Templates / SAD PERSONS scale: Scoring, risk bands & modified version

Mental Health & Therapy

SAD PERSONS scale: Scoring, risk bands & modified version

Free PDF • 2 pages, print-ready • Clinician-reviewed

Monika Lazarevska Last updated November 9, 2026 Reviewed by Dr. Vanja Kitanova

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The SAD PERSONS scale is a 10-item suicide risk mnemonic that scores one point per risk factor, for a total of 0 to 10. Patterson and colleagues published it in 1983, and emergency teams still use it as a quick, structured prompt.

A total of 0-2 points toward discharge with follow-up, while 7-10 points toward hospital admission. The catch is that a low score doesn't rule risk out, so the scale works best inside a fuller assessment. Using it well takes three habits. Score the right version, record each positive item and write down your reasoning.

Template details

Template type

Scale

Format

Printable PDF, 2 pages

Sections

4 sections

Fields to complete

6 fields

Best for

Mental Health & Therapy

Key takeaways

The SAD PERSONS scale scores 10 suicide risk factors at one point each, for a total of 0 to 10.

Patterson’s 1983 guidance splits totals into 0-2, 3-4, 5-6 and 7-10, which many teams simplify to low (0-2), moderate (3-6) and high (7-10).

Our PDF lists the modified items, so score four at 2 points, total out of 14 and write the version on the form.

A low score doesn’t rule risk out, since half of later attempters in one large emergency department study had scored as low risk.

NICE’s 2022 self-harm guideline advises against using risk scales to decide who gets treatment or discharge, so treat the score as a prompt.

Score our PDF as the modified scale, not the original

Our PDF lists the Modified SAD PERSONS items, with Stated future intent in place of Sickness. Its printed scoring follows the original scale, so a total from the form matches neither published version.

Score it as the modified scale instead. Four items earn 2 points each, and the other six stay at 1, so the total runs from 0 to 14.

Read the total against the modified bands: 0 to 5 is low, 6 to 8 is moderate and 9 to 14 is high. Don’t use the band table printed on the PDF. It calls 0 to 4 suitable for discharge and labels that original guidance, but Patterson advises close follow-up at 3 to 4.

Write “Modified SAD PERSONS” on the form before you file it, so the record names the version scored.

If you or a patient are in crisis, call or text 988 in the United States. In the UK, call Samaritans on 116 123.

What the SAD PERSONS scale measures and who it was built for

The SAD PERSONS scale turns ten established suicide risk factors into a mnemonic a clinician can work through in a few minutes. Each letter names one factor. You score 1 if the factor is present and 0 if it’s absent, then add up the total.

Patterson, Dohn, Bird and Patterson published it in 1983 as a teaching aid for medical students learning suicide risk assessment. It gave non-psychiatrists a structured checklist in place of an unguided impression. Hockberger and Rothstein adapted it for emergency departments in 1988, and both versions are still taught in nursing and medical programs.

Think of the total as a prompt for the conversation that follows. The score organizes what you ask, and your clinical judgment decides what happens next.

Each letter stands for one risk factor

Every item maps to a risk domain backed by epidemiological evidence on suicide. Here’s what each letter stands for and why it counts.

How the 0-10 total maps to a clinical decision

Scoring is binary. Each of the ten items scores 0 (factor absent) or 1 (factor present), so the total lands between 0 and 10. There are no partial points, and most trained clinicians finish in under five minutes.

Patterson’s original guidance attaches an action to four score ranges. Many teams simplify them to three bands: low (0-2), moderate (3-6) and high (7-10). That simplified grouping merges two different actions at 3-4 and 5-6, so check which version your local protocol uses.

Treat these thresholds as decision support. Clinical judgment, local protocol and the wider patient context always come first. Even a low-band discharge should leave with a written patient safety plan and a booked follow-up.

The modified version weights four items and swaps one

Hockberger and Rothstein built the Modified SAD PERSONS Scale in 1988 to make the tool more practical for emergency clinicians who aren’t psychiatrists. It changes the original in two ways.

• It replaces Sickness with Stated future intent, a direct question about whether the patient intends to act.
• It gives 2 points each to Depression or hopelessness, Rational thinking loss, Organized plan and Stated future intent. The other six items stay at 1 point, Previous attempt included.

That raises the maximum score from 10 to 14. Bolton et al. (2012) report the modified bands as 0-5 low, 6-8 moderate and 9-14 high.

Item-by-item scores, side by side

The higher ceiling is easy to forget at the bedside. The same total can land in a different band depending on which form you used.

Running the assessment, step by step

The scale works best as the structure for a clinical conversation. The patient shouldn’t fill it in alone. This five-step workflow fits an emergency or outpatient psychiatric setting.

1. Establish clinical context: Confirm the reason for presentation and any immediate safety concerns before you start. The scale is built for patients in crisis or with disclosed suicidal ideation. It isn’t meant as a screen for low-risk settings.
2. Work through each item in order: Use the mnemonic as your prompt. Ask open or targeted clinical questions rather than reading the letters aloud to the patient.
3. Score each item 0 or 1: Assign 1 only if the factor is clearly present from the patient’s history and your observations. On the modified form, the four weighted items score 0 or 2.
4. Calculate the total and identify the risk band: Sum all items and apply the original 0-10 or modified 0-14 scale. Then map the result to that version’s matching band.
5. Document the assessment and action taken: Record the total, the positive items, the band, your clinical reasoning and the agreed disposition or safety plan. A psychiatric evaluation template keeps those elements in a consistent, auditable format.

A patient in acute crisis may need de-escalation before any formal scoring. In high-acuity settings, pair the scale with practiced crisis intervention strategies.

Before you sign off the assessment

• The form names the version used, original or modified. On our PDF, write “Modified SAD PERSONS” at the top.
• Every positive item is ticked, with a line of supporting history.
• The total and its band match that version’s own cut-offs.
• Your reasoning explains any disposition that differs from the band.
• The safety plan, follow-up date and any referral are recorded.
• Collateral history is noted, or the reason it wasn’t available.

Scoring mistakes that change the outcome

• Mixing versions: Reading a modified total against the original bands overstates risk. An 8 looks high when it’s moderate.
• Scoring Sickness on the modified form: The modified scale has no Sickness item. Scoring it alongside Stated future intent inflates the total.
• Weighting Previous attempt: It stays at 1 point on both versions, even though it’s a strong predictor.
• Recording only the number: Without the item list, a reviewer can’t tell an organized plan from demographic risk.
• Letting a low score override a disclosure: A patient who describes a plan needs a fuller assessment, whatever the total says.

What the evidence says about its accuracy

The SAD PERSONS scale shaped emergency psychiatry, but its predictive power hasn’t held up well. Bolton, Spiwak and Sareen (2012) followed 4,019 emergency department psychiatric referrals in Manitoba, Canada. The scale predicted later suicide attempts no better than chance.

High-risk scores caught only 19.6% of later attempts on the original scale and 40.0% on the modified version. Half of the patients who presented with an attempt had been classed as low risk. The core weakness is sensitivity, so a low score offers little reassurance.

Known limitations include:

• Binary sex assumption: The original scale treats sex as binary, with males at higher risk of completion. That doesn’t reflect current understanding of gender identity or the risk profiles of transgender and non-binary patients.
• Static snapshot: The scale captures one moment. It can’t account for a patient who is calm during assessment but highly impulsive after discharge.
• Low sensitivity: Peer-reviewed studies show the scale misses many patients who go on to attempt suicide, so it can’t rule risk out.
• Not validated for children: The scale was designed for adults. Juhnke published an Adapted-SAD PERSONS Scale (A-SPS) for children in 1996, and the adult version shouldn’t be used in its place.

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Psychiatric Association both stress one point. No single scale should replace a comprehensive clinical risk assessment. The National Institute of Mental Health (NIMH) recommends an integrated approach. That means structured tools alongside therapeutic conversation and collateral history.

The UK’s National Institute for Health and Care Excellence (NICE) goes further. Its 2022 self-harm guideline advises against using risk tools or scales to predict suicide, or to decide who is offered treatment or discharged. It asks for a risk formulation built around the person’s needs, strengths and circumstances.

How it stacks up against C-SSRS and PHQ-9 item 9

Several tools now sit alongside the SAD PERSONS scale, or replace it outright. The table compares the four most common on the points clinicians use to choose between them.

The Columbia Suicide Severity Rating Scale (C-SSRS) was developed at Columbia University and is widely used and recommended in practice. The Joint Commission expects a validated screening tool, and C-SSRS is a widely used one.

Know both tools, and choose by setting, patient presentation and local protocol. Current American Psychiatric Association clinical practice guidelines are worth checking before you settle on one.

Where a standardized form pays off

The scale turns up wherever suicide risk stratification is part of routine care. Teams running therapy practice management software usually keep the completed form in the patient record. A printable version still earns its place in these settings.

• Emergency departments: Nurses and emergency physicians completing initial risk screens before psychiatric consultation use it as a structured prompt and a documentation record.
• Psychiatry and mental health outpatient practices: Teams tracking risk across several encounters get a consistent format that feeds the wider care plan.
• Community mental health services: Key workers and community psychiatric nurses on home visits often need a portable tool that works without a system connection.
• Medical education and training: Nursing students and junior doctors learn suicide risk assessment through the mnemonic. The form supports supervised practice and case-based learning.

Using the same form every time, in place of free-text notes, gives a team three clear gains.

Consistency across clinicians: Everyone assesses the same ten domains in the same order. That cuts the chance of a missed item during a busy emergency shift or a rushed outpatient slot.

Auditable records: A completed form shows regulators and peer reviewers what was assessed, what was positive and what action followed. That matters most after an adverse outcome or a complaint.

Training and supervision support: Supervisors can check whether a trainee applied the tool correctly and whether the action fit the score. The World Health Organization recommends structured training in suicide risk assessment as part of prevention, and standardized records make that review possible.

How Pabau keeps risk assessments audit-ready

Many teams still score SAD PERSONS on paper or in free-text notes, which buries the item-level detail. Regulators and accreditation bodies, including The Joint Commission and CMS, expect more than a number. Records should show the items assessed, the reasoning behind the risk band and the action taken.

Pabau, the practice management platform behind our mental health EMR, lets you rebuild the SAD PERSONS form item by item. With Pabau’s digital clinical forms, the ten items become discrete fields, so no domain gets skipped. The completed form attaches to the encounter note as an auditable record.

Psychiatry teams can go further. Dedicated psychiatry software links the risk form to safety planning templates, follow-up tasks and referral workflows. Structured patient records keep each assessment in date order, so you can see how a patient’s risk has moved across visits.

The result is a record that answers a reviewer’s questions without a call to the clinician who saw the patient.

Document suicide risk assessments with confidence

Pabau lets mental health teams build reusable assessment forms and capture SAD PERSONS scores in the patient record. Every encounter leaves an auditable trail.

Book a demo

Conclusion

Use the SAD PERSONS scale for what it does well. It’s a fast, structured prompt that makes sure ten known risk factors get asked about. Don’t let the total make the decision, because the evidence shows it misses too many patients who go on to attempt.

The practical change is small. Name the version on the form, record every positive item and write down the reasoning behind your disposition. That record protects the patient at the next visit and protects you at review.

Want that record built into your workflow? Book a demo to see how Pabau turns your SAD PERSONS form into structured, audit-ready patient records.

Continue your research

Need a full psychiatric evaluation framework? Psychiatric evaluation template provides a structured guide for comprehensive mental health assessments.

Working in crisis intervention? Crisis intervention strategies for clinicians covers de-escalation techniques and acute response frameworks.

Want a broader risk checklist? Suicide risk assessment checklist walks through risk and protective factors in one structured form.

Discharging a patient after a risk assessment? Patient safety plan gives patients warning signs, coping steps and contacts to use after they leave.

Running a mental health practice? Mental health EMR software from Pabau supports structured assessments, digital forms and auditable clinical records.

Frequently asked questions