Many patients sustaining traumatic brain injury (TBI) experience multiple deficits affecting cognition, personality, and physical independence. Often there is a dramatic and permanent change in work status, income, family life, support network, and quality of life. Clinical experience indicates that this can predispose patients to significant depressive reactions and increased risk of suicide. This article will describe clinical evaluation and treatment techniques that attempt to address suicide in TBI patients participating in an outpatient milieu-oriented rehabilitation program. Historical theories and research on suicide will be reviewed. Risk factors for TBI and their similarity to suicide will be explored. Preliminary clinical findings from a retrospective study of 111 TBI program participants will also be provided.