Synopsis
Formulate risks of harm by, to and around the person through specific scenarios, history, dynamic factors, safeguarding and environmental evidence, then use proportionate prevention without stereotyping mental illness or overlooking victimisation and self-neglect.
- Assess harm to others, harm from others, self-neglect, exploitation, safeguarding of dependants and environmental hazards as related but distinct scenarios.
- Start with actual behaviour: previous violence, pattern, context, severity, targets, triggers, access to means, consequences and what previously stopped escalation.
- Ask directly about current thoughts, grievances, named people, intent, planning, weapons, stalking, arson, sexual violence and ability to maintain distance.
- Identify dynamic drivers including symptoms, substances, pain, humiliation, housing, relationship conflict, peer influence, treatment disruption and anticipated events.
- Obtain collateral and records with consent where possible; urgent serious-harm or safeguarding information may justify proportionate sharing without consent.
- Use structured professional judgement where the service supports it, but do not let a tool replace formulation, current examination or individual context.
- Include vulnerability and victimisation: coercive control, county lines, cuckooing, financial abuse, hate crime, neglect and inability to protect oneself.
- Match interventions to the pathway through de-escalation, separation, means control, substance treatment, safeguarding, accommodation, victim support and clinical care.
- Record the specific feared event, timeframe, potential victim, warning signs, actions, information sharing and review owner instead of a global risk label.
Key red flags
A named target, recent surveillance, weapon access, rehearsal, command hallucinations or rapidly escalating grievance makes a violence scenario more concrete and urgent.
Intoxication, withdrawal, acute psychosis, mania, head injury, delirium, sleep deprivation and recent non-adherence can change risk rapidly and require cause-specific treatment.
Unexplained injury, fear of a companion, restricted money or communication, sexual exploitation, trafficking or forced medicine use may indicate that the patient is a victim rather than a perpetrator.
Malnutrition, untreated illness, unsafe housing, fire risk, medication omission or inability to seek help can constitute serious self-neglect even without overt suicidal intent.
A psychiatric diagnosis, ethnicity, homelessness or previous detention must not substitute for behavioural evidence or justify blanket coercion.
Investigation priorities
Define past acts, targets, context, severity, legal outcomes, triggers and previous successful prevention.
Management branches
Current behaviour or credible information suggests serious harm may occur soon.
- Secure exits, summon trained support, separate potential victim and aggressor where safe and remove accessible means without provocative confrontation.
- Assess physiology, intoxication, mental state, target, intent, plan and capability while activating emergency or police support when required.
- Use the least restrictive effective intervention and share necessary information with safeguarding or protection services, recording rationale and review.