The Columbia-Suicide Severity Rating Scale

David Boyer, one of our directors, was at the second annual conference of the Utah Association for Domestic Violence Treatment which was held in Provo on September 10-13, 2014.  This year's theme was "Safe Families, Peaceful Communities: Treatment for Victims, Children, and Offenders."  David brings us the following from the conference:

The first speaker addressed suicide assessment and prevention. As a parental defense attorney, I have had many experiences where I questioned whether my client was suicidal. The following information was very helpful in providing me with information I can use to asses and prevent suicide.

Please note that at the end of these comments, I have included the website address where the C-SSRS information sheet and other forms can be obtained. 

The Columbia-Suicide Severity Rating Scale (C-SSRS) 

The ongoing national and international tragedy of suicide has spurred substantial prevention efforts. Lack of effective screening and identification of persons at risk is an obstacle to effective prevention. An evidence-supported, low-burden solution is The Columbia-Suicide Severity Rating Scale (C-SSRS), a screening tool developed by multiple institutions, including Columbia University, with NIMH support has predicted suicide attempts—one of the foremost national priorities for prevention. 

Key Points: 

• Demonstrated ability to predict suicide attempts in suicidal and non-suicidal individuals (which is a national priority for prevention).

• The CDC adopted Columbia definitions of suicidal ideation and behavior; link to C- SSRS in CDC document.

• Field-use ready; mental health training not required to administer; Chaplains to first responders.

• Gathers key data to help direct limited resources to persons most in need.

• Track record of many millions of administrations.

• Available in 103 languages.

• Electronic self-report is available and widely used (e-CSSRS)

• The C-SSRS is used extensively in primary care, clinical practice, surveillance, research, and institutional settings. It is part of a national and international public health initiative involving the assessment of suicidal risk and behavior. Numerous states and countries have moved towards system-wide implementation. Use includes general medical and psychiatric emergency departments, hospital systems, managed care organizations, behavioral health organizations, medical homes, community mental health agencies, primary care, clergy, hospices, schools, college campuses, military, frontline responders (police, fire department, EMTs), crisis hotlines, substance abuse treatment centers, prisons, jails, juvenile justice systems, and judges. More reliable and valid risk assessment is likely to reduce unnecessary hospitalizations, so that limited resources may be targeted to those who most need them.

• The C-SSRS has been associated with decreased burden by reducing unnecessary interventions and redirecting limited resources; In the Rhode Island Senate Commission hearing on ER overuse and diversion, state senators discussed use of the C-SSRS by EMS or police in the community to address ER overuse and ER diversion.

• The C-SSRS is a key component of the strategy to develop and disseminate tools to enable better prediction of suicidal risk and more efficient allocation of limited healthcare resources.. In the past, typical screening has only identified suicide attempts, omitting some of the most important behaviors that are critical for risk assessment and prevention (e.g. collecting pills, buying a gun). The C- SSRS is the only evidence-based screening tool that assesses the full range of clinically important ideation and behavior, with criteria for next steps (e.g. referral to mental health professionals); thus, the C-SSRS can be exceptionally useful in initial screenings.

Copies of the C-SSRS can be downloaded from the center's website: http://www.cssrs.columbia.edu/scales_practice_cssrs.html. Training can be completed on the C-SSRS Training Campus website: http://c-ssrs.trainingcampus.net. For larger scale or systemic implementation, we are available to discuss optimal implementation and training strategies.

Kelly Posner, PhD  posnerk@nyspi.columbia.edu 
Director, Center for Suicide Risk Assessment Columbia University/New York State Psychiatric Institute 1051 Riverside Drive, Box 78
New York, NY 10032
direct: 212-543-5504
mobile: 646-286-7439
fax: 212-543-5344