Suicide prevention - what do you do when a patient is feeling suicidal?

Prompt evaluation. Reach out, try to establish trust. Address issue directly, ask if the patient has a formal plan: if s/he has access to lethal means/poor judgement & support -> hospital. Otherwise consider making a written "contract" for safely and evaluate for psych disorder or significant stressors. If safe, consider rx, counseling, alcohol rehab. Depression is a terrible disease, reach out and be a real friend.