Q/A Session Nov 2024: How should you document a prevention-oriented risk formulation when there is no risk?
If you encounter a member and you do not identify any specific suicide concerns such as recent or present suicidal ideation, past suicidal behaviour or other indicators of risk of suicide as an alternative to describing the member as "no risk,” which implies certainty, you can use comparative language in the rationale such as:
Based on available information the member’s risk does not appear to differ from other typical Defence members.
Understanding that when an MHP/MO has contact it is typically for a reason, we still recommend discussing with the member available resources, foreseeable change and developing contingency plans.
There can also be circumstances where there is no stated recent, present, or past suicidal behaviou, but the presentation or referral indicates risk factors. In this situation, prevention-oriented risk formulation provides a way to contextually describe the member’s risk.
Practice Example
A medical officer referred a Defence member due to sleep disruption and increased alcohol use following a recent relationship breakup. The member states they are not currently nor have they ever had suicidal thoughts or behaviours. But, thinking through the eight categories, there are other risk factors of note, including:
- Long-term risk factors: History of trauma and his mother's anxiety
- Substance use: Increased alcohol use
- Stressors/Precipitants: Recent relationship break-up
- Symptoms, suffering, recent changes: Sleep disruption
Risk status for suicide is similar to other members seen at the health centre seeking mental health support because it is common for members to be referred for assessment due to relationship difficulties and sleep disruption. The member is well engaged, and while they have a history of trauma and a family history of anxiety, they do not report any suicidal ideation or behaviour and have no known history of suicide attempts. Risk state is higher than it has been in the past since the recent relationship break-up due to sleep disruption that started since the breakup and increased alcohol use.
Response. Work with the member to devleop a contingency plan for two foreseeable changes identified. Member was also referred to a mental health professional for counselling and provided education on sleep hygiene and harm minimisation for alcohol use.
Takeaway
Even when no suicidal ideation is evident, the eight categories guide thinking through a member’s situation, and engage them in planning treatments for modifiable risk factors and provide a more detailed description of their circumstances for other clinicians.
Related Resources