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Risk Assessment: Key Elements

The following lists of risk assessment elements are meant to act as a guide for any clinician performing a psychiatric assessment in the ER setting. These elements should be kept in mind while the clinician formulates a risk assessment on any ER patient they assess. The following risk assessment elements have been adapted from information in Elbogen et al. (2006); Jacobs et al. (2003); Joiner et al. (2007); Pulay et al. (2008); and Swanson et al. (2006).

History of Present Illness

  • ? Anhedonia, hopelessness, insomnia, panic attacks/anxiety
  • ? Impulse control (poor, fair, good)
  • ? Able to cooperate in treatment
  • ? Suicidal behaviors, self-injurious behavior
  • ? Suicidal ideation/intent/plan/access to means to carry out plan
  • ? Physical threats
  • ? Verbally abusive
  • ? Violence: intent or plan
  • ? Assaultive behavior
  • ? Homicidal ideation/intent/plan/access to means to carry out plan

Psychiatric History

  • ? Current/past psychiatric disorder (especially mood/psychotic)
  • ? Multiple past psychiatric admissions
  • ? History of discharge against medical advice
  • ? History of noncompliance with treatment
  • ? Court-mandated mental health treatment
  • ? Prior suicide attempts and self-injurious behaviors (e.g., cutting or burning self)
  • ? History of assaultive behavior
  • ? History of cruelty to animals or fire setting

Medical History

? Serious medical or physical disability

Past Psychiatric History

? Family member with serious mental illness, suicide, and attempts

Social History

  • ? Change in living situation/homelessness
  • ? Conflict in family
  • ? Stability of home environment
  • ? Domestic violence
  • ? Child protective services involvement
  • ? Presence/absence of financial resources
  • ? Incarceration history
  • ? Prolonged impairment at work or school
  • ? Social isolation, lack of family and social support system
  • ? Access to weapons/firearms

Substance Use History

  • ? Current alcohol or substance use
  • ? History of alcohol use disorder/substance use disorder
 
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