When someone is experiencing significant grief, guilt, shame, isolation, or emotional pain after abortion, how do you know when to continue with compassionate conversation and when to pause and assess for suicide risk?
In this practical webinar, Support After Abortion Communications Manager Michele Mazelin and licensed counselor Dr. Amy Vogel guided providers through real, de-identified interactions from the After Abortion Line. Participants practiced distinguishing emotional distress from language that warranted suicide risk assessment, asking direct questions about suicide, and determining what to do next as new information emerged.
Rather than focusing primarily on presentation, this webinar was built around practice. Michele presented client interactions, providers shared what they noticed and how they would respond, and Dr. Vogel walked through her reasoning about what she noticed, what she would ask next, and how new information could shape the appropriate response.
For readers of this recap: Some of the real, de-identified client language discussed in the webinar may be difficult because of your own experiences or those of someone you care about. Please take care of yourself in whatever way makes sense for you, including stepping away and returning later.
BUILDING ON THE FOUNDATION: CARING FOR AFTER-ABORTION CLIENTS WHO MAY BE SUICIDAL
This practice webinar builds on the foundational Caring for Clients Who May Be Suicidal training.
We encourage you to review that training for the underlying suicide risk assessment and safety-planning framework, then use this webinar replay as an opportunity to practice applying it to real client interactions.
Providers who want to review the underlying suicide risk assessment and safety-planning framework should return to that training alongside the resources shared for this webinar, including the Columbia-Suicide Severity Rating Scale (C-SSRS) and Stanley-Brown Safety Plan.
The foundational training provides the framework.
This webinar provides the opportunity to practice applying it.
WATCH THE REPLAY: PRACTICE SUICIDE RISK ASSESSMENT ALONG WITH MICHELE & DR. VOGEL
The primary value of this webinar is the practice itself.
We encourage you to watch the replay and work through the scenarios alongside Michele, Dr. Vogel, and the providers in the room. You’ll have the opportunity to decide when compassionate conversation should shift into suicide risk assessment, identify the words or patterns that influence your decision, and then hear Dr. Vogel explain what she noticed, what she would ask next, and how her assessment changed as new information emerged.
Some scenarios contain clear suicide risk language. Others involve significant emotional distress without indicators of suicide risk. Still others ask providers to look more closely at the client’s language, circumstances, and changes in functioning before deciding what they want to ask next.
Watching the replay allows you to make those judgment calls yourself before hearing the discussion that follows.
FROM COMPASSIONATE CONVERSATION TO SUICIDE RISK ASSESSMENT
Before beginning the scenarios, Dr. Vogel briefly revisited several foundations from the earlier training.
Suicidal ideation exists on a spectrum, from thoughts of suicide to intent, planning, preparation, and imminent action. Providers also consider the larger picture, including risk factors, protective factors, previous attempts, current stressors, available support, and access to lethal means.
Just as importantly, suicide risk assessment should not sound robotic. Dr. Vogel encouraged providers to remain calm, curious, and gentle.
Michele then introduced the practice: she would read a real, de-identified client interaction and participants would decide whether they would continue with compassionate conversation and care (CC) or move into suicide risk assessment (SRA). When they chose SRA, they were also asked to identify what clients words specifically raised concern.
Not every client experiencing significant pain needed a suicide risk assessment.
But when something did raise concern, compassionate conversation did not disappear. Providers continue listening, mirroring, validating, and inviting the person to share while also becoming more direct and intentional about safety.
WHAT EMERGED ACROSS THE SUICIDE RISK ASSESSMENT PRACTICE
The ideas below are only a few of the themes that emerged across the scenarios. They are not a substitute for working through the practice yourself. We encourage you to watch the replay to hear the client interactions, consider how you would respond, and then listen as Dr. Vogel talks through what she noticed and what she would ask next.
Look At The Whole Picture
There is not always one sentence that clearly signals suicide risk.
Across the scenarios, providers practiced noticing clusters of concerns: major losses, isolation, significant changes in eating or sleeping, impaired daily functioning, hopelessness, self-hatred, giving-up language, or other changes that became more meaningful when considered together.
As Michele summarized during the discussion:
“Ambiguous language plus a concerning cluster is a reason to check safety.”
A single statement may not tell you what someone means. That is a reason to become curious, not to assume.
Ask Directly When Something Makes You Pause
Dr. Vogel repeatedly encouraged providers not to be afraid of asking directly about suicide.
Rather than bypassing ambiguous language or assuming a meaning behind language, providers were shown how to use the client’s own words as an invitation to learn more.
One scenario prompted a particularly useful discussion about what to do when the signs are concerning but not definitive. As Michele and Dr. Vogel talked through the client’s circumstances, both reconsidered whether they would ask directly about suicide.
Dr. Vogel offered a practical question for those gray areas:
“Am I going to regret not asking?”
There was no explicit suicide language in the information the client had shared so far. Additional information later revealed that the client was experiencing suicidal thoughts.
Dr. Vogel emphasized that in a gray area like this one, “it is never going to hurt to ask.”
Reassuring-Sounding Statements Do Not End The Assessment
Across several interactions, clients identified reasons they would not act on suicidal thoughts, said they did not intend to do anything, or described an important relationship that was keeping them going.
Those statements matter. So do protective factors.
But Dr. Vogel emphasized that providers still need to assess whether there is intent or a plan, previous suicidal behavior, and where the client falls on the spectrum of suicidal ideation.
A protective factor is meaningful information. It is not automatically proof that someone is safe.
Let New Information Change Your Assessment
Several scenarios unfolded over additional client messages, allowing providers to reconsider their response as new information emerged.
Sometimes the first message suggested compassionate conversation. The next revealed concerning or suicidal language. Sometimes a statement that initially seemed reassuring still left important safety questions unanswered.
Providers practiced responding to what they knew at that moment and adjusting as they learned more.
That flexibility was visible even among the presenters. Michele and Dr. Vogel openly changed their assessment of one scenario after talking through the client’s words and circumstances again.
Know When More Support for Suicidal Risk Is Needed
Some clients disclosed recurring suicidal thoughts, movement toward acting on those thoughts, or needs that went beyond what supportive conversation alone could address.
Dr. Vogel emphasized the importance of professional mental health care when the level or recurrence of suicide risk warrants it.
The webinar also highlighted the importance of responding to the person’s actual circumstances. Available crisis and mental health resources vary by location.
SAFETY PLANNING FOR SUICIDE RISK: SOMETHING CONCRETE TO RETURN TO
Safety planning remained an important part of the discussion.
Throughout the webinar, Dr. Vogel referred to the Stanley-Brown Safety Plan, which was discussed in detail in the earlier training, Caring for Clients Who May Be Suicidal.
Asking the questions and writing out a safety plan with someone who is experiencing suicidal thoughts helps them identify their warning signs, coping strategies, people or places that can provide distraction, supportive contacts, professional or crisis resources, and ways to reduce access to lethal means.
When someone is overwhelmed, they may temporarily lose sight of coping strategies or relationships they already know are available to them. A written safety plan gives them something concrete to return to.
Dr. Vogel also suggested making the plan easy for them to access, such as keeping multiple copies, taking a photograph of it, or keeping it on their phone.
Q&A
Q: IS A 72-HOUR HOLD ALWAYS APPROPRIATE, OR CAN IT BE HARMFUL?
A: When the Baker Act came up in the chat, Michele asked Dr. Vogel to explain when involuntary mental health intervention may be appropriate and whether it can sometimes affect trust.
Dr. Vogel explained that “Baker Act” is a Florida-specific term and that laws and procedures differ by jurisdiction. More broadly, the appropriate response depends on the person’s level of risk, including whether they are experiencing suicidal thoughts, intent, a plan, or imminent danger.
She cautioned against hearing the word suicide and automatically jumping to the most extreme intervention. Dr. Vogel described situations involving suicidal intent in which a 72-hour hold may enter the conversation, while also explaining that such an intervention can sometimes cause harm or affect how openly a client communicates afterward.
The first task is to remain calm and curious enough to understand what is actually happening.
Dr. Vogel also acknowledged that providers cannot control every outcome. They can assess, safety-plan, connect people with appropriate resources, and respond to the information available to them.
Q: IF SOMEONE SAYS THEY ARE NOT SUICIDAL, SHOULD WE ASK ABOUT SELF-HARM?
A: A participant asked whether providers should follow up by asking about self-harm if a client responds “no” to a question like, “are you having thoughts of suicide?”
Dr. Vogel returned to a theme that came up throughout the webinar: appropriate safety questions do not hurt, and a safety plan can be useful because people in distress may lose sight of their supports and coping skills.
Q: WHERE CAN PROVIDERS FIND THE SAFETY PLAN AND ASSESSMENT TOOLS?
A: Michele directed participants back to the foundational training video or transcript, along with the C-SSRS and Stanley-Brown Safety Plan handouts for that training.
Reviewing these resources can help providers become more familiar with the tools before they are needed in a difficult conversation.
KEY TAKEAWAYS: PUTTING SUICIDE RISK ASSESSMENT INTO PRACTICE
At the end of the webinar, Michele reviewed four key points for providers to carry with them:
Notice what the person is saying.
Ask directly when there’s a reason for concern.
Stay engaged as you learn more.
Respond based on what the suicide risk assessment reveals.
These steps help providers stay responsive to what a client is actually communicating. The next step may be continued compassionate support, further suicide assessment, safety planning, or connection with professional or crisis support.
The goal is to stay present, ask clearly when needed, and let the client’s answers guide what comes next.
© Support After Abortion
LINKS
Click here to watch the video of this webinar.
Click here for the foundational training video, Caring for Clients Who May Be Suicidal
Click here for the viewing note-taking handout for that foundational training.
Click here for the C-SSRA (Columbia-Suicide Severity Rating Scale)
Click here for the Stanley-Brown Safety Plan.
Click here to register for the next Abortion Healing Provider webinar.
Click here to access Support After Abortion’s Resource Library.
Click here to explore Support After Abortion’s services, resources, and training for Abortion Healing Providers.
© Support After Abortion