In summary:
- Avoid outdated risk categorisation – Risk fluctuates, making risk formulation more effective than low/medium/high labels.
- Look beyond risk management – Address underlying distress (e.g. financial stress, relationship breakdowns, isolation).
- Make safety planning standard – Use the Stanley & Brown model and avoid contracts that undermine client agency.
- Personalise crisis support – Ask if clients would use a helpline; offer alternatives like text-based services or scripts.
- Improve psychologist training – Suicide prevention skills should be embedded earlier in psychology education.
- Prioritise self-care – Debrief, diversify caseloads, take breaks, and access APS’s self-care for psychologists module.
- Access APS resources – Access CPD courses, ethical guidelines and more to enhance your psychological practice.
It's critical to move beyond a compliance-only approach when faced with clients experiencing suicidality. A psychologist and suicide prevention expert unpacks how to take a more holistic approach.
Note for readers: This is a reminder to practice self-care as you read this article and, if necessary, reach out to a support platform, such as Lifeline, if you require support.
Suicide prevention is one of the most complex and sensitive areas of psychological practice. Despite increased awareness and investment to address this issue, suicide rates continue to rise in Australia, highlighting the need for deeper understanding and more effective interventions.
“We’re putting all of this effort in, but the numbers are not changing. In some groups, like young women, self-harm and suicide attempts are increasing. That doesn’t necessarily get reflected in deaths. If we only look at those numbers, we’re missing key trends," says Dr Lyn O'Grady MAPS, a psychologist with a Masters in Suicidology.
Psychologists are often the first point of contact for individuals experiencing suicidal thoughts, yet it's common for some to feel unprepared about to handle these conversations, she says.
“The old thinking was that the minute there’s any talk about suicide, you'd refer [your client] on. But these days, it's such a common issue that gets talked about in a private practice setting, so you can't just refer these clients on – and there's sometimes nowhere to refer them to."
Unfortunately, formal psychology education often lacks comprehensive suicide prevention training, leaving many psychologists feeling unprepared when a client unexpectedly discloses suicidal thoughts or behaviours.
"It's life or death stuff, which we don't always deal with as psychologists. We learn a lot about grief – the aftermath of loss – but we haven't always done a lot of training for when a person is talking about suicide."
It’s essential for all psychologists to be equipped with the skills to respond appropriately when a client discloses suicidal thoughts. Knowing how to create a safe and trusting environment not only encourages open disclosure, but also enables meaningful interventions that can start to address the underlying distress.
Below, Dr O'Grady shares a non-exhaustive list of things psychologists can consider when trying to approach suicide response and intervention in a more people-centred manner.
Explore APS’ CPD library on suicide prevention, which includes a webinar from Lyn O’Grady, to learn how to better manage these challenging situations.
Building trust and encouraging disclosure
Many clients hesitate to disclose suicidal thoughts due to fear of being hospitalised, says Dr O'Grady. Psychologists can counter this by fostering a non-judgmental, open space.
“People worry that if they mention suicide, they’ll be locked away. But the vast majority of people in private practice or agency settings who are talking about suicide aren't necessarily at crisis point. We need to reassure them that talking about it won’t automatically lead to hospitalisation and instead help them develop strategies to stay safe.”
Psychologists should also avoid checklist-style questioning, as this can cause clients to shut down or avoid sharing critical details, she adds.
We need to move away from ‘Do you have a plan? What’s your method?’ as the first thing we ask, and instead focus on, ‘Tell me what’s been going on for you.’ That's how we can really honour their story. – Dr Lyn O'Grady MAPS
Instead, she suggests taking a conversational approach and integrating suicidality into broader discussions about life stressors.
“We need to move away from ‘Do you have a plan? What’s your method?’ as the first thing we ask, and instead focus on, ‘Tell me what’s been going on for you.’ That's how we can really honour their story," she says.
"It's about having the ability to put it into the context of the person's life and trying to understand what these suicidal thoughts or behaviors are telling us about what's happening for them.
"That approach is very calming for [psychologists]. It's what we do naturally. It's tapping into our natural ability to be curious, ask questions and formulate what's happening. That helps [clients] to feel more comfortable."
Moving beyond categorisation
A common misstep in suicide risk assessment is the continued use of categorisation – assigning clients to low, medium or high-risk levels.
Of course, there are some circumstances where this process is expected as part of workplace policies, but it’s best to be avoided where possible.
Dr O’Grady believes categorisation is a flawed process.
“Research going back to the 1950s has challenged this. We can't easily predict who is going to attempt suicide or die by suicide.
"There's even some research which suggests that those who were assessed as ‘low risk’ were dying more often than those in the high-risk category – the argument being that for the high-risk people, a lot of action is taken to protect them and that means we're missing [adequately supporting] the low-risk people.
"The problem is that risk is fluid – it can change rapidly. Someone can say things when they're sitting in a session with us but when they walk out of the room, something can change – a protective factor, such as a supportive relationship, for example, might then go away. Suddenly, that's gone from a low-risk to a high-risk situation.
“If someone is experiencing suicidal thoughts, there is risk, so we need to take action."
Instead, psychologists should move towards risk formulation, which considers all factors contributing to suicidality and how these might change over time.
“We used to think, ‘If there’s no plan, we don’t need to do anything.’ But we don’t know what might suddenly trigger that shift from thoughts to a plan.”
Approach suicidality as a reflection of the client’s distress and work to understand its underlying causes.
“We can get stuck on managing the risk, but we need to ask, what are the suicidal thoughts really about? Often, they stem from relationship breakdowns, financial stress, grief, or feelings of isolation. If we only focus on the suicide risk itself, we miss the bigger picture.
"If we can unpack, in our own minds, what the suicidal thoughts are really about, and then understand them in the context of the person's life, then we can show the person we're willing to hear and to help them with that, but also put it into context.
"It's not like the suicidal thoughts are separate to the person. The suicidal thoughts and actions are happening in response to a lot of different things that are going on in their life."
Safety planning as a standard practice
Instead of simply assessing and categorising risk, all clients experiencing suicidality should be guided through a safety planning process, says Dr O'Grady.
She says it's important not to adapt the core safety plan developed by Stanley and Brown in 2012, which is held up as a best-practice plan.
"I have seen short cuts and other elements added, which I think is unhelpful. For example, I’ve seen safety plans where people add a contract at the end where a client is asked to sign, saying, ‘I agree not to harm myself.’ But that doesn't work and it's not evidence-based.
"The safety plan is about empowering the person to take responsibility so they have a desire to keep themselves safe – you undermine that by making them have to agree with you and sign something. Then it becomes about me [the psychologists] rather than them keeping themselves safe and me supporting them to do that."
Through a collaborative discussion, you would then maintain deep curiosity and, collaboratively, come up with the elements of the safety plan together, such as some of the things they might do to calm themselves when they feel distressed or who they could talk to if they needed support.
Additionally, it’s crucial not to make assumptions about how someone might engage with the elements of their safety plan.
“It’s not enough to just write down a helpline number. We need to ask, ‘Would you actually call a helpline? Have you tried it before?’ Because sometimes they might say 'no' because they don't know what they'd say or they don't think their issues are important enough or they've heard from some people that they're not going to answer."
Dr O’Grady explains that small adjustments – such as helping clients draft a script or exploring alternative support options like online chat or text-based services – can make a significant difference. However, these solutions only emerge when psychologists take the time to ask the right questions.
Download the free 'Beyond Now' safety plan template here.
Self-care for psychologists
Given the emotional weight of suicide prevention work, psychologists must take steps to protect their own wellbeing.
“One of the biggest challenges for psychologists is the feeling of, ‘Have I done enough?’ It’s important to debrief, document properly – not just to cover our legal and ethical responsibilities, but to consolidate what you’ve done – and remember that your work makes a difference.”
Other key self-care strategies include:
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Diversifying caseloads: “Even though this is my area of expertise, I don’t only see people experiencing suicidality. You need balance.”
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Taking breaks between sessions to process emotionally charged conversations.
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Recognising limits: “Despite our best efforts, we can’t always change the outcome. We have to accept that.”
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Seek out specific self-care training: APS hosts a 'self-care for psychologists' e-learning module which is free for its members.
Moving forward
Dr O’Grady is eager to review the government’s National Suicide Strategy, which was released earlier today. We are pleased to have contributed to the development of this Strategy, and look forward to collaborating with the Government on the development of the National Suicide Prevention Outcomes Framework.
Dr O'Grady also emphasises the need for greater investment in early training for psychologists.
“Psychologists often don’t receive meaningful suicide prevention training until they’re already working, when they’re suddenly thrown into it. That can really affect them, so I think we need to embed this training earlier.”
Suicide prevention requires a fundamental shift from outdated risk assessment models to a person-centred approach built on safety, trust and deeper understanding. By strengthening their skills, psychologists can play a critical role in supporting clients experiencing suicidality, while also prioritising their own wellbeing in the process.
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