• Risk assessment determines the urgency of referral to specialist mental health services.
• Assess the risk of suicide:
• Consider risk factors for suicide, such as:
• Previous suicide attempt.
• Hopelessness.
• Assess for suicidal ideation:
• Ask a single question such as 'Are you feeling suicidal?'
• If the answer is yes, assess for suicidal intent.
• Assess for suicidal intent by asking:
• Have you made any plans for ending your life?
• Do you have the means for doing this available to you?
• What has kept you from acting on these thoughts?
• Consider other risks of harm to the individual, including:
• Financial ruin arising from overspending.
• Traumatic injuries and accidents.
• Sexually transmitted infections and unplanned pregnancy arising from disinhibition and increased libido.
• Damage to reputation, income and occupation, and relationships.
• Self-neglect, exhaustion, and dehydration during a manic episode.
• Exploitation by others.
• Alcohol and substance misuse.
• Consider the risks of harm to others:
• To family, in particular children and other dependents, from:
• Neglect.
• Depressive or paranoid delusions.
• Grandiosity, overspending, poor judgement, and erratic or chaotic behaviour during a manic episode.
• Rarely, violence and aggression (particularly if there is a personal history of violent behaviour).
• To the public from:
• Rarely, violence and aggression.
• Injuries arising from poor judgement or impulsive behaviour (e.g. whilst driving).

In depth