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  • Stephen Greggo

Easing the way to ask the hardest question: The Columbia-Suicide Severity Rating Scale (C-SSRS)

Updated: Mar 28

The prevalence of suicidal ideation and the substantial risk for acting out can seem overwhelming. The rising statistics and the stories around us are hard to fathom. Facing this threat squarely and compassionately with a real person sitting in front of us is a nearly everyday occurrence for mental health professionals. When it comes to assessing the risk of self-harm, it is essential that clinicians apply a smooth, soothing, and informed approach. This means probing appropriately while maintaining the standardization necessary to adequately touch on the factors necessary to monitor risk. For this reason, the Columbia-Suicide Severity Rating Scale (S-SSRS) is recommended for inclusion in the clinician’s toolbox of rapid assessment measures (see AACP, Chapter 12: “Outfitting the Clinician’s Toolbox” 220-246).


Here is a web assessment resource that is well worth a visit: The Columbia Lighthouse Project. For many years, the C-SSRS has been readily available at no charge as a free-access measure. The developers offer a simple but elegant message: “Just Ask. You can Save a Life.” This scale is indeed an evidence-supported measure that blends well into our critical dialogues with clients. There are variations of this tool that can be employed as an ongoing means to monitor ideation going forward. What is a particular blessing is that the Lighthouse Project has expanded its question sets into cue cards for families, first responders, coaches, primarily care providers, and even peer-to-peer accountability. These are extraordinarily helpful when assisting families and friends to implement a safety plan. The hard questions about this taboo topic are tough to ask, and this approach provides a helpful script to open the way towards hope before it is too late. Finally, the Lighthouse Project offers a range of training opportunities that tap into their research and guide users to optimally apply this family of monitoring questions.


For mental health professionals, these measures assist in our charge to employ a best practice approach to our therapeutic efforts. The answers to inquiries such as those in this protocol shed light on important matters. It is essential to recall that while the questions can increase our confidence to venture into this life-threatening arena, the success of this technique rests on the assumption of genuine self-report. All of our clinical skills and the openness of self to hear the heart of another must come together when conducting these assessments. For pastors, lay ministers, and Christians mental health professionals, our practice is to reach for these protocols as we whisper a prayerful plea to the Great Comforter for the capacity to generate hope where darkness has taken hold. We ask that our voices, our eyes, our physical presentation, and the empathy that passes through our lips will take the words of those questions and make them effective.


Blessings, Steve Greggo

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