C-SSRS Scoring Card: Ideation, Behavior, and Same-Day Action

Scoring card

Wish to be dead

• Section: Ideation, past month, first item

• What a yes means: A wish to be dead, or to sleep and not wake, without a thought of killing oneself

• Risk level: Low. Yellow on the 2026 screener legend

• Same-day action: Behavioral health referral. That is the outpatient example. You are already that clinician, so it is not a handoff to another clinic unless your policy requires one. Change the example to your setting’s resources and policies

• Chart note: Yes to a wish to be dead. No to suicidal thoughts, method, intent, plan, and behavior. Low risk. Action taken under setting policy

Suicidal thoughts

• Section: Ideation, past month, second item

• What a yes means: Thoughts of killing oneself. Method, intent, and plan have not been asked yet

• Risk level: Low, if method, intent, plan, and recent behavior are no

• Same-day action: Same referral example as a wish-to-be-dead yes. Then ask method, intent, plan, and behavior. A later yes can raise the level in the same sitting

• Chart note: Yes to suicidal thoughts. Method, intent, plan, and behavior recorded as no, or still open if you have not asked them

Method without intent or plan

• Section: Ideation, past month, third item. Ask only after a yes to suicidal thoughts

• What a yes means: Thoughts about a possible method, without a specific plan and without intent to carry it out

• Risk level: Moderate. Orange on the 2026 screener legend

• Same-day action: Behavioral health referral, not consultation and precautions. Orange does not upgrade the printed example. Change the referral to your setting’s resources and policies

• Chart note: Yes to a method without intent or plan. Moderate risk. Action taken under setting policy

Some intention to act

• Section: Ideation, past month, fourth item

• What a yes means: Suicidal thoughts plus some intention to act, without a worked-out plan

• Risk level: High. Red on the screener. A past-month yes here is one of the answers Columbia calls most worrisome in every setting

• Same-day action: Behavioral health consultation and patient safety precautions. That is the printed outpatient example. Change it to your setting’s resources and policies

• Chart note: Yes to some intention to act. High risk. Precautions recorded under setting policy

Plan and intent

• Section: Ideation, past month, fifth item

• What a yes means: A worked-out plan, and intent to carry that plan out

• Risk level: High. Red on the screener, same band as intention to act

• Same-day action: Behavioral health consultation and patient safety precautions, the same printed example as intention to act. Change it to your setting’s resources and policies

• Chart note: Yes to plan and intent. High risk. Precautions recorded under setting policy

Lifetime suicidal behavior

• Section: Behavior, lifetime, most recent episode older than 3 months

• What a yes means: An attempt, an interrupted attempt, an aborted attempt, or preparatory acts, and the most recent was more than 3 months ago

• Risk level: Moderate on the general screener color legend

• Same-day action: Behavioral health referral when that behavior is not within 3 months. Change that example to your setting’s resources and policies

• Chart note: Lifetime behavior yes, not within 3 months. Type and approximate date named. Moderate on the color legend. Action taken under setting policy

Behavior in the past 3 months

• Section: Behavior within the past 3 months

• What a yes means: An attempt, an interrupted attempt, an aborted attempt, or preparatory acts inside that window

• Risk level: High. Columbia groups recent behavior with a past-month yes to intent or plan as the most worrisome pattern in every setting

• Same-day action: Behavioral health consultation and patient safety precautions, even if this month’s ideation items were no. That is the printed example for behavior inside 3 months. Change it to your setting’s resources and policies

• Chart note: Behavior within 3 months. Type and date. High risk. Precautions recorded under setting policy

If the person in front of you is in immediate danger, use your local emergency protocol. In the US, the 988 Suicide & Crisis Lifeline is call or text at 988.

The note below is one clinic’s policy for a low yes. The means check, the dated next session, and 988 are that policy. They are not a universal step on the outpatient form.

How to ask the screener

Ask the first two ideation items of everyone you screen. If suicidal thoughts are no, do not ask method, intent, or plan. Still ask the behavior item, including whether any behavior was in the past 3 months. That skip rule is printed on the screener. A quiet ideation section does not retire the behavior question.

Use Columbia’s wording from the file in front of you. A paraphrase you half-remember will drift, and the triage colors only mean what they mean if the item you asked is the item Columbia wrote.

The questions are plain on purpose. About the protocol says asking them does not require mental health training. The next step does require your setting’s policy. You still decide disposition. The form does not discharge that judgment.

What sets the level

Record the highest ideation yes in the past month, and whether any suicidal behavior was in the past 3 months. The higher yes sets the level. A lower yes does not wash a higher one out.

Triage and risk identification says the score is low, moderate, or high depending on where the yes answers fall. Answers are color-coded. The most worrisome answers are the same in every setting: a past-month yes to ideation item 4 or 5, or any suicidal behavior in the past 3 months.

On the 2026 screener, yellow is low (wish to be dead, or suicidal thoughts with the later items no). Orange is moderate (method without intent or plan, or lifetime behavior). Red is high (intent, plan, or behavior in the past 3 months).

The outpatient and ambulatory screener prints a response protocol under the items:

• Items 1, 2, and 3, and lifetime behavior older than 3 months: behavioral health referral
• Items 4 and 5, and behavior within 3 months: behavioral health consultation and patient safety precautions

Item 3 is the awkward row. The color legend marks it moderate. The outpatient protocol’s example action is still a referral, not the high-risk precautions line. Follow the precautions line when the yes is red. For an orange yes, the printed example is a behavioral health referral. A means question, a named next contact, a crisis number, and a note that names the orange item can live in your setting’s policy. They are not a universal step on the form.

Columbia says those example actions should be changed to reflect your setting’s resources and policies. Do not soften a red yes because the person is likable, employed, or already in weekly therapy.

There is no total to add. Posner and colleagues (2011) reported initial validity and internal consistency for the scale in adolescent and adult samples. That paper is not a scoring key you sum in the chair. The level is which item was yes, and how recent the behavior was.

The full lifetime/recent scale adds an intensity subscale and separates attempt, interrupted attempt, aborted attempt, and preparatory behavior. Open the full scale when you need that detail. Do not invent an intensity cutoff the file does not print. The screener is enough for the same-day level.

The official file

When you need a cssrs pdf, open it from the Columbia Lighthouse Project toolkit. For a therapy office, the file to administer is the outpatient screener with triage points. A Columbia suicide severity rating scale PDF from that toolkit is the copy to keep. A retyped cssrs pdf, or a scan from an old training deck, is not the instrument.

The protocol is free for community and healthcare use, including placing the tools in your record system. You do not need a paid reprint. You also do not paste the items into the chart. Name the instrument, the version, the yes and no pattern, the level, and what you did.

The C-SSRS PDF is a suicide assessment scale for ideation and behavior. It is not a weekly symptom total. If you are choosing which brief measure to repeat for depression, anxiety, or functioning, start from the scales for mental health matrix, and stop that matrix when a suicide signal appears.

A chart note you can copy

Write the level in words the next clinician can find. “Denies SI” after a yes earlier in the month is how a chart loses the thread. Whether you give the screener again next session is your setting’s call.

Next contact and crisis number are policy fields. Leave them blank when your setting does not use them.

Where the result sits in the chart

The yes pattern belongs in the session note the same day. The fuller formulation, protective factors, and follow-up plan belong in your suicide risk assessment template. Keep the instrument name identical in both places so a later reader does not have to guess whether “Columbia” and “C-SSRS” were two different screens.

If you write the hour in session notes, the risk line stays in that same record. A side document that never makes it back to the note is how a high yes disappears between sessions.

Download the scales pack

The scales pack is the selection matrix for brief outpatient measures: what each one is for, how often to repeat it, and when to stop. It does not replace the cssrs pdf, and it does not include C-SSRS items. Use it when the question is which measure to trend. Use Columbia’s file when the question is suicide risk today.

References

• Columbia Lighthouse Project. (2026). About the protocol.
• Columbia Lighthouse Project. (2026). Triage and risk identification.
• Columbia Lighthouse Project. (2026). The Columbia Protocol for healthcare and other community settings.
• Columbia Lighthouse Project. (2026). Columbia-Suicide Severity Rating Scale: Screen version, recent.
• Columbia Lighthouse Project. (2026). Columbia-Suicide Severity Rating Scale: Screen with triage points for outpatient/ambulatory.
• Columbia Lighthouse Project. (2026). Columbia-Suicide Severity Rating Scale: Full scale, lifetime/recent.
• Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277.
• 988 Suicide & Crisis Lifeline. (n.d.).