Mental Health Risk Assessment Template – Free PDF

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Mental health risk assessment template

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Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.

Customize this template or build your own
Fill out templates via mobile app
Assign and track corrective actions
Get reports and analyse your data

Prices start from ░░░ per month

Book a demo

Learn more

This template empowers you to record and assess mental health risks in the workplace, from workload stressors and burnout to psychological hazards. It takes you through a structured process for assessing employee wellbeing and taking clear, actionable steps.

In a poll by the US National Alliance on Mental Illness, more than half of workers reported experiencing burnout over the past year. Being proactive with mental health risk assessments is then critical for meeting your duty of care. For broader needs, explore our stress risk assessment template or business risk assessment template, each tailored for unique compliance challenges.

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Preview of the template

Audit

SELF-HARM/SUICIDE

Does the patient have a history of hurting themselves?

Does the patient's family have a history of suicide or self-harm?

Is the patient in a low mood?

Has the patient hinted on suicidal ideation?

Has the patient experienced any recent adverse life events?

Is the patient in a high level of distress?

Is the patient suffering from a physical illness or disability?

Does the patient live alone? (Or will live alone after discharge?)

Has the patient been feeling isolated from society?

Was the patient recently discharged from a hospital/prison?

Did the patient's significant other express any concerns about them?

Does the patient have a criminal record?

List all of the offences here.

Any other observations related to self-harm.

CURRENT STATUS

Is the patient demonstrating any hostile or threatening behavior?

Has the patient expressed any violent thoughts or fantasies?

Does the patient have problems controlling their temper?

Does the patient possess weapons with possible intent to use?

Is there a current risk of violence from the patient?

Does the patient have access to a potential or threatened victim?

Has the patient expressed ongoing drug or alcohol misuse?

Have others expressed concern about potential violence from the patient?

Any other observations related to the patient's current status.

HISTORY

Does the patient have a history of violence?

Does the patient have a history of disengagement from services? (the patient has previously "dropped out" of a mental health care program)

Has the patient witnessed violence and/or emotional abuse in childhood?

Has the patient experienced violence and/or emotional abuse in childhood?

Does the patient have a history of deliberate or accidental fire setting?

Does the patient have a history of deliberately harming other people?

Does the patient have a history of deliberately harming children?

Any other observations related to the patient's history.

SERIOUS SELF-NEGLECT

Is the patient currently homeless?

Is the patient currently subject to unacceptable living conditions (e.g. hazards)?

Is the patient socially isolated? (e.g. refuses to talk to friends and family or has none)

Is the patient dehydrated?

Is the patient malnourished?

Does the patient have poor hygiene? (e.g. has verbally expressed poor hygienic practices or evident in appearance and scent)

Does the patient risk causing accidents for themselves or others due to negligence/apathy? (e.g. does not follow traffic lights, crosses the street with no regard for ongoing traffic)

Does the patient have any untreated physical health needs?

Does the patient have a history of persistent non-compliance with prescribed medication?

Does the patient have a history of alcohol abuse?

Does the patient have a history of substance abuse?

Any other observations.

EXPLOITATION/VULNERABILITY

Is the patient currently, or was previously at risk of physical abuse?

Is the patient currently, or was previously at risk of sexual abuse?

Is the patient currently, or was previously at risk of social abuse?

Is the patient currently, or was previously at risk of emotional abuse?

Is the patient currently, or was previously at risk of financial abuse?

Are there threats against the patients privacy and dignity (past and/or present)?

Is the patient displaying symptoms of disinhibition?

Is the patient displaying symptoms of impulsiveness?

Is the patient displaying precocious behavior?

Is the patient living in unacceptable home conditions (e.g. hazards)?

Any other observations.

SUMMARY RISK ASSESSMENT

Overall likelihood to cause self-harm/ harm to others

Severity of self-harm/ harm to others

Overall risk rating

Summary findings on degree of risk and recommendations

Health professional signature

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Frequently asked questions

How do mental health risk assessments help address stigma at work?

By making mental health a routine part of workplace risk management, assessments help normalize the conversation around these issues. When employees see leadership actively addressing mental health risks, it signals that mental wellbeing is valued and encourages people to speak up or seek support if needed.

What types of risks are commonly found in mental health risk assessments?

Common risks include excessive workloads, lack of role clarity, poor communication, workplace bullying, inadequate support, and major organizational changes. External factors like remote work isolation or traumatic events may also be considered, depending on the industry and setting.

How do you encourage staff to participate in mental health risk assessments?

Fostering open communication and confidentiality is key. Explain the purpose clearly, involve employees in discussions or surveys, and make sure feedback is genuinely valued. Letting staff know that their input will be used to create a safer, more supportive workplace will increase engagement.

How can you act on the findings from a mental health risk assessment?

After the assessment, you can develop targeted action plans based on identified risks, such as improving workload management, offering support resources, enhancing communication, or providing training for managers. Follow up with regular check-ins and adjustments to ensure changes make a real difference for staff wellbeing.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.