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 model helps health and behavioral health professionals feel confident navigating challenging conversations and offers key strategies for providing compassionate care to people at risk for suicide.
AMSR Approach
AMSR’s comprehensive approach recognizes that the best risk formulation requires multiple levels and factors, including:
- A broader understanding of suicide risk and behaviors
- Relevant population-specific risks – including risk levels among typical patients in similar levels of care
- The patient’s own current risk state and their typical level of risk over time
- The provider’s own reactions to suicide and their risk tolerance
- Establishing a collaborative relationship with patients and their supports to plan and respond to suicidal thoughts and behaviors
Suicide Risk Formulation Research
Research in the U.S. has demonstrated that many mental health professionals lack the training to assess suicidality among their patients. To help address the lack of training in appropriate risk formulation for suicide, Assessing and Managing Suicide Risk (AMSR) was developed to teach providers and support staff to utilize the latest research-informed suicide risk formulation in their day-to-day clinical work 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 a patient in four dimensions.
- Four Dimensions of Patient Assessment
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The four dimensions are:
- Risk Status: The types of information needed to assess risk status are more enduring factors particular to a patient’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 patient 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 a patient’s safety and treatment planning.
- Foreseeable Changes: Also considered is an assessment of foreseeable changes in a patient’s environment that could quickly increase risk state.
Contingency plans are then made with the patient and support systems based on the identified four areas.
- Benefits of Prevention-Oriented Risk Formulation
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Prevention-oriented suicide risk formulation challenges the status quo of prediction risk formulation commonly observed in the psychiatry field and taught in psychiatry preparation programs. This is because predictive suicide risk formulation traditionally assesses a patient’s risk as low, medium, or high without assessing the patient’s risk relative to other patients in the same context or settings.
Impact of Clinician’s Emotional Regulation on Treatment
Several recent 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.”
Another 2021 study explored how clinicians’ emotional responses to suicidal patients and their ability to regulate their emotional responses to suicide are related to their treatment recommendations. This study found that among clinicians with lower emotional regulation, the clinician’s recommendations about increasing treatment intensity or moving to a more restrictive level of care (i.e., increasing frequency of outpatient treatment; increase, substitute, or add medication; move to an intensive treatment program; add case management, psychotherapy, pharmacotherapy, or residential treatment to their current treatment modality; or referral to ER or admission to an inpatient unit for treatment) was associated with clinicians’ negative emotional responses to patient suicidal ideation at the initial clinical encounter—but not with the patient’s suicidal ideation.