Scribd
Upload
67 views2 pages

Brief Mental Health Risk Assessment

The document is a brief risk assessment form used to evaluate a client's risk of suicidality and aggression/violence. It includes sections for personal information, sources of information, risk factors, protective factors, and overall risk levels. Clinicians are required to fill out the assessment and provide a management plan if necessary.

Uploaded by

pshh030498
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
67 views2 pages

Brief Mental Health Risk Assessment

The document is a brief risk assessment form used to evaluate a client's risk of suicidality and aggression/violence. It includes sections for personal information, sources of information, risk factors, protective factors, and overall risk levels. Clinicians are required to fill out the assessment and provide a management plan if necessary.

Uploaded by

pshh030498
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

SURNAME: SEX:

FORENAMES: BIRTHDATE:
BRIEF RISK ASSESSMENT
CLIENT’S ADDRESS:

SOURCE OF INFORMATION The consumer Immediate carer (parent, spouse, child)

Other informants (family, friends) Previous clinical records Assessing clinician’s knowledge of consumer’s past
behaviour/current clinical presentation

Police/ambulance/other agencies Other (please specify) ___________________________________

SUICIDALITY Yes No Not Dynamic (current) risk factor Yes No Not


Static (historical) factors (1) (0) Known (2) (0) Known
Previous attempt(s) on own life Expressing suicidal ideas
Previous serious attempt Has plan/intent
Family history of suicide Expresses high level of distress
Major psychiatric diagnosis Hopelessness/perceived loss of
coping or control over life
Major physical disability/illness Recent significant life event

BRIEF RISK ASSESSMENT


Separated/Widowed/Divorced Reduced ability to control self
Loss of job/retired Current misuse of drugs/alcohol
PROTECTIVE FACTORS (describe) :

LEVEL OF SUICIDE RISK (total score): LOW (<7) MODERATE (7-14) HIGH (>14)

AGGRESSION/VIOLENCE Yes No Not Yes No Not


Dynamic (current) risk factor
Static (historical) factors (1) (0) Known (1) (0) Known

Recent incidents of violence


Expressing intent to harm others
Previous use of weapons

Male Paranoid ideation about others


Under 35 years old Violent command hallucinations
Criminal history Anger, frustration or agitation
Previous dangerous acts Preoccupation with violent ideas
Childhood abuse Inappropriate sexual behaviour
Role instability Reduced ability to control self
History of drug/alcohol misuse Current misuse of drugs/alcohol
PROTECTIVE FACTORS (describe) :

LEVEL OF VIOLENCE RISK (total score): LOW (<7) MODERATE (7-14) HIGH (>14)

OTHER RISKS IDENTIFIED (AND RISK FACTORS)

RISK MANAGEMENT ISSUES (please ensure alerts are noted here)


(To be completed by assessing clinician)
PRINT NAME: DESIGNATION: SIGNATURE: DATE:
(Where appropriate, management plan to be acknowledged by requesting medical practitioner)
PRINT NAME: DESIGNATION: SIGNATURE: DATE:

You might also like