Risk assessment

Determining the risk of harm to the patient, and sometimes to others, is an essential part of a psychiatric assessment. It is useful to know what questions to ask whether you’re at the hospital front door or on an inpatient psychiatric ward.

Self-harm/suicide risk assessment

The aim is to assess acute risk for a patient at that moment in time. Often this will tie in with a psychiatric history and you should still ask about any associated symptoms and screen for psychosis. The ‘before-during-after’ proforma allows you to capture a timeline of events and can be used in presentations of self-harm or overdose. It is useful to start these consultations with rapport building.

“I understood you took some tablets last night. I’m sorry things got that bad for you. I would like to reassure you that we would like to help you”

  • Prior events: “If you don’t mind me asking, did anything happen to lead you to feel you and to harm yourself/end it all?”
  • Planning: “What plans did you make?” “How long did you plan to do this?”
  • Precautions: “Did you try to make sure you wouldn’t get caught?”
  • Preparation: “Did you write a note, or make a will?”
  • Sequence: “Can you talk through what happened?” (how, where, when)
  • Substances: “Did you take anything else? (any alcohol or drugs)
  • Expectations: “What did you want to happen?” “Did you expect to die?”
  • Regret: “How do you feel now, do you regret what happened?”
  • Lingering thoughts: “What would you do if you left today?”
  • Future: “What does the future look like?” “What would you like to happen now?”
urn cambridge.org id binary 22069 20160510085846500 0872 87926tbl3 2
‘SADpersons’ scale to determine suicide risk – ≥6 may require psychiatric assessment

Screening for risk in psychiatric disorders

  • Self-harm or suicide – “Sometimes when people low, thoughts of self-harm can creep in, has this happened to you?”
  • Hopelessness – “When you look to the future, how do you feel?”
  • Worthlessness – “How do you feel about your life?”
  • Command hallucinations – “Do the voices ever give you instructions?”
  • Self-neglect (sleep, eating, hygiene) – “You sound busy, have you had time to sleep?”
  • Risky behaviours (spending, drug use, risky sexual behaviours)
Substance misuse
  • Impact on physical health (accidents, seizures, overdoses, abscesses, BBV)
  • Financial cost
  • Harm to others (e.g. driving under the influence)
Old age
  • Self-neglect
  • Falls
  • Wandering
  • Financial exploitation
  • Aggression to/from carers
  • Vulnerability

References and further reading

  • Chapter 3 – Suicide Assessments, Emergency Psychiatry 2013, Cambridge University Press

Written by Dr Muhammad Zain Haq, Psychiatry Lead (FY2)
Reviewed by Dr Patrick Ezeani (Consultant Psychiatrist)

How useful was this post?

Click on a star to rate it!

Average rating 4.8 / 5. Vote count: 14

No votes so far! Be the first to rate this post.

As you found this post useful...

Follow us on social media!

We are sorry that this post was not useful for you!

Let us improve this post!

Tell us how we can improve this post?

Related Posts

Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is a treatment that has been...
Management of the Aggressive Patient
At times as a junior doctor, you will be faced with the management...
Mental State Examination
Mental State Examination
The mental state examination (MSE) is an observational assessment...

Leave a Comment

Your email address will not be published. Required fields are marked *

Follow us


Trending Now

Doctor's Pay Calculator 2023
We’ve created a pay calculator to help you better understand your salary, how much tax you’ll...
Paracetamol Overdose
Paracetamol overdose is a common presentation in A&E and so you may often find yourself looking after...
Your e-Portfolio is an online tool to gather and store evidence of progression throughout your time as...
Passing the Prescribing Safety Assessment (PSA)
The PSA is aimed at final year medical students and those graduating overseas to assess their competency...
Prepare for FY1 Guide by Specialty
This amazing guide was created by so many amazing doctors like yourself helping each other. It is a...
Applying to Anaesthetics
Anaesthetics is a very hands-on specialty. Day-to-day work will have a mix of practical procedures and...
How to take a psychiatric history
Psychiatry, as a specialty is unique in that diagnostic methods, rely very heavily on symptomatology,...

Sign up for our awesome resources

Join over 25,000 users who have signed up for our free weekly webinars, referral cheat sheet & other amazing content!