practices, define professional accountability, and serve as a legal benchmark
in malpractice cases.
Suicide
Death by self-directed injurious behavior with an intent to die as a result
of the behavior (National Institute of Mental Health, n.d.-b). An additional
list of terms related to suicide includes the following:
Suicidal or suicide ideation:
Much more common than suicidal
behavior. Suicidal ideation or thoughts exist on a continuum of
severity from fleeting, vague thoughts of death to persistent and
highly specific considerations of suicide. Thoughts may only
occur periodically or may be unrelenting.
Suicide plan:
Significant because a plan signals a more serious
risk of carrying out suicidal behavior than does suicidal ideation
without planning. Suicide planning exists on a continuum from
vague and unrealistic plans to highly specific and feasible plans.
Serious suicide planning may also involve rehearsal or preparation
for a suicide attempt.
Suicide attempt:
A deliberate act of self-harm, undertaken by an
individual who has at least some intent to die, that does not
result in death. Attempts have two major elements: the subjective
level of intent to die (from the client’s perspective, how
intensely did they want to die, and to what extent did they
expect to die?) and the objective lethality of the act (from a
medical perspective, how likely was it that the behavior would
have led to death?). Although all suicide attempts are serious,
those with high intent (the client clearly wanted and expected
to die) and high lethality (the behavior could have easily led to
death) are the most serious.
Nonsuicidal morbid ideation:
Thoughts about death (e.g., “wish
to be dead”) without suicidal or self-injurious content.
Nonsuicidal self-injury (NSSI):
Intentional, self-inflicted damage
to one’s body without the intent to die. It is a behavior often used
as a way to cope with emotional distress. While NSSI is not a suicide
attempt, it can be a risk factor for suicide (see Apicella et al.,
2025; Nock & Favazza, 2009).
Suicide Assessment Instruments
Standardized, evidence-based tools (i.e., the measure has been tested
for validity and reliability with certain populations), instruments, or
protocols that are incorporated into an interview and used to identify
individuals who may be at risk for suicide. Some commonly used
standardized suicide risk assessments include the Brief Suicide Safety
Assessment (National Institute of Mental Health, n.d.-a), Suicide Status
Form (Jobes, 2012; also see https://cams-care.com/the-cams-frame
work/the-suicide-status-form), and SPRC’s (2026) Suicide Screening
and Assessment.
Suicide Intervention Strategies
Targeted actions designed to reduce imminent risk, stabilize clients in
crisis, and connect them with appropriate care. For suggested suicide-specific
interventions, see American Foundation for Suicide Prevention
(n.d.), CDC (2024b, 2025b), Center for Suicide Prevention and
Recovery
(n.d.), and SPRC (2025).
Suicide Prevention Resource Center (SPRC)
The only federally supported resource center devoted to advancing
the implementation of the National Strategy for Suicide Prevention,
funded by SAMHSA.
Suicide Prevention Strategies
Multilevel, evidence-based approaches designed to reduce suicide risk
and promote mental health and resilience, often including training of
community helpers/trusted helpers (i.e., persons in a position to identify
an individual at risk for suicide and make a warm handoff to an appropriate
resource; formerly known as “gatekeepers”). Trainings include
awareness of suicide risk and protective factors, how to talk to someone
at risk for suicide, and resources (CDC, 2025a; SPRC, n.d.-b). See
SPRC’s (n.d.-a) Best Practices Registry for more information on the
various community helper trainings.
Warm Handoff
In a warm handoff, a direct active referral is made to personally connect
an individual to a service provider rather than just telling the person to
contact a resource (Underwood et al., 2018).