Seeking Public Comments by March 31, 2026, for NASW Standards of Care for Suicide Prevention

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I want to express my gratitude to the task force for developing these standards of care. They are needed.

I look back on my own graduate education in social work and wish I had received more than Washington State's required six hours of mandatory training, which was not much more than a powerpoint slide deck. I confess it did not prepare me to treat suicidal patients. We need to teach new social workers how to work collaboratively and compassionately with suicidal patients. We need more than a cursory review.

I am especially grateful to the taskforce for continuously referring back to our fundamental values as social workers. All too often systems of care become systems of control doing iatrogenic harm, especially to our most vulnerable neighbors. Rooting these standards of care in our values can help prevent unintended harm.

I write to given my urgent support to the passage of these standards. As a CAMS certified clinician and adjunct university instructor, I can attest to the necessity of standards of care, and the desire of student social workers to embrace them.

My hope is that, like a good safety plan, these standards of care are living documents that evolve and grow as we gain new insights into this complex, painful, and stigmatizing behavior.

With gratitude,

William Benjamin Packard, LICSW
Seattle, Washington

The draft standards of care is a comprehensive document. Well done. The section on military and veteran populations was balanced. The population risks associated with identifying as male and/or living in a rural community were a missing component of this report.

I am an LCSW with about 20 years of social work practice experience solely concentrated in the Deep South. The past 13 years of my practice has been focused on work with Service Members, Veterans, and their Families, with an emphasis on preventing suicide among these populations.

Acknowledgment and Endorsement of Proposed Standard
I would like to express my sincere gratitude to the task force for their time, dedication, and thoughtful work in developing this standard. Your efforts are truly appreciated and reflect a strong commitment to advancing this important area. Overall, the standard looks excellent, and I am in full agreement with its direction and content. Thank you for your meaningful contributions to this work.

On pg 42, the SP field no longer uses the term Gatekeeper, but rather, Community Members. Also, I would have preferred to see the risk for First Responders included in the Military and Veteran population for their shared norms, values, and comfort level with firearms in particular. Oftentimes, veterans are first responders and vice versa. Instead, they were included in Working Adults. Perhaps in both places? Finally, on pg 36, with clinicians sometimes being loss survivors themselves when losing a client to suicide, an excellent resource for this is the VA Uniting for Suicide Postvention.

Hello! Thank you to the task force for this labor and important work. I am a social worker, director of a 988 crisis center, and participate in in city, county, and state efforts for suicide prevention. I would like to see more emphasis least invasive interventions (the least invasive intervention that is the most effective at keeping someone safe). Social workers have the unique opportunity to educate other service providers, clinicians, and clt facing personnel to confidently talk about suicide and interventions with safety and self-determination as the priority directly without policing folks. Additionally, I did not see any mention of AB988 or 988 Suicide and Crisis Lifeline as a national support and would appreciate that being plugged as a resource included on all safety plans.

Thank you for the opportunity to provide public comment on the draft NASW Standards of Care for Suicide Prevention. NASW is accepting comments through March 31, 2026, and the association asks commenters to include their professional background.

My name is Dr. Donte T. Boyd, PhD, MSW. I am an Associate Professor of Social Work whose scholarship focuses on suicide prevention, developmental assets, culturally responsive mental health research, and the well-being of Black adolescents and young adults.

Overall, I strongly support this draft. The document is thoughtful, values-driven, and well aligned with social work’s person-in-environment perspective. I especially appreciate that it frames suicide as a social, mental, and public health issue; emphasizes that all social workers across micro, mezzo, and macro settings need core suicide-related competence; and explicitly centers strengths-based, collaborative, and nonstigmatizing practice.

I also appreciate the draft’s alignment with the national six-step standard of care—screening, assessment, collaborative safety planning, counseling on access to lethal means, documentation, and follow-up—and its clear statement that safety planning should be collaborative and grounded in client agency, dignity, and reasons for living.

I offer the following suggestions for strengthening an already strong document:

1. Expand the developmental guidance for youth and emerging adults.
The current section appropriately notes that youth under 24 have unique developmental, social media, family, peer, and school-related vulnerabilities, and that caring adults and social connection are protective. I recommend going further by explicitly naming emerging adulthood as a distinct developmental period within or adjacent to the youth section. Young adults navigating identity development, educational transitions, housing instability, financial stress, relationship changes, and reduced family supervision may present differently than adolescents. More specificity here would improve the standards’ usefulness for practitioners working in schools, colleges, primary care, community mental health, and youth-serving programs.

2. Deepen the guidance on culturally responsive care for Black youth and adults.
I appreciate that the draft explicitly acknowledges racism, discrimination, violence exposure, limited access to health and mental health care, and historical harms as contributors to suicide risk in Black communities, while also naming relationships, racial or ethnic identity, spirituality, and help seeking as protective factors. I encourage NASW to make this section even more actionable by explicitly recommending that social workers assess how racial stressors, discrimination, and structural inequities interact with suicidal distress, and how culturally grounded strengths such as identity, family support, spirituality, and community connection can be incorporated into assessment, safety planning, and follow-up.

3. Strengthen attention to assets and protective factors throughout the standards, not only in the introduction.
The introduction does an excellent job describing protective factors as personal, relational, community-based, and structural, and it notes that strengths-based care should identify both risk and protective factors. I recommend making this expectation more explicit throughout the practice standards themselves. For example, the document could state that screening, assessment, safety planning, and follow-up should routinely include identification of reasons for living, supportive relationships, identity-based strengths, coping assets, cultural strengths, and environmental supports. This would further distinguish social work’s contribution and better align with prevention-oriented practice.

4. Add more explicit guidance for school and youth-serving settings.
Because this public comment page is housed under School Social Work and the standards note the role of social workers in families, schools, organizations, and communities, it would be helpful to add more concrete guidance for school-based practice. This could include collaboration with caregivers, school crisis teams, community providers, and procedures for re-entry, monitoring, and support after disclosure of suicidal ideation or hospitalization. A brief practice note on navigating confidentiality, family engagement, and school coordination would be especially helpful.

5. Consider a stronger emphasis on follow-up and continuity of care across systems.
The six-step framework includes follow-up, which is essential. I encourage NASW to emphasize “warm handoffs,” proactive outreach after acute crises, and coordination across schools, emergency departments, outpatient settings, and community-based services. This is especially important for youth and young adults who often fall through gaps during transitions.

In sum, this is a strong and much-needed document. It clearly communicates that suicide prevention is part of the ethical and professional responsibility of social workers across settings, and it meaningfully centers dignity, collaboration, and person-centered language. With additional specificity regarding emerging adults, culturally responsive assessment of racialized stress, strengths-based protective factors, and school/youth-serving implementation, these standards could become even more powerful and practical for the field.

Thank you for the opportunity to comment.

Dear NASW-
I am a social worker in practice for over 15 years and my current focus is on the mental health of other social workers. We need to address not only the mental health of social workers but also their suicide rates. There has only been one study from 2004 that looked at the suicide rates of social workers. Yes our clients are important and how we address their suicidal ideation, passive/active suicide attempts but we also need to be addressing the lack information. This is a real gap including how exposure to trauma, and working conditions impact the social worker themself. Research tells us that social workers come to the field with higher rates of anxiety, depression and trauma yet we are not deeply exploring mitigating factors, lack of organizational support as well as how systemic bias impacts the professional too. I hope to see more language around this experience and an acknowledgement of social workers having an experience of passive suicidal ideation through active suicide attempts and even the loss of life when a social worker completes suicide.

Thank you to the task force for the important work involved in developing these proposed standards. Setting a minimum standard of care for suicide prevention across all social work settings is both necessary and long overdue. The integration of ethics, person-in-environment, and the NAASP framework provides a strong foundation.

That said, I want to share a few thoughts based on my professional and personal experience:

1. Limited integration of family systems in practice standards.

While the document highlights the importance of human relationships and support systems, it lacks clear operational guidance on involving family members and caregivers in suicide prevention, intervention, and safety planning. Social work is uniquely rooted in person-in-environment and family systems perspectives, yet the standards remain mostly focused on the individual in practice.

For example, in sections such as assessment and safety planning, family involvement is mentioned but not made a core or mandatory part of care. Considering what we know about protective factors, this seems like a missed opportunity to set social work apart from a purely medical model and to establish clear expectations for ethically and collaboratively engaging caregivers.

2. Insufficient focus on veteran and military family contexts.

Although military and veteran populations are recognized as higher risk groups, the standards do not sufficiently reflect the complexity of these systems, especially the roles of spouses, caregivers, and children.

There is an opportunity to strengthen this section by:
• Addressing family reintegration, caregiver stress, and moral injury within the family system
• Recognizing family members as both protective factors and potential risks.
• Offering guidance on engaging with military culture beyond just the individual service member

3. Lack of clear postvention standards, especially for families.

The document explicitly separates postvention from these standards, noting it requires a different set of guidelines. While I understand the intent, the absence of even minimal postvention expectations, particularly for supporting families bereaved by suicide, is concerning.

From both a clinical and public health perspective, postvention is a form of prevention. Families and children bereaved by suicide face a significantly higher risk, yet there is little guidance available for social workers on:

• Immediate family involvement after a suicide death
• Ongoing grief and trauma support
• Preventing Intergenerational Impact

Even a brief outline of minimum expectations or a reference to upcoming standards would improve continuity of care.
4. Opportunity to more fully operationalize person-in-environment.

The document consistently references person-in-environment as a guiding framework; however, its application remains more conceptual than practical in several sections.

More explicit expectations around:
• Family engagement
• Community-based supports
• System-wide interventions would better align the standards with the core identity of social work practice.

Professional Background
I am an LMSW and have been heavily involved in the military and veteran families space. My work focuses on suicide prevention and postvention, family systems approaches, and supporting caregivers and children impacted by suicide. I am also a Doctor of Social Work student with a research focus on children bereaved by a veteran parent’s suicide.

On page 17, there is a sentence that addresses specialized populations, mentioning only American Indian and Alaskan Native populations. This example, although important and statistically high in SI and completed suicides, is too narrow of the intial descriptions of minoritized populations. As a clinician and professor in NYC, this does not speak to the populations I both study and work with. There needs to be mention of other races/ethnicities in this initial example of the high SI risk of specialized populations, especially minoritized populations.

To: NASW Task Force for Suicide Prevention
Date: March 26, 2026
Subject: Public Comment and Review of Draft Standards of Care for Suicide Prevention
Submitted by: Don L. De Lapp, MSW, LCSW, LCADC, SAP, MAC, CCS

Thank you for the opportunity to review the draft NASW Standards of Care for Suicide Prevention. This is a comprehensive and deeply necessary document that successfully balances clinical rigor with compassionate care.

In arriving at the following recommendations and observations, I applied a rigorous review process grounded in my extensive professional background. As a dually licensed clinical social worker and addiction counselor (LCSW, LCADC), a Substance Abuse Professional (SAP), a Master Addiction Counselor (MAC), and a Certified Clinical Supervisor (CCS), I evaluated this draft through the intersecting lenses of frontline clinical reality, co-occurring disorder assessment, supervisory risk management, and strict adherence to the NASW Code of Ethics. My feedback focuses on areas where clinical mandates, ethical guidelines, and legal liabilities must be perfectly aligned to protect both the vulnerable client and the practicing social worker.

1. NASW Ethical Scrutiny & Alignment
Drawing from my experience in clinical supervision, I identified a few areas where the draft could create friction with the core NASW Code of Ethics, potentially placing supervisees and practitioners in ethically ambiguous situations.

Competence (NASW 1.04) vs. Universal Assessment (Standard 3.2): The document states that all social workers must possess baseline competency. However, Standard 3.2 mandates that "All social workers are to gather information about risk and protective factors, ideation, intent, and plan..." From a supervisory standpoint, expecting a macro-level practitioner (e.g., policy analyst or grant writer) with no clinical training to conduct a formal assessment of "intent and plan" could directly violate NASW 1.04 (Competence). I recommend clarifying that while screening (Standard 3.1) is universal, formal assessment (Standard 3.2) must be conducted by clinically trained professionals. Non-clinical workers should instead be directed to initiate an immediate warm handoff or crisis protocol.

Privacy and Confidentiality (NASW 1.07c) vs. Extreme Risk Firearm Protection Orders (ERFPO): In Section 3.5, the text notes a social worker's potential duty to petition a court under ERFPOs (red flag laws). Because petitioning a court involves breaking client confidentiality, the document must explicitly cite NASW 1.07(c). 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."

Self-Determination (NASW 1.02) vs. Involuntary Hospitalization: Section 5 correctly notes that a practitioner's fear may cause them to unnecessarily "recommend hospitalization, both of which could violate the client’s rights to dignity and personal autonomy." Given the severity of overriding self-determination, I recommend strengthening this by explicitly using the ethical and legal phrasing of the "least restrictive environment."

2. Legal and Risk Management
As a licensed practitioner and supervisor who frequently manages high-risk clinical scenarios, I heavily scrutinized the risk management implications of these standards.

No Suicide Contracts: The distinction made in Section 3.3 between collaborative safety plans and "no harm" contracts is excellent. Explicitly stating that "no harm contracts" provide a false sense of security and are not legally binding is a crucial, evidence-based liability shield for practitioners.

Risk Stratification: In Section 3.1, the warning against the false security of risk stratification (Low/Medium/High) is legally sound. However, I recommend adding that if a practitioner’s agency requires this stratification, the social worker must clearly document the dynamic, point-in-time nature of that risk. This protects the clinician against malpractice claims if a client's status rapidly changes hours after an assessment.

3. Structural & Consistency Feedback
Missing Age Demographics: In Section 4 (Developmental Considerations), the following demographics are listed: Youth (24 and Under), Working Adults (45–65), and Older Adults (75 and Older). This completely omits the 25–44 age group, as well as the 66–74 age group. From a lifespan development and clinical assessment perspective, this leaves a massive gap. I have provided drafted text for these missing cohorts at the bottom of this comment to ensure the standards are fully comprehensive.

Formatting Inconsistencies: The Table of Contents lists "1. Ethics and Values" and "2. Knowledge Basics", but then switches to "Standard 3. Specialized Practice Standards". The numbering and naming conventions should be uniform.

4. Grammatical, Spelling, and Phrasing Corrections
Finally, to ensure the document reflects the highest professional standards, I noted several copyediting needs:

Page 6 (Bullet 3): "...since it can dismiss the seriousness of the suicidal behavior..." I recommend changing "dismiss" to "minimize", which is more clinically appropriate.

Page 28 (ERFPO): "ERFPO require certain people..." Change to the plural: "ERFPOs require..."

Page 30: "LBTQIA+ individuals are not inherently at higher risk..." Typo: Missing the "G". It should be LGBTQIA+. Furthermore, the document alternates between "LGBTQIA+" and "LGBTQ+". Please select one acronym for consistent use throughout.

Page 35: "...social workers recognize the value of intercollegiate and interdisciplinary work..." The word "intercollegiate" is incorrect here. The correct term is interprofessional.

Page 39: "...to also lead take the lead in addressing stigma..." Delete the redundant "lead" to read: "...to also take the lead in addressing stigma..."

Proposed Additions to Section 4 (Developmental Considerations)
To address the omitted 25–44 and 66–74 age cohorts noted in Section 3 of my feedback, I recommend inserting the following developmental considerations into Section 4. These additions are heavily informed by my clinical experience treating co-occurring mental health and substance use disorders across the lifespan.

Young to Middle Adults (25–44)
This cohort is navigating critical life transitions, including career establishment, family formation, and significant financial responsibilities. From a clinical perspective, this age group is also highly vulnerable to the entrenchment of co-occurring mental health and substance use disorders.

Risk Factors: Major stressors often include relationship dissolution (separation/divorce), parenting stress, infertility, postpartum depression/psychosis, and housing or economic instability. Furthermore, untreated trauma or the escalation of substance use disorders as a maladaptive coping mechanism significantly increases suicide risk. The onset or exacerbation of severe, persistent mental illness (such as bipolar disorder or schizophrenia) often solidifies during the early years of this stage.

Protective Factors: Meaningful employment, stable partnerships/marriage, child-rearing responsibilities (which often serve as strong "reasons for living"), access to employee assistance programs (EAPs) or employer-sponsored healthcare, and active community or religious engagement.

Early Older Adults (66–74)
This demographic is in a profound transitional period, moving from active employment into retirement and facing the early stages of aging-related changes. Suicide risk in this group is frequently under-assessed, particularly regarding the role of late-onset substance misuse or prescription medication interactions.

Risk Factors: A primary driver of risk in this cohort is the loss of identity and purpose following retirement. Other significant risk factors include the onset of chronic illness, chronic pain, early cognitive decline, and living on a newly fixed income. Relational losses, particularly the death of a spouse or close peers (widowhood/bereavement), can trigger profound isolation. Additionally, the misuse of alcohol or prescription medications to cope with grief or physical pain is a frequently overlooked risk factor that lowers impulse control.

Protective Factors: A redefined sense of purpose through volunteerism, grandparenting, or new hobbies; strong and accessible social networks; stable retirement income; and consistent access to medical and mental health care (often facilitated by the transition to Medicare).

Thank you for your time, dedication, and vital work on these standards. I look forward to seeing the finalized document.

Thank you for providing an opportunity for public comment for the draft Standards of Care document. A potential recommendation for review would be the frequency of the assessment area. Depending on the scope of practice and the type of support provided to a client, interactions may be minimal, not ongoing. It may be a good idea to provide a disclosure here based on the setting and visit frequency, to ensure any follow-up up aligns with scope of work.

I have practiced social work for more than 23 years in the area of school social work, social work education, and medical social work.

Thank you

I have over 20 years of micro, mezzo, and macro experience in suicide prevention, intervention, and postvention primarily with youth across elementary and secondary education. I am an instructor in Safety Planning Intervention, Counseling on Access to Lethal Means, AS+K? About Suicide to Save a Life, Adult and Youth MHFA, AFSP's Talk Saves Lives and It's Real: Teens and Mental Health for Middle and High School Students, and Hope Squad. I have worked in public school settings, county level mental health community centers, and state level suicide prevention.
This is an amazing document and is so greatly needed. I have provided numerous trainings and presentations to social workers at all levels of education and training and have been advocating for more training and education in this field at the state level. This is truly my passion and my calling.
I have comments, suggestions, and feedback.
Page 9, 3rd bullet: I suggest adding "screening and" before "assessment" as not all social workers are clinically adept or allowed to assess for suicide risk.
Page 14, 2nd paragraph under Importance of Human Relationships: I would suggest adding "and also crisis helplines such as the 988 Suicide and Crisis Lifeline and the Crisis Text Line, and local crisis helplines" after "...such as faith-based organizations."
Page 15, top paragraph: Curious about what you meant by "administration" in the last sentence of that paragraph. I believe social workers are sometimes alone in their organization and may not have supportive suicide prevention, intervention, and postvention protocols and procedures.
Page 19 at the very top: I suggest rewriting the sentence as follows - "Social workers must ask all clients initially in a clear and direct manner about thoughts of suicide.
Page 19, last sentence, 1st paragraph under Interpretation: I suggest replacing "permission" with "a safe environment" as we shouldn't possess the ability to grant or not grant permission.
Page 24, the title, "3.3. Development of Collaborative Safety Plan - did you mean to say, "a Collaborative Safety Plan" or "Collaborative Safety Planning"? Also, why is there no mention of the Stanley-Brown plan here?
Page 32, top paragraph: I think you meant to say "ethnic" and not "ethical" in the last sentence about protective factors.
Page 33, under Military and Veteran Communities: I would add "and a" after "purpose" and before "strong identity"
Page 33, under Developmental Considerations: I would add "IA" to "LGBTQ+" and remove the word "age" that comes afterwards since age is already stated.
Page 34, first sentence under Older Adults: I think it should read "Older adults have the highest rates of death by suicide and lowest ratio of suicide attempts to death."
Page 36, first sentence of 2nd paragraph: I think it should read "Social workers can be considered survivors of suicide loss following the suicide of a client,..."
Page 37, 1st bullet under Interpretation: I would add "for" before "public policy" and add "and" before "digital"
Page 37, 3rd bullet: I would rewrite the sentence to "Develop, adopt,... related to these standards, including implementation of effective suicide prevention and suicide-specific intervention strategies, and postvention protocols."
Page 39, 2nd paragraph: I would remove "lead" after "also" and before "take"
I would also recommend changing the word "gatekeeper" to "community helper" as gatekeeper implies ability to deny a resource because the person can open or close the gate.
Page 43, 2nd sentence under Lived Experience: I would add "a" before "direct"
Page 46, top sentence: Do we really want to use the word "imitation" Instead, maybe say "may spur suicidal behavior..."?
Page 48, first sentence under Suicide: I would replace "result" with "an intent" so that it reads "... behavior with an intent to die..."
Page 48, regarding Suicide plan: I would remove the "s" from "suicide plans" and then change the sentence to read " Significant because it signals a more..."
Page 50, under Suicide Prevention Strategies: replace "gatekeeper" w/ "community helper"
Under Resources: why isn't Safety Planning Intervention and CALM not included?
Laura Hernandez Gold, LCSW-S (laura.gold@austin.utexas.edu)

Failed attempt should be added to the table. 1
Risk factors can be reframed as impact factors - this helps externalize what is happening and can help reduce stigma (prejudice and discrimination).
I am concerned that several of the cited sources are 20+ years old.
There are several typos and grammatical errors throughout the document.
The PHQ-9 is not a suicide assessment tool, no matter how emphatically the medical community says it is. It is a screening tool for major depressive disorder, and the 9th symptom happens to be suicidal thoughts, feelings, and behaviors.
"It is important to note that safety plans are different from “no harm” or “no suicide” contracts" This section should more strongly reinforce that using "safety contract and contract for safety" have been unacceptable terms for at least 25 years. These terms should never be used.
3.4. Counseling about Access to Lethal Means
Interpretation - this section should mention that lethality does not only depend on method; age and health issues can make most methods more lethal.
"Military and Veteran Communities." If you are thinking that communities include family (partner/child), okay, if not, the DOD also tracks deaths of family members, and they should be included in this section.
Youth (24 and Under) - should be 24 - 5. Age 5 is the youngest age at which the cause of death would be noted as suicide. The CDC has a data bracket for youth 5 - 9 for this reason.
I could have missed it; SAMHSA also has an evidence-informed framework for assessment.

Focused concern: chronic suicidality and the need for more consistent national guidance

NASW’s suicide prevention policy is an important and timely contribution. At the same time, it would be strengthened by more directly addressing chronic suicidality and the ethical, clinical, and policy questions that arise when suicidal thoughts are persistent, enduring, and not reducible to acute crisis alone. A policy that does not meaningfully engage this population risks leaving individuals whose experiences most test the profession’s commitments to autonomy, dignity, self-determination, and quality of life with insufficient guidance.

Need for clearer treatment of chronic suicidality.

The policy would benefit from clearer language defining what is meant by chronic suicidal ideation. Without that clarification, it becomes difficult to distinguish among passive desire for death, persistent suicidal thinking, and acute suicidal intent. That distinction matters both clinically and ethically. Chronic suicidal ideation reflects serious and sustained psychological suffering, yet it is not always synonymous with imminent self-harm. A framework organized primarily around acute danger may therefore fail to capture the needs of individuals who live with long-term suicidal thoughts that fluctuate over time.
Chronic suicidal ideation also raises practice concerns that warrant explicit attention in the policy. Over time, suicidal thoughts can become woven into a person’s daily functioning and may, in some cases, operate as a maladaptive coping strategy. In such circumstances, conventional risk-management approaches may be insufficiently nuanced. Both clients and practitioners may become desensitized to the ongoing presence of suicidal thoughts and miss meaningful shifts toward acute risk. At the same time, interventions triggered by chronic ideation alone may disrupt employment, relationships, and overall quality of life without adequately addressing the underlying suffering.

Ethical scope of the policy

NASW’s policy currently approaches suicide primarily through prevention, risk management, and preservation of life. That orientation is understandable in situations involving acute crisis, impulsivity, or potentially reversible instability. However, it does not fully address individuals whose suffering is persistent, whose wish to die may be enduring, and whose lived experience may not fit a crisis-only model. As written, the policy places its strongest emphasis on survival while giving less attention to whether the individual always experiences continued life as protection, dignity, or benefit.
This creates an ethical tension within social work that would be better addressed directly. NASW affirms the dignity and worth of the person, autonomy, and self-determination as core professional values. Yet in the context of suicide, those values can become narrowed or overridden without sufficient acknowledgment of that shift. A more complete policy would openly engage this tension. Even if the policy remains prevention-oriented, it should still recognize chronic suicidality and enduring wish-to-die experiences as ethically significant realities rather than secondary concerns.

Need for more consistent implementation across jurisdictions.

A second important gap is inconsistency across state lines, on questions involving suicide and end-of-life decision-making; a fragmented state-by-state landscape can produce unequal access, uneven recognition of autonomy, and inconsistent expectations for practitioners. Individuals facing profound suffering should not encounter materially different standards of dignity, self-determination, or professional response based solely on geography. Likewise, practitioners should not be left to navigate a patchwork of conflicting assumptions and obligations on matters this consequential.
Although NASW cannot by itself eliminate legal variation among states, it can articulate a clearer national ethical framework and advocate for greater consistency in policy and practice. At minimum, the profession should pursue more uniform guidance so that core principles are not interpreted in fundamentally different ways across jurisdictions. Greater consistency would reduce confusion, support professional clarity, and better protect individuals from inequitable treatment based solely on residence.

Recommendation

To strengthen this policy, NASW should explicitly distinguish chronic suicidality from acute suicidal crisis, address the role of persistent suffering and quality of life in ethical decision-making, and clarify how autonomy, dignity, and self-determination should be weighed when preservation of life conflicts with the client’s stated experience of harm. The policy should also move toward more consistent national guidance rather than leaving key questions vulnerable to fragmented interpretation across state lines. These additions would not displace prevention. Rather, they would broaden the policy’s ethical and clinical scope and make it more responsive to the realities many individuals and practitioners encounter in practice.
In short, a more comprehensive policy would preserve NASW’s commitment to prevention while offering more complete guidance on chronic suicidality, enduring suffering, and consistent standards of practice.

I want to acknowledge the importance of addressing suicidality in our communities, and social work is certainly poised to comprehensively support the efforts to reduce suicide rates among many populations and geographies. It is certainly commendable that the task force members have put forth the efforts in developing this critical document. With that, I offer the following constructive feedback.

1. While these standards are critical and address the overall needs, primarily in a clinical context, there is nothing 'new' or 'different' in these standards of care when compared to other professions. My doctoral dissertation research explored the ways in which different professions understand and intervene with suicidality, arriving at the conclusion that social work is not approaching suicidology any different. So, are these truly social work standards of care?

2. The proposed standards are grounded in literature. However, roughly 45% of the resources are 10+ years old. And a noticeable portion of the remaining percentage is (n.d.). I would like to see these standards grounded in more contemporary literature. Many of the leading voices in suicidology are not coming from social work, so I'd like to see these standards being in alignment with social work literature (compared to psychology, psychiatry, etc.). This is a great opportunity to elevate the voices of social workers whose primary scholarship and practice is in suicidology.

3. NASW has a Youth Suicide Policy Statement that was revised within the past 2 years; there is no reference to this, which seems odd to me, given that NASW has spoken directly to suicide in other venues.

4. I'd like to see the standards more directly address chronic suicidality, which is historically overlooked when discussing suicide assessment, treatment, and management.
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I am a doctorate-level scholar practitioner who is licensed as an LICSW. I serve as an Assistant Professor in a state that has disproportionately higher rates of suicide. I also have been a practicing clinician for over a decade working with various high-risk populations. Furthermore, I am a suicide-attempt survivor myself and have personally found some of these standards to not fully address the needs of those struggling with suicide. We need something different--what we're doing isn't reducing the rates.

Many children are struggling with self-harm thoughts earlier in life as they cope with bullying and stressful situations at home. Social workers can make a difference in their lives! Early intervention matters!

“Risk factors are traits, circumstances, or other variables associated with an increased likelihood of suicidal behavior, while protective factors (personal, relational, community-based, or structural) strengthen resilience and buffer against risk” – Comment: it’s worth noting that no one risk factors is directly linked to suicide and there's never a single cause

“Language is important in the field of suicidology. Given that the language used to address suicide and suicidal behaviors continues to evolve, social workers must keep abreast of current, objectively focused language that avoids stigma, negative attitudes or judgment in both practice settings and documentation” Comment: negative attitudes added to sentence

“Goals of the Standards of Care for Individuals at Risk of Suicide” Comment: Attention to suicide loss survivors ought to be included here.

“These standards of care for suicide are intended to enhance social workers’ awareness of the skills, knowledge, values, and sensitivities required to work with clients who are at risk for suicide or who are experiencing suicidal thoughts or behaviors, or have lost someone to suicide and to guide social work practice in prevention and intervention.” Comment: or have lost someone to suicide added to sentence

“Depending on relevant factors like culture, resource allocation, or organizational or institutional protocols, these standards may be adapted differently. Regardless of variation in implementation, the goal is to improve social work practice and reduce suicide deaths and support those affected by suicide. “Comment: support those affected by suicide added to sentence

“While this document establishes professional standards of care for social workers across all practice settings when providing services to individuals at risk of suicide or coping with the impact of suicide , it is important to understand what this document does not provide”Comment: coping with the impact of suicide added to sentence

“Social workers must also consider populations that are at higher risk for suicide such as LGBTQIA+ individuals; military-affiliated and veteran populations, American Indian, Alaska Native, and Native Hawaiian individuals; and older adults (75 years and over) whose needs may be complicated by intergenerational trauma, social inequities, and intersecting identities”. Comment: - have higher rates, not at higher risk. For example, there is nothing inherent in LGBTQ+ or other populations that inherently increases risk, there are external factors that contribute to higher rates

“In some jurisdictions, clients may have legal access to MAID as part of end-of-life care. “Comment: It might be good to mention that some clients also have Psychiatric Advanced Directives for when they experience a mental health crisis.

“There are, however, some limitations in these tools that social workers should consider” Comment: These are important points about the limitations of screening, assessment tools and interventions. I would add that an overreliance on suicidal ideation in the absence of other suicide risk and protective factors is also a tendency that should be considered. This would include the point about social determinants/drivers of suicide risk. Historical and more recent trauma for example, mental and physical health experiences, interpersonal conflict or rejection, cognitive shifts toward rigid thinking or hopelessness- are all important to include, among many other contributing and protective factors for suicide.

“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. “ Comment: Comment: Excellent point. Appreciate the dynamic nature of suicide risk being highlighted here.

“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.” Comment from Dr Christine Moutier: This is critical and consistent with Tony Pisani's "Prevention Oriented Suicide Risk Assessment" in which the person's social, environmental, relationships, and likely foreseeable events/changes are considered in the risk assessment process https://safesideprevention.com/media/documents/External/Pisani-et-al-2022-risk-formulation-chapter-PROOF.pdf
The same approach is in my clinical handbook https://www.cambridge.org/core/books/suicide-prevention/8BE216EF6EF05ABAF83B5C0D7FC9B969

“Initial screening is warranted in all social work settings, whether generalist or clinical, independent of whether a client is demonstrating signs of suicide risk.” Comment: agree with this approach

“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 suicidality 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.” Comment: Excellent, well-stated.

“Dynamic Nature of Suicidality and Risk Stratification.” Comment: This section is outstanding.

“It is important to recognize that some clients may be reluctant to acknowledge suicidality during the screening process.” Comment: Recommend consider avoiding the term suicidality since it is vague in meaning. Could say something like "suicidal thoughts or risk for suicide more generally".

“But if the client continues to deny suicidality within the context of a safe therapeutic relationship, 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…” comment: Similarly, here the term suicidality could be replaced with "suicidal thoughts or plans".

“Even if your organization requires risk stratification, the provider must 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.” Comment: Again, this is well stated.

“Rather than using a medical model of diagnoses and deficits, when social workers employ these joining techniques the risk factors of isolation and hopelessness can transform into feelings of connection and hope, which are protective factors for suicide.” Comment: This is historically accurate, however even in the field of medicine, this is considered old and outdated way of approaching patient care. Could just say "outdated models that focus on diagnoses and deficits".

“Development of Collaborative Safety Plan: All social workers should complete a collaborative safety plan with clients who are at risk for suicide or experiencing suicidal thoughts or behaviors.” Comment: This is not consistent with safety plan guidance. The presence of a suicidal thought does not indicate the need for a safety plan as most people have vague or underdeveloped thoughts and the safety plan would not apply or have meaning for them. There is stigmatization that can happen by thinking that everyone who has a thought of suicide is at risk for suicide attempt or death. It can lead to over-reaction and reduce the likelihood of discussing SIB.

General Comment: It would be good for social workers to also be educated on the cultural and legal aspects of firearm ownership and mental health diagnosis/ involuntary commitment, etc., as it often infuences the client and family's willingness to accept help.

“Rather, their risk increases due to disparities associated with racism, oppression, and other structural inequities and this contributes to higher rates for this group.” Comment: Culturally responsive care must address these layered experiences to support LGBTQIA+ individuals effectively. “and this contributes to higher rates for this group” added to sentence.

“The main goal of a suicide assessment is to evaluate modifiable risk:. Comment: important to identify all potential risk factors, not just those that are modifiable. Also need to gather info about history of SIB for future, even if not currently in a period of risk.

“This definition highlights the importance of tailoring interventions to an adolescent’s developmental stage and context” Comment: Even in looking at developmental competence, it is important to remember that the signs of emotional distress can look different culturally as well.

"GATEKEEPER" comment: This term has been falling out of favor in the SP field. Could reference this as an older perhaps outdated term that is still used at times. Perhaps use "trusted messenger" as opposed to "gatekeeper".


“LIVED EXPERIENCE” Comment: At AFSP we use this term broadly to encompass any personal or professional connection to suicide. Suicide loss, personal suicidal thoughts/behaviors, or supporting others with STB.
“Risk factors can be found at the individual, relationship, community, and societal levels.” Comment: Risk factors can also be biological.

“SAFETY PLANNING INTERVENTION” Comment: SP is more general. SPI refers to the Stanley Brown

“SOCIAL DETERMINANTS OF HEALTH” Comment: Since the term 'determinants' may imply determinism, could add that the term 'social drivers of health' may be used synonymously to avoid the implication that suicide is a determined or predestined outcome.

American Foundation for Suicide Prevention (AFSP)