Synopsis
Assess what the person can do, what has changed, what matters and which internal, relational and practical resources genuinely reduce harm or support recovery, translating findings into proportionate care and review.
- Establish baseline and current ability with dated examples across self-care, domestic tasks, work or education, relationships, parenting, money, housing, leisure and healthcare use.
- Separate capacity from performance: a person may understand a task yet be prevented by fatigue, symptoms, poverty, environment, coercion or lack of opportunity.
- Ask what matters, what the person is proud of, how previous crises were survived and which skills or routines remain intact.
- Protective factors include internal skills, reasons for living, relationships, responsibilities, stable housing, treatment access and willingness to seek help.
- Test each protection against the specific feared scenario: who is reachable overnight, whether medication is collected, and whether the safe place remains accessible.
- Avoid adding risks and protections as a score; formulate how dynamic factors interact, when safeguards fail and what action changes the pathway.
- Assess carers' actual tasks, willingness and strain separately, offering support without assigning unlimited responsibility to family.
- Use functional goals chosen by the person to guide treatment and measure recovery, not symptom reduction alone.
- Document an action, owner and review point for every important functional deficit or protective arrangement.
Key red flags
Rapid loss of washing, eating, mobility, medication use, money management or caregiving may signal severe mental illness, delirium, neurological disease or coercion.
A nominal support person who is absent, exhausted, frightened or abusive cannot be counted as reliable protection during crisis.
Children, pets, work or religion should not be assumed to prevent suicide; they may be sources of purpose, burden or both.
Preserved basic self-care can conceal dangerous impairment in driving, finances, parenting, employment, cooking or treatment decisions.
Service attendance is not synonymous with safety if transport, language, stigma, cost or executive dysfunction prevents use of the agreed plan.
Investigation priorities
Identify change across basic, instrumental, relational, occupational and caregiving domains.
Management branches
Symptoms may be affecting daily safety, roles or independence.
- Map basic, instrumental, occupational, relational and caregiving tasks using recent concrete examples and previous baseline.
- Identify the mechanism for each change, including symptoms, cognition, medicine, physical health, environment, poverty and coercion.
- Prioritise urgent unmet needs and agree which functions should become treatment goals and monitoring markers.