Mental Health Risk Assessment Template | Free Download

Mental health risk assessment template

About the Mental health risk assessment template

Thorough assessments are essential for ensuring patient safety and effective care. As a mental health professional, you need a tool that enhances the efficiency and accuracy of your evaluations. Our mental health risk assessment template is designed to streamline documentation and analysis, allowing you to focus on delivering high-quality care. This template enables the seamless capture of critical details, providing a comprehensive overview of each patient's mental health status. By incorporating our template into your practice, you can perform consistent and detailed evaluations, empowering informed decision-making and improved patient outcomes.

Purpose and benefits of the mental health risk assessment template

A mental health risk assessment form is a valuable tool designed to evaluate and address potential risks and hazards to an individual’s mental well-being. It provides a structured framework for identifying and mitigating factors that could negatively impact mental health. This assessment form can be optimized to cover various areas such as workplace stress, workload, organizational culture, interpersonal relationships, and personal factors. By utilizing this form, employers and organizations can proactively identify potential triggers or stressors that may contribute to mental health issues. The mental health risk assessment form serves as a proactive measure to promote a mentally healthy environment. It allows individuals and organizations to assess and prioritize the well-being of employees, identifying areas of improvement and implementing appropriate interventions.

Key elements of the mental health risk assessment template

The mental health risk assessment template includes the following key sections:

Self-harm/suicide: This section helps you identify any history or indicators of self-harm. By capturing details about past incidents and current mental states, you gain insights into potential risks, enabling proactive intervention.
Current status: Here, you’ll evaluate behaviors and potential risks, such as hostility or substance misuse. This section ensures that immediate concerns are addressed so you can prioritize patient safety and necessary actions.
History: Delving into past experiences, this part includes any history of violence or disengagement from services. Understanding these patterns is vital for tailoring long-term care strategies and anticipating future challenges.
Serious self-neglect: You’ll assess living conditions and personal care and check for areas needing intervention. By identifying issues like poor hygiene or malnutrition, you can address underlying problems that may affect mental health.
Exploitation/vulnerability: This section identifies risks of abuse or exploitation, safeguarding the patient's well-being. Recognizing these vulnerabilities allows you to implement protective measures and support systems.
Summary risk assessment: In the final section, you’ll provide an overall evaluation of the likelihood and severity of risks and offer recommendations for patient care. You’ll then be able to make more informed decisions and craft a cohesive care plan.

Download Lumiform’s mental health risk assessment template today

Make your assessment process more systematic and organized with our user-friendly template. Capture critical details with ease and boost the accuracy of your evaluations. This customizable form comes with structured sections leading to comprehensive insights and data analysis features, empowering you to optimize your patient care.

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Risk management and compliance templates
Health care templates
Risk assessment templates

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

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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.