Risk assessment | Flashcards
What is risk?
probability or threat of damage, injury, liability, loss, or any other negative consequence that is caused by internal or external vulnerabilities, that may be reduced through pre-emptive action
What are the factors that affect risk (2)?
- It changes over time
2. Current mental state
What are the 5 types of risk?
- Risk to self
- Risk to others
- Risk of self-neglect
- Risk of abuse, harrassment or exploitation by others
- Risk to property/driving
What should you ask about to ascertain someones risk to self?
- Thoughts of harm to self
- Thoughts of death/dying/ending own life
- Hopes or plans for the future
- Previous deliberate self-harm or attempts to end own life
- Particular clinical pictures associated with increased risk of deliberate self-harm or suicide
What specific qs can you ask about deliberate self-harm or attempts to end own life (7)?
- How many times?
- Methods (e.g. Cutting, overdoses, ligature etc.)
- Intention (What did you think would happen? Sleep, injury, death?)
- Precipitants (Was there something that triggered this? Was it planned?)
- Location (Were attempts made to avoid discovery? Did you contact help?)
- Final acts (Was a note left, or a will made etc?)
- Feelings afterwards (Were you glad to have lived? Did you regret what happened?)
What particular clinical pictures are associated with increased risk of deliberate self-harm or suicide (4)?
- Depression, bipolar affective disorder
- Schizophrenia (Particularly in early stages of recovery from acute episode)
- Emotionally unstable personality disorder
- Obsessive-compulsive disorder
What should you ask about to ascertain if there is a risk of harm to others?
- Thoughts of harming others
- Thoughts that other may cause harm
- History of harm to others
- Access to weapons
- Particular clinical pictures associated with increased risk to others
What specific questions would you ask about in terms of history of harm to others (2)?
- Previous police involvement/charges/convictions
2. Age at time of first violent act (Younger age of onset of violence suggests higher risk)
What specific questions would you ask about in terms of particular clinical pictures associated with increased risk to others (5)?
- Command hallucinations, passivity phenomena
- Delusional jealousy
- Dissocial personality disorder
- Frontal lobe damage
- Substance misuse
What should you ask about with regards to self-neglect (4)?
- Interest in self-care
- Appetite, oral/fluid intake
- Social support
- Particular clinical pictures associated with increased risk of self-neglect
What particular clinical pictures are associated with increased risk of self-neglect (5)?
- Schizophrenia (particularly negative symptoms)
- Severe depression with psychotic symptoms (e.g. related to nihilistic delusions)
- Diogenes syndrome (picture of self-neglect, social isolation, hoarding)
- Substance misuse
- Obsessive compulsive disorder (where rituals prevent self-care)
What should you ask about to check for risk of abuse/harrassment or exploitation by others?
Particular clinical pictures associated with increased risk of vulnerability to others
- Learning disability
- Dementia
- Substance misuse
If the patient has a child, what is important to ask about?
- Whether the father is around
- What would you want for your child if you were to take your own life? -> Would you do it? (only dangerous if there is intent)
