Suicide risk assessment includes estimating the likelihood of suicide in words such as ‘low, medium or high’. A ‘high suicide risk’ rating can trigger a powerful urge to eliminate risk immediately. But it is far from clear what ‘high suicide risk’ actually means. In the current state of knowledge, suicide reduction measures should apply to all psychiatric patients, irrespective of an individual patient's perceived risk. For patients presenting with suicidal thoughts, feelings and behaviour, assessment and management should focus on reducing or tolerating emotional pain.