AMSR developed from key research

AMSR is a research-informed risk formulation model developed from best practices recommended by the nation’s leading experts in the research and delivery of suicide care.

The AMSR risk formulation helps health and behavioral health professionals determine an individual’s risk of suicide and be prepared to collaboratively plan with the person what will best support them in the least restrictive environment.

AMSR Approach

AMSR’s comprehensive approach recognizes that the best risk formulation requires multiple factors, including:

  • A broad understanding of suicide risk and behaviors
  • Relevant population-specific risks
  • The individual's own current risk state and their typical level of risk over time
  • The provider’s own emotions and reactions to suicide
  • Establishing a collaborative relationship with individuals and their supports to plan and respond to suicidal thoughts and behaviors

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Suicide Risk Formulation Research

Research in the U.S. has demonstrated that many mental health professionals lack the training to assess suicidality among individuals in their care. To help address the lack of training in appropriate risk formulation for suicide, AMSR was developed to teach providers and support staff to utilize the research-informed suicide risk formulation in their work with individuals at risk of suicide while embracing a culturally competent and collaborative approach to care. 

What makes AMSR unique is its reliance on the prevention-oriented suicide risk formulation, which requires practitioners to assess an individual in four dimensions.

Four Dimensions of Patient Assessment

The four dimensions are:

  • Risk Status: The types of information needed to assess risk status are more enduring factors particular to an individual’s population, such as strengths and protective factors, long-term risk factors, impulsivity and self-control, and past suicidal behavior.  
  • Risk State: Risk state is the risk relative to the individual at baseline or at a selected time and is often affected by more dynamic factors, such as recent or present suicidal ideation, stressors, symptoms, recent changes, and engagement with others (i.e., acute risk).  
  • Available Resources: Risk status and state are considered alongside immediately available internal and social resources that can support an individual’s safety and treatment planning.
  • Foreseeable Changes: Risk status and state are considered alongside immediately available internal and social resources that can support an individual’s safety and treatment planning.

Contingency plans are then made with the individual and their support system based on the identified four dimensions.

Benefits of Prevention-Oriented Risk Formulation

Prevention-oriented suicide risk formulation challenges the status quo of prediction risk formulation commonly taught and used in practice. A predictive suicide risk formulation traditionally determines an individual’s risk as low, medium, or high and does not compare the individual with others in a similar context or the individual’s history of suicidality. 

See the research

Impact of Clinician’s Emotional Regulation on Treatment 

Several studies have explored the impact of clinicians’ emotional responses and regulation on the treatment of suicidal individuals.

In a 2020 study, researchers found an association between a clinician’s negative emotional responses to a patient’s suicidal ideation at the initial encounter and that patient’s perception of therapeutic alliance. The authors argue that “clinicians’ awareness and management of their emotional states appear essential both for the identification of suicide risk and to enhance therapeutic alliance and treatment outcomes.”

See 2020 study

Barzilay et al. (2021) studied the connection between clinician emotional regulation, treatment intensification recommendations, and patient outcomes. They found that clinicians often made emotion-based decisions for their suicidal patients. In this study clinicians who did not regulate their emotions well, implemented higher levels of treatment intensity (e.g., recommended intensive outpatient, increased frequency of appointments) had patients with higher levels of suicidality at one month compared to the clinicians with higher emotional regulation levels who also increased treatment intensity. The patients of the clinicians with higher emotional regulation had lower rates of suicidality at one month. 

See 2021 study