MH Discharge Risk Assessment

Risk Report for [text name="Name"]
Assessment date and time: [text name="date"]

-- SUICIDE RISK SUMMARY -- 

Pt confirmed having [checkbox name="freq" value="no suicidal thoughts.|suicidal thoughts"][conditional field="freq" condition="(freq).is('suicidal thoughts')"] [checkbox value="every now and then|every other day|every day"], and rated these thoughts as [checkbox value="mild|moderate|severe"] in their intensity. 

When asked about having suicide plans, the patient reported: [checkbox value="no current plans|vague plans|having a definite plan|they are unwilling to discuss it"]. 

When further asked about how close have they been to acting on these thoughts in the past, the patient reported [checkbox value="not close at all|very close|they did indeed attempt suicide|they do not wish to discuss it"]. 

When asked how certain they feel about acting on these thoughts in the future, the patient reported [checkbox value="it's unlikely|they weren't sure|they were absolutely certain|they did not wish to discuss it"] 

Finally, when I asked about having access to the means to suicide, the patient reported [checkbox value="no|yes possibly|yes absolutely"][/conditional]

Risk state is [checkbox value="higher than|similar to|lower than"] the Pts usual baseline of risk.

Risk status is [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other Pts in the current service setting.

Foreseeable changes in risk: 

[textarea default=""]

Available resources immediately accessible to the Pt: 

[textarea default="Help line numbers, Acute Care Team, PRN meds, Friends, Family, Counsellor, Community Mental Health Clinician, Disability Support Worker, NGO Caseworker"]

[checkbox name="stat" value="-- ENDURING RISK FACTORS --"][conditional field="stat" condition="(stat).is('-- ENDURING RISK FACTORS --')"] 

Strengths and Protective Factors

[checkbox value="treatment responsiveness|connectedness to friends|supportive family|community involvement|involed with social institutions|problem-solving skills|coping skills|ability to adapt to change|has a sense of purpose or meaning in life|personal beliefs that discourage self-injury|good social skills|ability to manage feelings of anger|good health|access to mental and physical health care|healthy fear of risky behaviours and pain|hope for the future and optimism|sobriety|medical compliance|a sense of the importance of health and wellness|impulse control|they strong sense of self-worth or self-esteem|a sense of personal control or determination|access to a variety of clinical interventions and support for seeking help|resiliency|expressed reasons for living|being married|being a parent|strong relationships, particularly with family members|opportunities to participate in and contribute to school or community projects and activities|living in a reasonably safe and stable environment|having restricted access to lethal means|sense of responsibility and duty to others|being a pet owner"]

Long-term Risk Factors

[checkbox value="Hx of denying the need for service contact|Hx of avoiding service contact|Dx of eating disorder|Dx neurological disorder|persistent psychotic illness|non-responsiveness to pharmacological treatment|non-responsiveness to psycho-social interventions|chronic stressors|Hx of psychiatric illness|long-standing fascination with death|social isolation|romantises death and dying|Hx of discrimination|a background of childhood adversity|having a family history of suicide|a disruptive and unsupportive family background|Dx of PTSD|combat veteran|background of being a first responder|Hx of relationship conflicts|divorced|complex family dynamics|unsupportive family|demographic - male - single age 35-64|substance misuse|absolutistic thinking|tunnel vision|perfectionism|sexual orientation rejected by family|guns in the home|access to abundant medications|chronic medical illness|chronic pain"]

Socio-demographic Risk Factors:

[checkbox value="nil known|social isolation|unemployment|low socioeconomic status|low education|single|low income|living alone|non-religious|no children"]

Family History Factors:

[checkbox value="nil known|family Hx of mental health|suicide of family member|suicide attempt of family member"]

Clinical Factors:

[checkbox value="nil known|unspecified mental health Dx|depression|schizophrenia|bipolar disorder|substance use disorder|alcohol use disorder|anxiety disorder|dysthymia|unspecified personality disorder|borderline personality disorder|paranoid personality disorder|dependent personality disorder|avoidant personality disorder|antisocial personality disorder|Hx of psychiatric treatment|Hx of self-harm|previous suicide attempt|smoker|physical illness"]

Adverse Life Events:

[checkbox value="nil known|relationship conflict|legal problems|family-related conflict|abuse|victimization|financial problems|early separation from parents|work-related conflict|school conflict"]

Australia Specific Risk:

[checkbox value="not applicable|male|male aged 15 to 24|male aged 45 to 54|female aged 25 to 54|male aged over 85|Indigenous Australian male aged 15 to 24|rural and remote resident|diagnosis of depression|diagnosis of bipolar disorder|diagnosis of substance abuse disorder|diagnosis of anxiety disorder|diagnosis of schizophrenia|diagnosis of PTSD|chronic illness or pain|history of suicide attempts|family history of suicide|social isolation|recent traumatic events|history of abuse or trauma|LGBTQ+ identity|financial stress|unemployment|low socio-economic status|veteran"].

Shneidman's criteria:

[checkbox value="nil known|intense psychological pain that feels unbearable to the individual|self-destructive behaviours|life stressors that contribute to mental distress|high levels of emotional turmoil or agitation|the fatal potential of the method considered for suicide|a deep sense of despair about the future|subtle hints or behaviours suggesting suicidal thoughts|drug or alcohol use|previous attempts|recent losses like personal, financial, or professional|the belief that there are no solutions other than suicide"]

Impulsivity/Self Control:

[checkbox value="Hx of impulsive behaviour|problem-solving difficulties|unstable personality structure|Hx of substance abuse|low threshold for boredom|Hx of provocative behaviours|Dx with ABI|Dx with intellectual disability|Dx with developmental delay|Pt struggles with decision-making|Hx of sensation seeking behaviours|Pt struggles to delay gratification|Pt struggles to self-regulate emotions|low threshold for emotional arousal|Pt struggles to maintain goal focus|external locus of control|Hx of reckless self-endangerment|Pt struggles to inhibit aggression|limited capacity for self-soothing|low expecations for positive future|Dx with ADHD|Pt remains pre-occupied with suicide"]

Past Suicidal Behaviour

[checkbox value="nil known|history of self-harm|history of previous suicide attempts|previous hospitalization for suicidality|previous hospitalization for self-harm"]

Time elapsed since suicide attempt:

[checkbox value="not applicable|within 1 month|within 3 months|within 6 months"][/conditional]

[checkbox name="Dyna" value="-- DYNAMIC RISK FACTORS --"][conditional field="Dyna" condition="(Dyna).is('-- DYNAMIC RISK FACTORS --')"] 

Recent/present suicide ideation or behaviour

[checkbox value="current suicidal ideation|has a suicide plan|suicide plan has high lethality|preparation behahiours|vocalising threat to suicide|rehearsal behaviours|access to lethal means|recent suicide attempt|Pt regrets not dying|mood lability|persistent agitation|tearful|guarded|withdrawal from services|increased impulsivity|increased recklessness|increased anger|seeking revenge|recent violent behaviours|final act behaviours"]

Stressors:

[checkbox value="financial loss|poor health|pending incarceration|detention|stressful loss|rejection|sense of being a burden|feeling alone|feeling isolated|suicide contagion in community|feeling trapped|recent humiliation|recent assualt|social rejection|anniversary of loss|suicide command hallucinations|argument with intimate|relationship conflict|loss of status|loss of self-esteem|loss of purpose and meaning|loss of social support|recent loss of job|suicide of an intimate"]

[textarea default=""]

Symptoms, suffering and recent changes

[checkbox value="increased depressive symptoms|reports inner torment|persistent negative thoughts about self|reports self-hatred|social media posts about suicide|persistent crying|final act behaviours|mental illness Sx|unremitting pain|recent discharge from MHIPU|feeling trapped|increased substance abuse|persistent self-devaluation|no reasons for living|stalking|comorbid MH concerns|increasing impulsivity|being victimised|pending unemployment|increasing financial pressures|persistent nightmares|increasing financial pressure|recklessness|feeling out of control|feeling intolerably alone|withdrawal|feeling anger|icreased anxiety|panic|fear|agitation|hopelesness|pending legal issues|negative appraisals of self|insomnia|intense jealousy over ex|low expectation for recovery|pending criminal charges|declining health|feelings of shame|change in sleep patterns|change in appetite|access to lethal means|unmet needs|feelings of anger"]

[textarea default=""][/conditional]

-- VIOLENCE RISK --

Documented incidents of violence: [textarea default="Nil. Yes."]

Violence risk state is [checkbox value="higher than|similar to|lower than"] the Pts usual baseline of risk.

Violence status is [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other Pts in the current service setting.

When asked, the patient [checkbox name="vicon" value="denied any current violent ideation or actions|disclosed current thoughts about violence|disclosed plans and / or intent to carry out acts of violence|admitted to recently committing an act of violence"][conditional field="vicon" condition="(vicon).is('disclosed current thoughts about violence')||(vicon).is('disclosed plans and / or intent to carry out acts of violence')||(vicon).is('admitted to recently committing an act of violence')"], because the patient felt: [checkbox value="current circumstances are unfair|mentally confused|tormented by thoughts|paranoid|righteous|outraged|not listened to|disrespected|impinged upon by others|current circumstances are out of their control|bullied|disrespected|wronged|the need for revenge|afraid for their safety|threatened|they have lost something of value|victimized by recent violence|excited by violence|their routine was disturbed|the need to assert toughness|forced to commit violence by peers|affected by substances|controlled by the behaviour of others."][textarea default=""][/conditional].

Foreseeable changes in risk: [textarea default=""]

[checkbox name="violence" value="Known risk factors:"] [conditional field="violence" condition="(violence).is('Known risk factors:')"] [checkbox value="nil|documented violence towards others|Dx of conduct disorder|Dx of ASPD|Dx of ASD|attention deficits|hyperactivity|learning difficulties|an ABI|developmental delay|episodes of mania|poor theory of mind|impulse control difficulties|low frustration tolerance|low threshold for emotional reactivity|a history of early aggressive behaviour|low empathy|psychopathic traits|perspective-taking deficits|poor moral reasoning|drugs and/or alcohol misuse|intellectual difficulties|depression|poor behavioural control|excited by violence|fire-setting behaviours|deficits in social cognitions|sadistic traits|cruelty to animals|deficits in information-processing|documented incidents of dishonesty|attributes hostile intent to others|maternal alcohol abuse|is shame prone|paranoia|self-esteem is linked to violence|feels intense emotional distress|a psychotic illness|a history of treatment for emotional problems|antisocial beliefs and attitudes|an exposure to violence and conflict in the family|gang membership"][textarea default=""][/conditional]

[checkbox name="famfac" value="No known familial risk factors.|Familial risk factors:"] [conditional field="famfac" condition="(famfac).is('Familial risk factors:')"] [checkbox value="authoritarian childrearing attitudes|harsh, lax or inconsistent disciplinary practices|low parental involvement|low emotional attachment to parents or caregivers|low parental education|low parental income|parental substance abuse|parental criminality|poor family functioning|poor monitoring and supervision of children"][textarea default=""][/conditional].

[checkbox name="peerfac" value="No known peer risk factors.|Peer risk factors:"][conditional field="peerfac" condition="(peerfac).is('Peer risk factors:')"] [checkbox value="association with delinquent peers|involvement in gangs|feels socially rejected by peers|lacks involvement in conventional activities|academic underperformance|low commitment to education|school failure"][textarea default=""][/conditional].

[checkbox name="comfac" value="No known community risk factors.|Community risk factors:"][conditional field="comfac" condition="(comfac).is('Community risk factors:')"] [checkbox value="diminished economic opportunities|living in an area with a high concentration of underprivileged residents|has high levels of transiency|experiences high levels of family disruption|has low community participation|lives in a socially disorganised neighbourhood"][textarea default=""][/conditional]. 

[checkbox name="protfac" value="Protective factors:"][conditional field="protfac" condition="(protfac).is('Protective factors:')"] [checkbox value="an intolerant attitude towards deviant behaviour|a high IQ|good academic grades|a positive social orientation|highly developed social skills|plans ahead|realistic expectations for the future|religious|connected to family|connected to non-violent peers|fears violence and aggression|discusses problems with others|perceives parental disapproval for aggression|shares activities with family|supportive spouse|involved in pro-social activities|has positive role models|has affective relationships which are strong, close and prosocially oriented|is commited to education|is commited to work|has high needs for achievement|non-deviant peers|peer group rejects  antisocial behaviour|involvement in pro-social activities|early exposure to positive parenting practices"][textarea default=""][/conditional].

[textarea cols=90 rows=20 default="No additional information about violence risk known"].

-- SELF-HARM RISK --

Documented incidents of self-harm: [textarea default="Nil. Yes."]

Self-harm risk state is [checkbox value="higher than|similar to|lower than"] the Pts usual baseline of risk.

Self-harm status is [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other Pts in the current service setting.

When asked, the patient [checkbox name="shcon" value="denied any current self-harm ideation or actions|disclosed current thoughts about self-harm|disclosed plans and / or intent to carry out acts of self-harm|admitted to recently committing an act of self-harm"][conditional field="shcon" condition="(shcon).is('disclosed current thoughts about self-harm')||(shcon).is('disclosed plans and / or intent to carry out acts of self-harm')||(shcon).is('admitted to recently committing an act of self-harm')"], because the patient felt: [checkbox value="current circumstances are overwhelming|mentally confused|tormented by thoughts|paranoid|hopeless|helpless|not listened to|disrespected|impinged upon by others|current circumstances are out of their control|bullied|wronged|the need to escape|afraid for their safety|threatened|they have lost something of value|victimized by recent events|numb and seeking to feel something|overwhelmed by emotions|affected by substances|controlled by the behaviour of others."][textarea default=""][/conditional].

Foreseeable changes in risk: [textarea default=""]

[checkbox name="selfharm" value="Known risk factors:"] [conditional field="selfharm" condition="(selfharm).is('Known risk factors:')"] [checkbox value="nil|history of self-harm|family history of self-harm|diagnosis of depression|diagnosis of anxiety disorders|diagnosis of borderline personality disorder|diagnosis of eating disorders|diagnosis of PTSD|substance misuse|poor impulse control|feelings of hopelessness|feelings of worthlessness|chronic physical pain|chronic mental pain|lack of social support|relationship difficulties|academic pressures|work pressures|history of bullying or victimization|low self-esteem|poor problem-solving skills|emotional dysregulation|difficulty expressing emotions|recent significant life changes|grief or loss|financial stress|social isolation|history of psychiatric hospitalization|history of frequent emergency room visits|poor coping skills|exposure to self-harm in others|lack of access to mental health services|perceived burdensomeness|sleep disturbances|unresolved trauma|difficulty with interpersonal relationships|high levels of daily stress|gender dysphoria|identity issues|sexual orientation issues|lack of healthy outlets for emotions|recent changes in medication"][textarea default=""][/conditional].

-- VULNERABILITY RISK --

Reported vulnerabilities: [textarea cols=90 rows=20 default="nil known"].

[checkbox name="patvul" value="Vulnerability risk factors:"] 
[conditional field="patvul" condition="(patvul).is('Vulnerability risk factors:')"] 
[checkbox value="nil known|being an older adult|ethnic minority background|immigrant status|living in poverty|having limited income|being dependent on services|having a disability|being a child|having literacy and communication difficulty|being lower in SES|being geographically isolated|being socially isolated|being homeless|being frail and malnourished|having drug and alcohol dependence|having cognitive difficulties|having a socially undesirable status|being labelled as difficult|having no advocacy|having no family support|being financially dependent on others|being in an imbalanced power relationship|unrealistic self-appraisal|reality avoidant|poor insight|denying difficulties|high needs to please others|low assertiveness|genetic or biological factors|perinatal trauma|early malnutrition|behavioural and learning difficulties|traumatic brain injury|low family income|poor parenting and inconsistent discipline|family size|abuse – emotional, physical, or sexual|emotional or physical neglect|household alcohol or substance misuse|household mental health issues|family violence|family breakdown|household offending behaviour|unsafe or violent communities|low social integration and poor social mobility|lack of possibilities for recreation|lack of infrastructure for the satisfaction of needs and interests of young people|socio-economically deprived communities|high unemployment|homelessness or poor housing|a culture of violence, norms, and values which accept, normalize, and glorify violence|discrimination|difficulties accessing services|peer rejection|exposure to media violence|school failure|bullying or victimization|chronic illness or disability|lack of access to quality education|parental criminality"]
[/conditional]

-- RISKS TO CHILDREN (U18) --

Reported risks to children: [textarea cols=90 rows=20 default="nil known"].

[checkbox name="riskstochildren" value="Risks to children:"]
[conditional field="riskstochildren" condition="(riskstochildren).is('Risks to children:')"] [checkbox value="nil known|parental substance abuse|parental mental illness|domestic violence in the home|emotional neglect|physical neglect|lack of supervision|poor parenting skills|unstable living conditions|exposure to criminal activities|financial instability of the family|parental criminality|inconsistent parenting or discipline|exposure to parental conflict|frequent changes in caregivers|involvement with child protective services|poor school attendance|lack of access to educational resources|chronic illness or disability of the child|lack of social support for the family|poor parent-child relationship|history of trauma or abuse|exposure to unsafe environments|limited access to healthcare for the child|food insecurity|lack of appropriate clothing or shelter|parental absence due to incarceration or hospitalization|high stress levels in the home|parental unemployment|lack of positive role models|exposure to parental gambling or other addictive behaviors|parental engagement in risky sexual behaviors|inadequate access to community resources|cultural or language barriers affecting the child|recent significant family changes|low parental education|involvement in custody disputes|documented exploitative relationship with children|exposure to environmental hazards"]
[/conditional]

-- OTHER RISKS --

Reported other risks: [textarea cols=90 rows=20 default="nil known"].

[checkbox name="otherrisks" value="Other risk factors:"] [conditional field="otherrisks" condition="(otherrisks).is('Other risk factors:')"]
[checkbox value="nil known|poor medication adherence|lack of insight into illness|non-compliance with treatment|history of frequent hospitalizations|recent discharge from psychiatric facility|poor social support|history of homelessness|financial instability|unemployment|chronic physical health conditions|poor access to healthcare|legal issues|recent life stressors|history of trauma or abuse|lack of coping skills|substance abuse|isolation from family or friends|lack of stable housing|frequent changes in living situations|involvement with criminal justice system|stigma related to mental illness|inconsistent follow-up care|unresolved grief or loss|difficulty accessing mental health services|exposure to environmental toxins|history of gambling or other addictive behaviors|engagement in risky sexual behaviors|high levels of daily stress|lack of access to transportation|recent significant life changes|problems with daily living activities|poor nutrition|sleep disturbances|cultural or language barriers|recent changes in medication|lack of continuity of care|challenges with healthcare providers|lack of educational or vocational opportunities"]
[/conditional]
Risk Report for
Assessment date and time:

-- SUICIDE RISK SUMMARY --

Pt confirmed having

Risk state is the Pts usual baseline of risk.

Risk status is the general population, and other Pts in the current service setting.

Foreseeable changes in risk:



Available resources immediately accessible to the Pt:







-- VIOLENCE RISK --

Documented incidents of violence:


Violence risk state is the Pts usual baseline of risk.

Violence status is the general population, and other Pts in the current service setting.

When asked, the patient .

Foreseeable changes in risk:




.

.

.

.

.

-- SELF-HARM RISK --

Documented incidents of self-harm:


Self-harm risk state is the Pts usual baseline of risk.

Self-harm status is the general population, and other Pts in the current service setting.

When asked, the patient .

Foreseeable changes in risk:


.

-- VULNERABILITY RISK --

Reported vulnerabilities:
.




-- RISKS TO CHILDREN (U18) --

Reported risks to children:
.




-- OTHER RISKS --

Reported other risks:
.

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.71, 90 form elements, 152 boilerplate words, 2 text boxes, 20 text areas, 54 checkboxes, 14 conditionals, 677 total clicks
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