The decision to hospitalize patients at imminent risk for suicide requires careful assessment of risk factors, including sociodemographic, psychiatric, general medical, and mental status considerations. Assessment of these risk factors is essential and can usually be accomplished in a straightforward manner, although clinical obstacles sometimes make assessment more difficult. Key issues regarding imminent suicide risk are intent and means, severity of psychiatric illness, the presence of psychosis or hopelessness, lack of personal resources, and older age among men. Once the decision to hospitalize is made, reasonable care should be taken to assure that the patient is transported to the treating hospital safely and is not left alone. On arrival at the hospital, the patient should be closely monitored, and reasonable precautions must be taken to assure the patient’s safety at all times, especially during the first few days. Proper assessment, monitoring, and treatment of patients at imminent risk for suicide save lives. A person who is determined to kill himself/herself will probably prevail despite our best efforts. However, most people who are imminently suicidal at one time will feel very differently at some later time.