Passive ideation example
- Patient reports wanting “to disappear” when overwhelmed.
- No current plan or intent disclosed.
- Protective factors and follow-up discussed.
- Document that safety planning was reviewed.
Passive ideation is not the same thing as low risk.
Passive suicidal ideation generally refers to thoughts about death or about not being alive, without a current plan or immediate intent. Active suicidal ideation usually implies current thoughts about killing oneself and requires direct follow-up about intent, plan, means, and preparatory behavior.
The difference matters because a note can be precise about what was asked and what was answered without minimizing the clinical situation.
A good assessment asks what is current, specific, and actionable.
- Are the thoughts passive, active, or both?
- Is there intent, a plan, or access to means?
- Has the patient taken any preparatory behavior?
- What protective factors, if any, are actually present today?
- What is the history of prior attempts or self-harm?
- What supports or barriers affect disposition right now?
NIMH assessment pathways emphasize asking directly about frequency, plan, means, and prior behavior. That directness is the point. Documentation should reflect the actual questions and the clinician’s response to the answers.
Two charts can sound similar and still mean different things.
Active ideation example
- Patient reports thoughts of killing self several times this week.
- Plan, means, and access were assessed.
- Preparatory behavior and history were reviewed.
- Disposition and urgent next steps were documented.
The note should show the assessment, not just the label.
Suicidal ideation documentation checklist
- Did you document whether ideation was passive, active, both, or not assessed?
- Did you ask about plan, means, intent, and preparation when indicated?
- Did you capture protective factors only if they were actually discussed?
- Did you avoid converting uncertainty into reassurance?
- Did your note point to the disposition or safety plan that followed?
Sources reviewed
- Ask Suicide-Screening Questions (ASQ) ToolkitNational Institute of Mental HealthLast reviewed 2026-07-20
The ASQ toolkit is a brief screening pathway for identifying patients who need further assessment.
- Adult Outpatient Brief Suicide Safety Assessment GuideNational Institute of Mental HealthLast reviewed 2026-07-20
NIMH suggests asking directly about frequency, plan, means, past behavior, symptoms, and disposition.
- Warning Signs of SuicideNational Institute of Mental HealthLast reviewed 2026-07-20
NIMH describes warning signs, including hopelessness, withdrawal, making a plan, and preparing means.
- Frequently Asked Questions About SuicideNational Institute of Mental HealthLast reviewed 2026-07-20
NIMH distinguishes risk factors, warning signs, and the need for urgent action in some situations.