MH Risk Assessment1

Risk Assessment:I am updating [text default="the patient's"] risk assessment [checkbox name="riskreason" value="as part of their 13-week clinical review.|to reflect recent changes associated with a change in their risk."]Suicide Risk Formulation:[text default="The patient"] reported [checkbox name="sucon" value="nil concerns about suicide|having thoughts of suicide|and has plans and / or intent to suicide"][conditional field="sucon" condition="(sucon).is('having thoughts of suicide')||(sucon).is('and has plans and / or intent to suicide')"]. When asked what might have contributed to this recent change in risk, patient name identified [checkbox value="a relationship break-up|a loss of friendship|a relationship conflict|a legal problem|a disciplinary issue|an anniversary of someone else's suicide|a pregnancy|a fear of being pregnant|a loss of freedom|physical abuse|sexual abuse|bullying from peers|bullying|humiliation|loss of self-esteem|parental disappointment|parental disapproval|false accusations|loss of social status|threats to loss of children|loss of employment|an increase in mental health symptoms|symptoms associated with a medical problem|worrying about academic failure|worrying about disappointing others|nothing in particular, just an overwhelming feeling of wanting to end their life|such that suicide seems like a viable solution."][/conditional]There were [checkbox name="warning" value="no warning signs of an increased suicide risk identified during this assessment|some warning signs that the patient may be at an increased risk of suicide:"][conditional field="warning" condition="(warning).is('some warning signs that the patient may be at an increased risk of suicide:')"] [checkbox value="openly expressing threats of suicide|threatening to self-harm|seeking access to lethal means|having recently acquired lethal means|talking about death and suicide|writing about death and suicide|increased they substance abuse|having recently lost a reason for living|having recently lost of sense of purpose for living|being in an 'at risk' mental state (hopelessness, despair, agitation, shame, guilt, anger, psychosis, psychotic thought processes)|recently experiencing an interpersonal rejection / humiliation|recently experience of a major loss|recently experiencing the anniversary of a major loss|being presently intoxicated|being presently in a drug-withdrawal state|experiencing chronic pain|experiencing a medical illness|recent experience of a major financial difficulty|recently being made unemployed|impending legal prosecution|recently experiencing a major family breakdown|experiencing child custody difficulties|feeling trapped|experiencing increased anxiety|they appearing to be agitated|being unable to sleep|expressing new feelings of hopelessness|recent social withdrawl|being uncharacteristically happy after a period of depression|reporting significant neuro-vegetative changes|settling practical affairs (making a will, giving away possessions etc.)"][/conditional].There were [checkbox name="statsu" value="no static factors identified that predispose the patient to an elevated risk of suicide.|static factors identified that predispose the patient to an elevated risk of suicide:"][conditional field="statsu" condition="(statsu).is('static factors identified that predispose the patient to an elevated risk of suicide:')"] [checkbox value="denying the need for service contact|avoidance of service contact|non-responsiveness to pharmacological treatment|non-responsiveness to psycho-social interventions|having chronic stressors|having a history of self-harm|having a history of previous suicide attempts|previous hospitalization for suicidality|previous hospitalization for self-harm|a history of psychiatric illness|a history of substance abuse|having a diagnosed personality disorder|having a background of childhood adversity|having a family history of suicide|belonging to a higher risk demographic group (age, gender, marital status) for suicide|having problem-solving difficulties"][/conditional].There were [checkbox name="dysu" value="no dynamic factors identified that predispose the patient to an elevated risk of suicide.|dynamic factors identified that predispose the patient to an elevated risk of suicide:"][conditional field="dysu" condition="(dysu).is('dynamic factors identified that predispose the patient to an elevated risk of suicide:')"] [checkbox value="expressing suicidal intent|articulating feelings of hopelessness|the psychological symptoms associated with they mental health diagnosis|treatment compliance|the abuse of substances|recent discharge from a psychiatric unit|psycho-social stressors"][/conditional].There were [checkbox name="prosu" value="no protective factors identified to buffer the patient from the risk of suicide|protective factors identified that may buffer the patient against the risk of suicide:"][conditional field="prosu" condition="(prosu).is('protective factors identified that may buffer the patient against the risk of suicide:')"] which include [checkbox value="treatment responsiveness|connectedness to individuals, family, community, and social institutions|problem-solving skills|coping skills|an ability to adapt to change|a sense of purpose or meaning in life Cultural, religious, or personal beliefs that discourage self-injury|good social skills|an ability to manage feelings of anger|good health|access to mental and physical health care|a 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|strong sense of self-worth or self-esteem|sense of personal control or determination|they 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|they being a pet owner"][/conditional].Violence risk:The patient [checkbox name="violence" value="has no reported history of violence|has background factors associated with an increased risk of violence,"] [conditional field="violence" condition="(violence).is('has background factors associated with an increased risk of violence,')"] such as: [checkbox value="a history of violent victimization towards others|attention deficits, hyperactivity or learning difficulties|a history of early aggressive behaviour|involvement with drugs and/or alcohol|intellectual difficulties|poor behavioral control|deficits in social cognitive|deficits in information-processing abilities|intense emotional distress|a history of treatment for emotional problems|antisocial beliefs and attitudes|an exposure to violence and conflict in the family"][/conditional].I was [checkbox name="famfac" value="unable to identify familial factors that contribute to an increased risk of violence|able to identify factors within the patient's family, that may contribute to an increased risk of violence"] [conditional field="famfac" condition="(famfac).is('able to identify factors within the patient's family, that may contribute to an increased risk of violence')"] such as: [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"][/conditional].I was [checkbox name="peerfac" value="unable to identify peer and social factors that contribute to an increased risk of violence|able to identify peer and social factors that may contribute to an increased risk of violence"][conditional field="peerfac" condition="(peerfac).is('able to identify peer and social factors that may contribute to an increased risk of violence')"] such as [checkbox value="they association with delinquent peers|they involvement in gangs|they feeling socially rejected by peers|they lack of involvement in conventional activities|they poor academic performance|they low commitment to school and school failure"][/conditional].
I was [checkbox name="comfac" value="unable to identify community risk factors that contribute to an increased risk of violence|able to identify community factors that may contribute to an increased risk of violence"][conditional field="comfac" condition="(comfac).is('able to identify community factors that may contribute to an increased risk of violence')"] such as [checkbox value="they having diminished economic opportunities|they living in an area with a high concentration of underprivileged residents|they having high levels of transiency|they experiencing high levels of family disruption|they having low community participation|they living in a socially disorganised neighbourhood"][/conditional].
It is further worth noting, [checkbox name="protfac" value="there were no apparent protective factors supporting the patient against violence, which remains an ongoing concern|there were protective factors buffering the patient from the risks of becoming violent"][conditional field="protfac" condition="(protfac).is('there were protective factors buffering the patient from the risks of becoming violent')"] such as: [checkbox value="intolerant attitude towards deviant behaviour|having a high IQ|having good academic grades|having a positive social orientation|having highly developed social skills|having the ability to plan ahead|they having realistic expectations for the future|they being religious|being connected to family|being connected to non-violent adults outside the family|an ability to discuss problems with others|perceiving parental expectations about good performance at school|sharing activities with parents|having the consistent presence of a parent|involvement in pro-social activities|having positive role models|having affective relationships which are strong, close and prosocially oriented|being commited to school|being commited to work|having high needs for achievement|having non-deviant peers|having peer groups that do not condone antisocial behaviour|involvement in pro-social activities|exposure to positive parenting practices"][/conditional].[textarea cols=90 rows=20 default="additional information about violence"].Self Harm Risk:When I asked the patient about the recency and frequency of deliberate self-harm behaviours they reported: [checkbox name="selfharm" value="never deliberately self-injuring|having a history of deliberate self-harm behaviours,"][conditional field="selfharm" condition="(selfharm).is('having a history of deliberate self-harm behaviours,')"] indicating that they most recently self-harmed [checkbox value="less than 1 week ago|between 1 week and 1 month ago|between 1 and 3 months ago|between 3 and 6 months ago|6 months and 1 year ago|between 1 and 2 years ago|more than 2 years ago|only once|2-3 times|4-5 times|6-10 times|11-20 times|21-50 times|more than 50 times|on the wrists|on the hands|on the arms|on the fingers|on the calves|on the ankles|on the thighs|on the stomach|on the chest|on the back|on the buttocks|on the head|on the feet|on the face|on the lips|on the tongue|on the shoulders|on the neck|on the breasts|on the gentials or rectum|to feel something|because friends also hurt themselves|as a self-punishment or to atone for sins|to get a rush or surge of energy|to deal with frustration|to cope with uncomfortable feelings (e.g., depression or anxiety)|in hopes that someone would notice that something is wrong or that so others will pay attention to them|so they do not hurt myself in other ways|because it feels good|to deal with anger|to get control over myself or my life|to shock or hurt someone|to avoid committing suicide|because I get the urge and cannot stop it|to relieve stress or pressure|to change emotional pain into something physical|because of self-hatred|because of the way it looks|as a way to practice suicide|as an attempt to commit suicide|for other reasons described below"][/conditional].When I explored factors that may increase the patient's risk of future self-harm [checkbox name="futureharm" value="I was unable to identify any particular risk concerns|I identified the following factors that may increase they risk of engaging in deliberate self-harm behaviours"][conditional field="futureharm" condition="(futureharm).is('I identified the following factors that may increase they risk of engaging in deliberate self-harm behaviours')"] [checkbox value="a history of previous self-harm|a diagnosed personality disorder|feelings of hopelessness|a history of psychiatric treatment|a diagnosis of schizophrenia|alcohol abuse/dependence|living alone|impulsivity|problem-solving difficulties|a history of being abused|ongoing stressful life events|work or school problems|relationship problems|family relationship problems|financial problems|a positive attitude towards self-harm"][/conditional].[textarea cols=90 rows=20 default="additional information about self-harm"].Absconding risk:[textarea cols=90 rows=20 default="No identified risks"].Risk of harm to children:[textarea cols=90 rows=20 default="No identified risksOther risks:[textarea cols=90 rows=20 default="No other risks identified"].