Why Traditional Suicide Risk Assessments Fall Short
The Case for an Attachment-Informed Approach to Suicide Prevention
Suicide risk assessments are a critical part of mental health care, but the tools we often rely on—standardized checklists, acute risk factors, and crisis protocols—can sometimes miss the deeper psychological terrain that drives suicidality.
While identifying prior attempts, access to means, or current suicidal ideation is essential, these factors don't tell the whole story. They don't explain why someone feels suicidal. They don't capture the lived experience of emotional pain, isolation, and relational trauma.
To truly meet clients where they are, we need a more compassionate and comprehensive lens. Attachment theory, with its profound insights into human relationships, offers precisely that.
The Limits of Traditional Risk Assessment
Standard suicide risk protocols tend to emphasize:
Acute risk factors (such as past attempts or current ideation)
Crisis interventions, often centered around immediate safety
Standardized checklists that may feel impersonal or incomplete
This approach, while clinically necessary, can overlook key drivers of suicidal ideation—particularly when those drivers stem from early relational trauma, attachment insecurity, or chronic emotional isolation.
As Dr. David Jobes (2006) notes, this method can unintentionally reduce people to risk profiles, missing the emotional context that fuels suicidal behavior.
Why Attachment-Informed Risk Assessment Matters
Attachment theory helps us ask more profound questions:
How do early relational wounds shape an individual's ability to regulate emotion?
What role does disconnection or rejection play in their current distress?
How might attachment insecurity contribute to chronic suicidality?
An attachment-informed assessment allows us to recognize that suicidality is not just about danger—it's about disconnection. People who feel suicidal are often searching for belonging, understanding, and emotional safety.
Suicide Risk Through an Attachment Lens
Common Risk Themes
Reasons for Dying (RFD):
Loneliness, hopelessness, burdensomeness, and self-criticism.
These reflect core attachment injuries—feeling unwanted, unworthy, or unseen.
Reasons for Living (RFL):
Family, relationships, responsibility to others, hope for the future.
These reflect attachment strengths—the desire to stay connected, to matter, to love and be loved.
Research from CAMS (Collaborative Assessment and Management of Suicidality) shows that both RFDs and RFLs are deeply rooted in attachment (Jobes & Mann, 1999). This alignment underscores the importance of relational, emotional, and social dynamics in suicide prevention.
Breaking the Cycle: Clinician Attitudes Matter
Clients with chronic suicidality often have attachment wounds rooted in inconsistent or rejecting caregiving. When clinicians unintentionally reinforce these patterns, it can deepen distress.
Common Pitfalls and Their Impact:
Clinician Response: Impact on Suicidal Clients
"They're just doing this for attention." Dismisses pain, reinforces abandonment.
"They're always here—it's the same story." Leads to less thorough care and burnout.
"They never follow through, so why bother?" Creates emotional distance and mistrust.
"I can't get too invested for my protection." Clients feel emotionally abandoned.
Attachment-informed care challenges these reflexive attitudes. It asks clinicians to stay present, curious, and compassionate—even when it's hard.
Practical Steps for Attachment-Informed Suicide Prevention
1. Validate the Client's Experience
Acknowledge that suicidal ideation is often rooted in real emotional pain—not manipulation.
Approach each conversation with empathy, not skepticism.
2. Assess for Attachment Vulnerabilities
Ask more profound, relational questions:
"Who do you feel most connected to right now?"
"When do you feel most alone?"
"What makes you feel like a burden?"
3. Strengthen the Therapeutic Alliance
Consistency matters.
Being reliably available, emotionally attuned, and nonjudgmental helps counteract attachment wounds.
4. Use Attachment-Based Interventions
Emotion-Focused Therapy (EFT): Identifies unmet attachment needs.
Mentalization-Based Therapy (MBT): Improves relational awareness and emotion regulation.
CAMS Framework: Centers risk around relational and emotional themes.
A Call for Change
To reduce suicide, we must go beyond checklists.
We must understand why someone feels life is no longer worth living. That often means addressing attachment injuries, emotional dysregulation, and relational trauma.
By embracing an attachment-informed approach, we provide care that is not only safer but also more meaningful, attuned, and healing.
If You or Someone You Know Is in Crisis
Support is available. Reach out to one of the following resources:
📞 988 Suicide & Crisis Lifeline – Call or text 988
📞 Crisis Text Line – Text HOME to 741741
📞 Veterans Crisis Line – Call 988 and press 1, or text 838255
🌎 Find local crisis resources by searching for mental health crisis centers in your area