SI/HI
Formal Definition
Abbreviations for Suicidal Ideation (SI) and Homicidal Ideation (HI); SI refers to thoughts of ending one's own life, while HI refers to thoughts of harming or killing others; both require structured risk assessment including intent, plan, means, and timeline.
How It's Used on the Ward
"Denies SI/HI" is a near-universal phrase in any psychiatric or medical note for patients with mood or behavioral concerns — its absence from documentation is notable.
Example
""29-year-old with major depressive disorder presenting with worsening mood: patient endorses passive SI with no plan or intent, denies HI. Increased sertraline and scheduled outpatient follow-up in one week.""
Clinical Context
Passive SI ("I wish I were dead") carries lower immediate risk than active SI with plan and means. Always ask about: current intent, specific plan, access to means (firearms especially), prior attempts (strongest predictor of future attempt), protective factors (children, religious beliefs, social support). Document findings explicitly — "patient denies SI/HI" without any assessment of risk stratification is insufficient. Duty to warn applies if credible HI toward an identified third party (Tarasoff obligations).
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