Structured Risk Assessment Note (IIPAP + FINDIE Integrated) - Clinical Psychology

**Date and Context:** 1 November 2024 In-person **Identified Risk Factors:** Static: History of recurrent major depressive disorder, childhood trauma, previous suicide attempt 2 years ago. Dynamic: Recent job loss, relationship breakdown, increased alcohol consumption, social isolation, poor sleep hygiene. **Ideation (I):** Suicidal ideation present, specifically thoughts of ending life due to feelings of hopelessness and burden to others. Frequency: Daily, often in the evenings. Intensity: Rated as 7/10 on a subjective distress scale. Explicit number of times ideation occurred: Client reports experiencing these thoughts multiple times each day for the past two weeks. Duration or temporal pattern: Episodes last between 30 minutes to 2 hours, particularly when alone. Impact of ideation: Significant impact on functioning, leading to difficulty concentrating at work (prior to job loss), poor sleep (waking frequently with intrusive thoughts), and reduced engagement in social activities. Client reports feeling 'drained' by the thoughts. Exceptions, protective contexts: Ideation slightly reduced when engaged in active tasks or spending time with his sister. **Intent (I):** Client expressed fluctuating intent to act on suicidal ideation, stating, "Sometimes I wish I could just disappear," but also, "I don't really want to hurt my family." **Plans (P):** Client admitted to having fleeting thoughts about taking an overdose of prescribed medication, but stated they had not taken any steps to acquire extra medication or research methods. Denied having a specific timing or location in mind. **Actions (A):** Client has been researching 'ways to cope with severe depression' online, which included some pro-suicide forums, though client denies engaging with these actively. No preparatory behaviours, recent self-harm, or acquisition of means reported. **Protective Factors (P):** Internal: Client values his relationship with his sister and expresses a desire to not cause her pain. He also mentioned a fleeting hope that things could improve. Expressed a strong internal value against self-harm due to religious beliefs. External: Supportive sister who checks in regularly. Previous positive therapeutic experience. Engaged with the current therapy session. **Changeable Factors (Risk Modifiers):** Factors that may increase risk: Increased alcohol intake, social isolation, recent relationship breakdown, financial stress due to job loss, access to prescribed medications. Factors that may decrease risk: Engagement in therapy, support from sister, development of coping skills, reduction in alcohol consumption, engagement in meaningful activities. **Current Risk Presentation:** Client presents with persistent suicidal ideation, low mood, anhedonia, and feelings of hopelessness. While there is no explicit, detailed plan or active preparation, fluctuating intent is present. Affective state is subdued, and client appears withdrawn. Acute triggers include recent job loss and relationship breakdown. **Clinical Judgement and Stratification:** Clinical judgement of risk level is moderate due to persistent ideation, fluctuating intent, passive planning, presence of multiple static and dynamic risk factors, and a history of previous attempts. Protective factors are present but are currently being outweighed by stressors. **Immediate Actions Taken:** Safety planning was initiated, focusing on identifying triggers, developing coping strategies (e.g., calling sister, going for a walk, engaging in a hobby), and identifying a crisis contact number. Grounding techniques were practised during the session. Crisis signposting provided, including local mental health crisis line and emergency services numbers. Client agreed to remove excess medication from immediate access and store it securely. **Follow-Up Plan:** Next appointment scheduled for 3 days' time to review safety plan and continue therapeutic work. Client encouraged to contact therapist or crisis services if ideation intensifies or intent becomes more concrete before the next session. Referral to a support group for individuals experiencing job loss will be provided. Monitoring of alcohol intake to be reviewed at the next session.