First and foremost, we applaud Dr. Cohen and her colleagues for developing the suicide crisis syndrome (SCS) and its attendant focus on high and acute suicide risk, in particular that of high and acute suicide risk that is not dependent upon the patient’s communicated suicide ideation (SI) as a gateway to its assessment. In several published papers (Berman & Silverman, 2014; Silverman & Berman, 2014a, 2014b) we have observed and commented upon the inadequacy of communicated or reported SI as a necessary condition to further establishing a patient’s acute risk of suicide and lamented that clinicians too often assume that the absence of SI indicates the relative absence of suicide risk. There are now more than a dozen published studies of individuals
who died by suicide who denied that they were thinking about suicide when they were last asked by a clinical caregiver often within days of their deaths (see Berman, 2018).