Suicide risk assessment — structured clinical viva

This is a high-stakes post-discharge review. Early days after psychiatric hospitalisation are a documented peak-risk period; passive ideation plus possible preparatory behaviour (giving away tools) and firearm access elevate concern beyond a casual outpatient chat.[1][4]

Assessment priorities: ask directly about ideation, intent, plan, timeline, hope vs hopelessness, mixed features, substance use, sleep, adherence to lithium, and what “giving away tools” means. Collateral from partner is essential. Do not be reassured by a therapeutic lithium level alone.[1][3]

Means restriction: collaborative firearm safety is urgent — temporary transfer or storage with a trusted person under local law, ammunition separation, and verification. Lock other lethal means. This is a clinical intervention, not optional lifestyle advice.[3]

Safety plan: Stanley-Brown-style written plan with warning signs, coping, supports, crisis contacts (local numbers), means steps, and reasons for living; partner involved as agreed.[3]

Lithium: continue with monitoring; cite Cipriani meta-analysis on suicide prevention in mood disorders as part of the long-term risk reduction conversation, while emphasising that lithium does not remove the need for acute safety work.[2]

Disposition: low threshold to re-admit if intent escalates, means cannot be secured, or supports fail. Otherwise same-day or next-day crisis follow-up, not routine weeks-away clinic. Document formulation, means actions, who was informed, and review time.[1][4]