Client Risk Assessment Form: Fill & Download for Free

Hi,Mental health clinicians vary in their ability to predict the level of risk a patient poses to themselves or others. Suicide is one of the most difficult areas that a mental health clinician has to deal with.Discuss the client of concern with other cliniciansWhen a clinician believes that their client may be a suicide risk, the best thing they can do is to remain calm and think clearly about the issue. Most clinicians will talk about a client of concern with a colleague or if they are working with others in a clinical team, they usually talk about the client’s risks and other concerns with a clinical supervisor or other team members.Experience and EmpathyI believe that an experienced clinician is better able to predict suicide risk in a client. I also believe that an emphatic psychotherapist is better able to sense if their client is considering suicide or is a serious suicide risk.Communication and listening skillsMoreover, in order for a clinician to develop a good working relationship and empathy with a client, they must have good communication and listening skills. In fact, when it comes to suicide, clinicians are trained to ask a person directly if they are contemplating suicide.Clinician’s personality and ability to think under pressureI believe that a clinician’s personality and their ability to stay cool, calm and collected are essential when it comes to working with suicidal patients. I have worked with many clinicians that just could not cope with the ongoing stress and fear that one of their patients might kill themselves.It takes a particular kind of person to work in Emergency Services and mental health teams that treat people with serious mental illness. For example, whilst working in Psychiatric Triage, I would receive calls from psychotherapists on Thursdays and Fridays that wanted to refer their clients to CATT for treatment over the weekend.I found that certain psychotherapists regularly called to handball their clients to CATT because they just could not relax on the weekend with the thought that their client may self-harm. I discovered that this group of psychotherapists stopped working in the sector or stopped taking on clients that suffered from severe mental illness or that they felt may be a suicide risk.It is impossible for a mental health clinician to accurately predict the future, including the likelihood of self-harm or homicidal behaviour in other people. However, a qualified, skilled and empathic mental health clinician is expected to identify those at risk and deliver an acceptable clinical response.Asking the right questions during a risk assessmentIf a clinician believes that a client is a suicide risk, they must ask the client specific questions that explore various clinical hypotheses. For example, the clinician must ascertain how advanced the patient's suicide plan is.For example:Does the patient have a method in mind (i.e. pills)?Does the client actually have the pills that speak of and do they have enough of them to result is death or serious harm?Does the client have a well thought out premeditated plan?Is the client’s mental state unstable and do they have a history of impulsive behaviour?Has the patient attempted suicide in the past?Has the patient been giving away their possessions?Has the patient been saying goodbye to their significant others?Risk Assessment formsMental health services and private practitioners have developed risk assessments forms that they use to assist them to assess the patients risk factors. The risk assessment form assists the clinician to:make a more comprehensive risk assessment,make a clinical decision about the client’s risk level, anddecisions about treatment/intervention.Please click on the link below to view the South Australian Government Mental Health Services Risk Assessment Guide:https://www.square.org.au/wp-content/uploads/sites/10/2013/05/Risk-Assessment_Colour_May2013_Handout2.pdfI have learnt that the above-mentioned strategies and Risk Assessment forms can assist a clinician to better accurately predict the patient’s suicide risk. However, I have learnt that sometimes our patients make a decision to commit suicide and we cannot save them.The patient may attend their regular therapy session. They compose themselves, state that everything is going well for them and do not give the clinician any indication that they plan to kill themselves.I have also learnt that a good clinician can predict if a particular patient will make an attempt to end their own life. However, to my frustration, we cannot predict the timing of the event or when the patient will actually try to end their life.Kamal

Both psychiatrists and clinical psychologists can diagnose personality disorders.The Psychological Assessment ProcessPsychiatrists, like psychologists assess the patient over three one-hour face to face sessions in an attempt to make a diagnosis.However, due to the complexity of personality disorders, both the above-mentioned clinicians may request to see the patient over a longer period of time.Experienced mental health clinicians often use a combination of their clinical judgement and assessment results. Clinical psychologists in particular, may administer personality tests to obtain detailed information that will either regulate or support their diagnostic hypothesis.Psychiatrists may conduct medical tests and refer the patient to allied health clinicians for further testing.The use of streamlined psychological assessment formsOver the years, mental health services have streamlined the psychiatric assessment process. Psychiatric assessment forms have been developed that consists of 10 or so pages of questions. The clinician must complete and sign the assess forms and file them in the patients medical records.The assessment forms prompt the clinician to ask questions related to cognitive and emotional functioning. Recent graduates find the assessment forms more useful than experienced clinicians.The mental health clinicians must also closely observe the patient during the assessment sessions. In particular, they have been trained to observe the patients body language, gait, eye contact, grooming and so on.The majority of mental health clinics develop their own psychiatric assessment forms. However, the majority of psychiatric assessment forms are very similar (an attempt to adhere to best practice guidelines).Specifically, a psychiatrist or clinical psychologist would collect the following information during a psychiatric assessment:presenting problems,demographic information,the patients medical and mental health history,the prevalence of mental illness in the client’s family (develop a Genogram),information regarding the client’s childhood,the number and duration of friendships the patient has had,the number of intimate relationships the client has had, in particular long-term relationships,clients current living conditions,a more detailed examination of current symptoms,a risk assessment, andother relevant areas.Please click on the link below to view a psychiatric assessment form developed by the Behavioural Healthcare Group:http://www.bhicares.org/wp-content/uploads/2016/12/NEW-Mental-Health-Assessment-Form.pdfIn additional to basically going through the assessment form, the psychiatrist or clinical psychologist must formulate a diagnostic hypothesis based on the information they collect from the assessment, previous assessments of the patient (from their file), and their clinical judgement.The clinician then weighs up all the information they have collected from the patient against the criteria for a specific DSM diagnosis (in this case, a personality disorder).Different Possible DSM Diagnoses For People With Personality Disorder’sIf after completing their assessment, a psychiatrist is not absolutely sure that the client meets DSM criteria for a specific personality disorder, they can offer a provisional or preliminary diagnosis that can be changed in future. However, they must assess the client again (several times) before making a formal diagnosis and note why they made such a decision.Alternatively, a client may be given a differential diagnosis if they appear to meet the criteria for two or more disorders. Differential diagnoses are made when patients present with a complex condition.The DSM classification system also allows a clinician to make a Not-Otherwise-Specified diagnosis if the patient doesn't appear to meet the criteria for any specific disorder. For example, Personality Disorder-Not Otherwise Specified.Clinical Psychology: Psychometric, Personality & Projective TestingIf a psychiatrist is not sure of a patients' diagnosis, they should refer the patient to a Clinical Psychologist for psychometric, personality and projective testing and an opinion.A clinical psychologist would generally use psychometric testing to test their hypothesis about a client’s diagnosis and personality structure. Many psychiatrists do not refer their patients to a clinical psychologist unless the client presents with a diagnostic dilemma.Most Western countries have laws that limit psychometric & personality testing to psychologists. The laws were passed because these tests require competent clinics such as psychologists to be administered correctly.Psychologists undergo extensive training that focuses on the administration, scoring and interpretation of these tests. Moreover, it is important that an experienced clinician sit with the client and explain the rest results.In fact, the Church of Scientology forced the Australian government to pass specific legislation pertaining to the administration of such psychological tests several decades ago. The Church of Scientology developed their own personality and IQ tests (unreliable and invalid) and encouraged people to sit their tests as a way of engaging potential followers.Psychometric tests include IQ tests such as the Wechsler Intelligence Scales (children, adults).Personality tests include the Psychological Inventory, Eysenck Personality Questionnaire, MMPI, Myers Briggs Personality test.Projective tests include the House Tree Person drawing test, Thematic Apperception Test, the Rorschach and others.These tests provide detailed information about the person. The psychologist examines the test results, the psychiatric assessment results and use their clinical judgement to formulate a diagnosis and treatment regime. The above-mentioned tests add another layer to the psychological assessment and hopefully increase the probability that the diagnosis is accurate.DSM Multi-Axial Diagnostic SystemI believe that psychiatrists and psychologists really should use the DSM Multi-Axial diagnostic system. The previous versions of the DSM used this system. However, the DSM 5 (current version) has done away with the system.They provided multiple reasons for the change, however, I do not believe that they made a good decision. I believe that the Multi-Axial diagnostic system provided a more in-depth understanding of a persons functioning.The Multi-Axial diagnostic system was designed to assist the mental health clinician to make a more detailed assessment of the patients function and life in general. For example, instead of making a Major Depressive or Personality disorder diagnosis, the clinician was able to make five Types of Axes By Disorder.The following information briefly outlines the five types of Axes:Axis 1: Major Depressive Disorder (acute clinical disorders);Axis 2: Personality Disorder/Intellectual Disability;Axis 3: Medical/Physical Conditions;Axis 4: Environmental/ Psychosocial Factors;Axis 5: Global Assessment of Functioning.I believe that it is important for experienced psychiatrists, clinical psychologists and other mental health clinicians to work with people that may have a personality disorder. I also believe that many inexperienced or unsuitable clinicians should not be working with people that have personality disorders (they only make matters worse).Kamal

A mental health clinician must conduct a risk assessment every time they meet with their client. Depending on the outcome of the risk assessment, a therapist must decide the best treatment approach for their patient.Generally speaking, No, a therapist does not need to report to or contact the relevant authority every time a client disclosures suicidal ideation.Many people that suffer from severe mental illness report that they think about self-harm or suicidal on a daily basis. Admitting a person to a psychiatric ward every time they express suicidal ideation is not an appropriate treatment response.If we admitted every person that expressed suicidal ideation to hospital the system would not cope. More importantly, in many instances, a better response would entail the therapist assisting the patient to develop coping strategies to help them deal with their suicidal thoughts.There are cases where the therapist assesses the client to be an immediate slide risk and must act to prevent the client taking their own life. If you lived in Australia, the therapist would contact the CATT team or psychiatric triage and request that they assess the patient and admit them to a psychiatric ward.The CATT or Psychiatric triage is under no obligation to admit a patient referred for assessment by a therapist or other mental health clinicians. They will conduct their own assessment and decide on the most appropriate treatment response.For more information about how a clinician should go about conducting a risk assessment and treat a suicidal patient, please click on the link below:Kamal Bekhazi's answer to As a therapist, how do you know when a client is serious about ending their life?I have worked as a clinical psychologist on the crisis assessment and treatment team and psychiatric triage. Most of the patients we assessed were either suicidal or expressing homicidal ideas.We did not admit every person that expressed suicidal or homicidal ideation! It is difficult working in such as high-risk role and the clinician must be competent and skilled in their assessment.Mental health services and government departments (Department of Health) have developed risk assessments forms, guidelines and policies for dealing with high risk patients. However, the above-mentioned tools cannot replace clinical judgement!I frequently received calls from therapists that requested their client be admitted to hospital because they told them they had suicidal thoughts. Many therapists that work alone struggle with patients that express ongoing suicidal ideation and often make complaints to the DOH if their request is denied.It is my view that therapists should carefully select the clients that they take on for treatment. They should be honest with themselves about their ability to manage and treat high risk patients.If a therapist cannot cope with the treatment needs of high-risk clients then they should avoid taking them on as clients. Therapists that find themselves in a situation where a stable client becomes suicidal over a period of time must decide if the client is better off being referred to another clinician or service better able to treat them.I make the above recommendations because every life is precious and I do not want to hear more stories about patients that have self-harmed because their clinician did not have the necessary skill set to treat them and ensure their safety.Kamal