"How bad has it gotten?"

When I teach about clinical interviewing, I often recommend this phrase (or some variation) as an entry point to questions about suicidal ideation. This accomplishes a couple of things:

1. Frames the discussion about suicidal ideation as one that is exploring the person's subjective experience and suffering, avoiding the impression of ticking through the required elements of a clinical interview.

2. It begins a sequential approach where it then feels logical to ask about the extremes of desperation.

3. Signals to the person that you want to hear the full extent of the pain.

The exact words don't matter, of course, but it is probably helpful for each clinician to develop a few standard ways he or she enters in to the conversation. This could be one of them.