ABSTRACT
Background
Suicide risk assessment is a routine yet high-stakes aspect of mental health practice, shaped by protocols, institutional norms and legal obligations. Research has largely emphasised tools, prediction and procedural compliance, with less attention to how clinicians experience and enact this work.
Aims
This qualitative study examines suicide risk assessment as relational labour, exploring how clinicians define, navigate and live with risk in therapeutic relationships.
Materials and Methods
Semi-structured interviews with eight registered psychologists in Canada were analysed using reflexive thematic analysis, generating eight themes across three domains.
Results
The first domain describes how participants make sense of risk through categorical thinking, emotional attunement and relational orientation. The second examines practice, including balancing protocols with flexibility, resisting pathologising and coercive approaches, engaging risk transparently and using conversations to support clients. The third highlights the emotional and ethical toll, marked by anxiety, moral distress and uncertainty.
Discussion
Findings show suicide risk assessment as relational and ethical work shaped by institutional demands, clinical judgement and vulnerability.
Conclusion
Misalignments between protocols and good care appear structural, with implications for training, supervision and policy in Canada.