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Today we'll discuss a number of evidence-based screening tools for suicide and substance abuse. These tools are supported by the Suicide Assessment Five-step Evaluation and Triage framework, or "Safety" (S.A.F.E.T.). The steps in this framework will help you determine a patient's level of risk.

• Step 1. Identify risk factors.
• Step 2. Identify protective factors.
• Step 3. If the patient is at-risk, ask about substance abuse and/or current suicidal thoughts, plans, behavior, and intent.
• Step 4. Determine his or her risk level and the appropriate intervention.
• Step 5. Document your risk assessment, rationale, intervention, and follow-up.

Steps 1 and 2 cover the preliminary factors to look for when screening a patient. Let's examine these more closely.

1. Identify risk factors. The first step in recognizing an at-risk patient is to notice warning signs, and be aware of risk factors for suicide and substance abuse as they present themselves in your interview with the patient.

Some risk factors may already be indicated in the patient's history and physical exam, like a history of psychiatric illness, such as depression, bipolar disorder, or schizophrenia. Others you may only discover during the interview. Some other general risk factors are:

• A history of previous suicide attempt
• A family history of suicide or psychiatric illness
• Chronic illness or chronic pain
• Social stressors, like unemployment or financial loss that leads to a sense of worthlessness
• Substance abuse
• Tendency toward impulsive behavior,
• Or the recent death of a loved one

2. Identify protective factors. Some protective factors to ask the patient about include:

• Strong family and community supports
• Restricted access to lethal means of suicide
• Physical and mental health supports
• And, problem solving and conflict resolution skills