Brian Foster Shadow Health — Mental Health & Suicide Risk Assessment

Brian Foster presents with a two-month history of persistent depressed mood, anhedonia, sleep disturbance, decreased energy, poor concentration and feelings of hopelessness and worthlessness. He recently lost his job and lives alone — two significant risk factors for both depression severity and suicide risk. He endorses passive suicidal ideation but denies a specific plan, intent or means.

This case tests your ability to conduct a sensitive psychiatric interview, administer the PHQ-9 and C-SSRS accurately, complete a thorough Mental Status Examination and develop an appropriate safety plan.

The PHQ-9 must be administered item by item — not summarised. Each of the nine questions covers a DSM-5 symptom criterion for major depression, scored 0 (not at all) to 3 (nearly every day).

Brian scores 18 — in the severe depression range (score ≥15). The scoring interpretation matters for management: mild (5-9) warrants watchful waiting, moderate (10-14) may benefit from medication or therapy, moderately severe (15-19) indicates active treatment is warranted, and severe (≥20) typically requires medication plus therapy and close follow-up.

Critical point: Question 9 of the PHQ-9 asks specifically about thoughts of death or self-harm. Brian endorses this item. Any positive response to Q9 must trigger a full suicide risk assessment using the C-SSRS.

The Columbia Suicide Severity Rating Scale (C-SSRS) is the gold standard tool for structured suicide risk assessment in Shadow Health. It must be administered completely — not summarised.

Brian's C-SSRS findings: Ideation — passive (wishes to be dead, no active ideation). Intensity — low frequency, low duration, no plan, no intent, no ability to control thoughts rated low. Behaviour — no prior attempts. Deterrents — family, fear of pain.

Risk classification: Low-moderate risk — passive ideation, no plan, no intent, protective factors present. This risk level informs the intensity of the safety plan and follow-up.

Never skip the C-SSRS. Shadow Health deducts heavily for failing to formally assess suicide risk when a patient endorses suicidal ideation.

The safety plan is a specific scored deliverable in this module. It must include: warning signs that a crisis is approaching, internal coping strategies the patient can use alone, social contacts who provide distraction, people the patient can reach out to for help, professionals to contact in a crisis (including the 988 Suicide and Crisis Lifeline), and means restriction counselling.

For Brian: warning signs include increasing isolation and not answering phone calls. Coping strategies include going for a walk and listening to music. Social supports include his sister. Professional resources include his new psychiatrist and 988. Means restriction: Brian has firearms at home — counsel on temporary removal or lock-up with a trusted person.

The completed Brian Foster Shadow Health Mental Health Assessment is available on NursingProxy. Includes the full psychiatric interview transcript, PHQ-9 item-by-item scoring, complete C-SSRS administration, full Mental Status Examination, risk stratification and safety plan documentation.