As a 15-year veteran of emergency psychiatry, Amy Barnhorst, MD, vice chair for community mental health at the University of California (UC) Davis Department of Psychiatry, said she feels that most of the existing tools to help identify suicidality are inadequate. Her patients are often people with serious mental illness who end up in the emergency department or the county jail. Commonly used screening devices and checklists don’t capture the breadth and depth of their problems.

By way of example, she points to the omnipresent Columbia-Suicide Severity Rating Scale, saying that it “seems like it was designed with the assumption that all suicidal patients being evaluated are rational, and able to answer those questions clearly and honestly.” She added that the Columbia Protocol was probably created “by someone with high-functioning outpatient clientele. And it’s probably great for those patients, but those are not my patients.”

Recently Barnhorst heard about another new framework for identifying suicidality — this one developed by a team based out of Mount Sinai’s Suicide Prevention Research Lab in New York City. Her initial response was skepticism. She assumed it would be one more attempt to make suicide screening more effective and efficient that would miss the mark. But the more she read about Suicide Crisis Syndrome (SCS), a diagnosis identified by the Mount Sinai team, the more she became convinced that it was a breakthrough.

“SCS really gets at that final state that people are so often in,” said Barnhorst, who is also the associate director of the UC Davis Centers for Violence Prevention. “This is the framework we should really be using.”

The approach was developed over the course of 15 years of study — research that has included clinical investigation and data collection by questionnaires — led by Igor Galynker, MD, director of Mount Sinai’s Suicide Prevention Research Lab. Galynker was driven to the work because, during four decades of working as a psychiatrist, he felt like too many of the patients he’d encountered suffered from a “terminal illness without a description,” as he said. “I treated hundreds of people who attempted suicide after telling their clinicians and loved ones that they would never.” He added, “As a clinician, I recognized a pattern in their behavior which urgently needed to be described so lives could be saved.”

 In 2024, Galynker and his team published a paper about their work and the related narrative model they have developed, aimed at helping clinicians identify and treat those with SCS. Their study provides stage-specific treatments along with “an empirically grounded conceptual framework for intervention at each stage of the psychological progression towards suicidal action.” Unlike the Columbia Protocol, Galynker’s approach doesn’t rely on patients to report suicidal ideation or planning. That’s because, as he explained, people at high risk for suicide often can’t accurately foresee or grasp their own intentions, and therefore also can’t accurately answer questions about if or how they intend to kill themselves.