The clinical assessment and management of suicide risk depends primarily on face to face contact with the individual who presents the risk, and aims to predict behaviour in the very near future. Whether or not clinical intervention prevents suicide depends a great deal on the clinician's skill in reaching out to the individual patient. This poses a dilemma, because much of what has been written about predicting suicide has been based on averaged data concerning long-term outcome in large cohorts of patients.

Summary This article considers the role that assessment of suicidal ideation may have in short-term prediction of suicide. Suicide risk assessment is a multifactorial process and it is assumed that assessment of suicidal ideation is one component. Denial that suicidal ideation has any useful role in risk assessment fails to allow for the marked ongoing short-term variability in severity of intent, which is a common feature of the suicidal state of mind. It is concluded that the assessment of suicidal ideation, provided it is carried out correctly and applied appropriately, should continue to be regarded as a central component of the overall prediction process. A ‘two-take’ approach to short-term risk assessment and mitigation is proposed that takes variability in severity of intent into account and includes anticipatory treatment planning for any problems that may occur in the near future.

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