In crisis assessment, which question best screens for imminent self-harm risk?

• A. Have you had thoughts of harming yourself lately?
• B. Do you have a plan to harm yourself?
• C. Are you thinking about harming yourself right now?
• D. Do you feel overwhelmed by emotions?

Answer: (C)

The key idea here is immediacy: to identify imminent self-harm risk, you need to know if the person is thinking about harming themselves at this very moment. If they are having current thoughts of self-harm, danger is present now and requires urgent safety steps, such as closer monitoring, safety planning, and involving appropriate supports. This direct question focuses on the present state, which best guides rapid decision-making in a crisis.

Asking about thoughts they’ve had recently or whether they have a plan also provides important information, but they don’t speak as directly to what’s happening right now. A plan suggests risk and intent, but someone can have a plan yet not be actively thinking about it at this moment, or vice versa. Being overwhelmed by emotions is a broader indicator of distress but doesn’t specifically signal self-harm risk. So, in the moment-to-moment triage of imminent risk, inquiring about current thoughts of self-harm is the most precise and actionable screen.