Columbia-Suicide Severity Rating Scale Risk
Columbia-Suicide Severity Rating Scale Risk Assessment
YOU CAN SAVE A LIFE.
The first step is to ask. We used research and real-world experience to determine the right questions to ask to identify people of all ages at risk for suicide. The C-SSRS is designed for use around the world for research, communities and healthcare, and families, friends, and neighbors.
C-SSRS Helping to Reduce Suicide and Decrease Workload via Evidence-Based Thresholds for Imminent Risk
Kevin Hines, suicide attempt survivor,
says Most people considering suicide want someone to
save them. What we need is a culture in which no one is
afraid to ask. What we needed were the questions people
could use to help save us. Thats why the pioneering
change the C-SSRS is enabling is so essential to
A Unique Suicide
Risk Assessment Tool
Suicide Prevention Benefits
The first step in effective suicide prevention is to identify everyone who needs help. The Columbia Protocol was the first scale to address the full range of suicidal thoughts and behaviors that point to heightened risk. That means it identifies risk not only if someone has previously attempted suicide, but also if he or she has considered suicide, prepared for an attempt (for example, buying a gun, collecting pills, or writing a suicide note), or aborted plans for suicide because of a last-minute change of heart or a friends intervention.
The Columbia Protocol screens for this wide range of risk factors without becoming unwieldy or overwhelming, because it includes the most essential, evidence-supported questions required for a thorough assessment. The Columbia Protocol is:
Simple. Ask all the questions in a few moments or minutes with no mental health training required to ask them.
Efficient. Use of the protocol redirects resources to where theyre needed most. It reduces unnecessary referrals and interventions by more accurately identifying who needs help and it makes it easier to correctly identify the level of support a person needs, such as patient safety monitoring procedures, counseling, or emergency room care.
Effective. Real-world experience and data show the protocol has helped prevent suicide.
Evidence-supported. An unprecedented amount of research has validated the relevance and effectiveness of the questions used in the Columbia Protocol to assess suicide risk, making it the most evidence-based tool of its kind.
Universal. The Columbia Protocol is suitable for all ages and special populations in different settings and is available in more than 100 country-specific languages.
Free. The protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research.
Endorsed, Recommended, or Adopted by:
Action Alliance, CDC, FDA, NIH, SAMHSA, The Joint Commission, World Health Organization
Using the Columbia Protocol
Protocol administrators ask a series of questions about suicidal thoughts and behaviors. The number and choice of questions they ask depend on each persons answers. The questioner marks yes or no, as well as how recently the thought or behavior occurred and for some versions of the protocol a scoring of its severity. The shortest screeners are condensed to a minimum of two and a maximum of six questions, depending on the answers, to most quickly and simply identify whether a person is at risk and needs assistance. For a more thorough assessment of a persons risk, Columbia Protocol askers should use the standard versions.
The Columbia Protocol questions use plain and direct language, which is most effective in eliciting honest and clear responses. For example, the questioner may ask:
Determining Next Steps
To use the Columbia Protocol most effectively and efficiently, an organization can establish criteria or thresholds that determine what to do next for each person assessed. Decisions about hospitalization, counseling, referrals, and other actions are informed by the yes or no answers and other factors, such as the recency of suicidal thoughts and behaviors.
The Columbia Lighthouse Project provides many examples of triage documents that Columbia Protocol users in hospitals, primary care practices, behavioral health care facilities, military services, prisons, and other settings employ to make these decisions. The Project also provides assistance to any organization that is thinking through its policy and establishing a care plan.
Origins of the Columbia Protocol
Columbia University, the University of Pennsylvania, and the University of Pittsburgh supported by the National Institute of Mental Health (NIMH) developed the screening tool for a 2007 NIMH study of treatments to decrease suicide risk among adolescents with depression. The Columbia Protocol, based on more than 20 years of scientific study, filled an urgent need for suicide research and prevention: a better way to uniformly and reliably identify people who are at risk. The Columbia Protocol achieved accurate and comparable results by using consistent, well-defined, and science-based terminology. Just as important as its ability to identify who might attempt suicide, it was the first tool to assess the full range of a persons suicidal ideation and behavior, including intensity, frequency, and changes over time. .
In 2011, the Centers for Disease
Control and Prevention adopted the protocols
definitions for suicidal behavior and recommended the use of
the Columbia Protocol for data collection. In 2012, the Food
and Drug Administration declared the Columbia Protocol the
standard for measuring suicidal ideation and behavior in
clinical trials. Today, the Columbia Protocol is used in
clinical trials, public settings, and everyday situations,
such as in schools, faith communities, hospitals, and the
military, to identify who needs help saving lives in
45 nations on six continents.
Protocol for Families, Friends, and Neighbors
The Community Card version of the Columbia Protocol is the one best suited for use by family members, friends, and others who have a relationship with a person who may be at risk. It involves asking just three to six questions, but the answers provide enough information to determine whether someone needs help and if immediate action is needed. The questions plain language also may make it easier for you to talk to someone who may be suicidal. Start the conversation now.
(2 page PDF each)
Protocol for Your Setting
(2 page PFD each)
You do not need special permission from us to take the Columbia Protocol tools and use them in your setting, create your own unique triage next steps, or embed the Columbia Protocol in your electronic health record keeping systems (EHR). We are happy to look at any materials you develop, policies you write or screenshots of your EHR to confirm their accuracy. You can send them to us at email@example.com
See our C-SSRS for Research page for versions of the scale and information for researchers.
Configure Your Toolkit
Its easy to assemble and download a toolkit of the Columbia Protocol versions and related documents you need to assess suicidal ideation and behavior using the versions of the protocol that are appropriate for your setting. Just make the selections below.
Note: The screener versions require
just two to six questions and are commonly used for clinical
triage by first responders, emergency room and crisis call
center staff, and non-mental health users like teachers or
Student Suicide with Just a Few Simple Questions
1. Separate suicide and NSSI
One of the obstacles in providing proper interventions is educators not grasping the difference between suicidal behavior and non-suicidal self-injury (NSSI). Both are serious and require intervention, but the response for suicidality is different than for NSSI. Properly identifying a students behaviors is an important first step in getting them the right help. A few key characteristics of the two include:
2. Explore the C-SSRS
The Columbia-Suicide Severity Rating Scale (C-SSRS) was developed to provide a simple, accurate, and effective tool that anyone can use to evaluate risk for suicide. You do not need to be a mental health professional to administer it; all it requires is asking a series of simple questions and referring them to mental health services if their answers raise any red flags.
The full C-SSRS screening tool is available in several versions.
Below are a few quick links to commonly used versions.
Click here to access all versions of the C-SSRS.
3. Identify ideation
The first step in applying the C-SSRS is identifying ideation. If you are concerned your student may be at risk for suicide, start by asking these 2 questions:
4. Ask more as needed
When administering the C-SSRS, you only need to ask as many questions as it takes to determine whether your student has had suicidal ideation or behaviors. If your student answered no to both ideation questions, you can rule out ideation and jump right into the behavior questions listed in our next point. If they answered yes to either or both ideation questions, ask a few more ideation questions to gain understanding:
5. Assess for behaviors
Whether or not your student has indicated ideation, you must also ask behavioral questions. Determine whether theyve engaged in suicidal behaviors by asking the following questions:
6. Inquire about interruptions
Next, ask your student if there were ever times where they had attempts that were either stopped by someone interrupting them, or by them having second thoughts:
7. Ask about preparatory behaviors
Even if your student has not indicated making any attempts, its important to find out if theyve done anything to prepare to end their life. Examples could include collecting pills, purchasing a gun, writing a suicide note, or giving valuables away.
Have you taken any steps toward making a suicide attempt or preparing to kill yourself?
8. Know when its an emergency
If your student answers yes to any questions regarding ideation, behaviors, or non-suicidal self-injury, its important to refer them to mental health resources. For a student to require a 911 call and/or immediate escort to emergency services, they should meet either of the following criteria:
9. Reach out and speak up
If your students answers have indicated suicidal ideation, suicidal behaviors, or non-suicidal self-injury, quickly share your findings with the school leadership, crisis response team, school psychologist, school counselor or other mental health professional on campus. If youre not sure who to alert, call 911. As a preventative measure, advocate for mental health programming to be offered on campus so that all students learn healthy coping skills and become aware of available resources.
10. Host a C-SSRS training
The best way to prevent tragedy on campus is to get your faculty on the same page with effective tools that address mental health emergencies. While you dont have to be a mental health professional to administer the C-SSRS, its best to complete a brief online training and receive additional in-person education from a mental health professional to fully grasp how to evaluate student answers in real-life scenarios.
If you represent a private school or district that would like to do an in-service teacher training, our Specialists can:
The purpose of this article is to provide an overview of the highlighted topic.
The Columbia Lighthouse Project (2018). The Columbia Protocol for Your Setting. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english
The Columbia Lighthouse Project (2018). Community Card for Teachers. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Teachers-2023c.pdf
The Columbia Lighthouse Project (2018). Community Card for Friends and Family. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-2women-2023c.pdf
The Columbia Lighthouse Project (2018). Community Card for Teens. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Teens-2023c.pdf
The Columbia Lighthouse Project (2018). Community Card for Parents. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Parents-2023c.pdf
The Columbia Lighthouse Project (2017). C-SSRS Training. [Video webinar]. Retrieved from https://www.youtube.com/watch?v=epTDFFv3uwc&list=PLZ6DpvOfzN1kV1F_lDw9-26JifBSDlIbF&index=2&app=desktop
Shinn, M.M. (2018). Cutting & Other Self-Harm: What Every Parent Needs to Know. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from https://www.variationspsychology.com/blogs/cutting-other-self-harm-what-every-parent-needs-to-know
Shinn, M.M. (2018). 8 Tips to Create a Mentally Healthy Classroom. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from https://www.variationspsychology.com/blogs/8-tips-to-create-a-mentally-healthy-classroom
Shinn. M.M. (2019). Parents Guide: What to do When Your Childs Friend Dies by Suicide. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from https://www.variationspsychology.com/blogs/parents-guide-what-to-do-when-your-childs-friend-dies-by-suicide
Shinn. M.M. (2019). Suicide
Prevention in the School Setting. Variations Psychology,
Futures Academy. [Webinar].