As we wind down September’s suicide prevention month, it’s a good time for those of us who treat eating disorders and other mental health conditions to evaluate our own suicide assessment skills and remind ourselves to be on the lookout for specific risk factors that come up in the ED population.
At our “sister” outpatient program, Columbus Park in NYC, when providers feel it’s necessary to conduct suicide risk assessment, they use Marsha Linehan’s Risk Assessment and Management Protocol (LRAMP). The LRAMP is a seven-page tool that guides providers in assessing patients’ suicidality and documenting actions taken.  The tool outlines the rationale for conducting the assessment, guides you in evaluating risk factors and protective factors present and supports you in documenting your thorough assessment of the individual’s level of risk.  
When you, as providers, consider if a thorough risk assessment is in order, consider the following…
Factors that suggest acute risk for suicide:

  • Current intent, including any conviction that he/she is going to hurt him/herself
  • Preferred lethal method is available or easy to obtain
  • Patient believes that he/she is a burden to others
  • Severe hopelessness, psychosis, agitation
  • Alcohol intoxication
  • Past – especially recent – suicide attempt
  • Significant precipitating events like a loss, disciplinary action, legal problems
  • Recent diagnosis with serious or life- threatening illness
  • There are few protective factors

Factors that suggest moderate risk for suicide:

  • No specific plan for suicide in place
  • Patient denies current suicidal intent
  • There appears to be no preparatory behavior
  • Overall, patient exhibits low impulsivity
  • You can identify some protective factors

Factors that suggest low risk for suicide:

  • Suicidal thoughts but no clear plan or intent
  • No access to lethal means
  • No history of suicidal behavior
  • You can identify several
  • protective factors
  • Few risk factors

Protective Factors:

  • Problem solving skills; general confidence in coping skills
  • Hopefulness
  • Cultural and religious beliefs that discount suicide and support self-preservation
  • Family, friends, support systems
  • Pets
  • Community involvement or other connectedness
  • Attachment to therapist or other service provider
  • Social life
  • Access to mental health and services
  • Belief that suicide is morally, culturally or spiritually improper
  • Fear of death
  • Fear that there would be social disapproval if patient were to suicide
  • Individuals suffering from anorexia nervosa and bulimia nervosa have a suicide mortality rate that is 23x higher than the national population.
  • Women suffering from anorexia nervosa are more likely to die from suicide than any other cause of death.  These women are 12x more likely to die of suicide.
  • Suicide and suicidal ideation occur most often in the later stages of the disease but are also noted during time of symptom remission and occur at a rate of 57x that of healthy women.
  • Ten percent of patients (N=342) in a recent study reported a suicide attempt by the age of 23.


List of Public Blogs. (2013, September 19). Retrieved from SSN-LRAMP-updated-9-19_2013.pdf

Balz,C, Freizinger, M. (Unknown) Suicidality and Eating Disorders [PowerPoint slides].
Retrieved from

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