What a risk assessment is
A risk assessment is a structured clinical conversation, and this template is the record of it. Suicide risk is the core, but the same document covers self‑harm without suicidal intent, risk to others, self‑neglect and risk from others, such as abuse or exploitation. It ends with a formulation of why the risk is what it is right now, and a plan.
This page is a documentation aid. It doesn't replace training in suicide risk assessment, your organization's policy or clinical consultation, and it isn't a scoring tool.
Screening, assessment and safety planning
These three are often confused, and they go on different forms. Screening is brief and finds who needs a closer look. The National Institute of Mental Health's Ask Suicide-Screening Questions (ASQ) is four yes/no questions that take about 20 seconds, designed for medical patients aged 8 and above. NIMH's toolkit says patients who screen positive should get a brief suicide safety assessment by a trained clinician, which decides whether a fuller mental health evaluation is needed.
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| Identifies who needs further assessment | ASQ or another validated screen, recorded with the date and answers |
| Evaluates the nature of the risk, its drivers and what reduces it | |
| Gives the client steps to use in a crisis | |
| Records presentation at the time of assessment | |
What each section holds
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| Why the assessment is happening now, and who and what you drew on: the client, collateral, records, screens |
Current suicidal thoughts | Onset, frequency, how long they last, passive or active, any plan, intent, preparatory behavior, and what stops the client acting |
| Past attempts, self-harm, previous crises and what helped |
| Firearms, stockpiled medication and other means relevant to the plan, and what has been done about each |
Risk factors and warning signs | Current factors and recent changes, such as a loss, a discharge or new substance use |
| Reasons for living, people, beliefs, engagement in care, in the client's words where possible |
| Self-harm without suicidal intent, harm to others, self-neglect, risk from others |
| A short paragraph on why the risk is at its current level and what would change it |
| Safety plan, means counseling, session frequency, contacts with others, referral or higher level of care, crisis numbers |
| When risk will be reassessed |
Risk assessment example
Lena (fictional), 45, is in outpatient therapy for recurrent depression. Her divorce was finalized three weeks ago and she has moved into a small apartment. At today's session she said she has been thinking "everyone would be better off without me". Her therapist completed the assessment below.
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| Client disclosed thoughts of death in session. Sources: client interview, last four progress notes, phone call with her sister (with Lena's consent). |
Current suicidal thoughts | Started about two weeks ago, most evenings, lasting up to an hour. Mainly passive ("I wish I wouldn't wake up"). Twice thought about taking her pills, with no decision and no steps taken. Denies intent. Says her son stops her. |
| Overdose at 19 during her first depressive episode, treated in hospital. No self-harm since. No attempts during the 2019 episode. |
| Prescribed medicines at home. No firearm in the apartment; her former husband kept the household handgun. |
Risk factors and warning signs | Recurrent depression, now worse. Past attempt. Recent divorce and move. Drinking three or four glasses of wine most evenings for the past month. Sleeping poorly. |
| Son, 16, who stays with her every other week. Close to her sister. Kept every appointment. Says she wants to "get through this for him". |
| No thoughts of harming others. Self-care slipping: skipping meals. No risk from others identified. |
| Lena's risk is higher than at any time in treatment. Recent losses and evening drinking have deepened the depression, and she has thought about the method she used at 19. She has no current intent, has a strong reason for living in her son and is engaged. The most likely route to acute risk is an evening alone after drinking, especially in the weeks her son is away. |
| Safety plan written together today, including evening steps and her sister's number. Agreed her sister will hold her medicines and give her a week's supply at a time. Evening drinking discussed; she agreed to stop for two weeks and track it. Sessions increased to twice weekly for three weeks. Referral to her psychiatrist for a medication review this week. Crisis line: call or text 988. Will go to the emergency department or call 911 if she feels she might act. |
| F33.2, major depressive disorder, recurrent severe without psychotic features. R45.851, suicidal ideations. Z91.51, personal history of suicidal behavior. |
| Next session, October 23. Reassess at every session while sessions are twice weekly. |
Notice that the formulation names a specific scenario: evening, alone, after drinking, son away. That scenario is what the safety plan and the medicine arrangement target, and it's what the covering clinician needs to read if Lena calls in.
ICD-10-CM codes that come up in risk assessment
| | Notes from the FY2027 tabular list |
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| | Category R45.85- has an Excludes1 note for suicide attempt (T14.91-) |
| | Same category and Excludes1 note |
| | Includes nonsuicidal self-injury. Code also the injury, if known. |
| Personal history of suicidal behavior | Includes personal history of suicide attempt and of self-poisoning |
| Personal history of nonsuicidal self-harm | Includes personal history of nonsuicidal self-injury |
| Suicide attempt, initial encounter | For a current attempt, not a history of one |
Category Z91.5‑ carries a note to code also the mental health disorder, if known, so the depressive disorder or other diagnosis stays on the record alongside the history code. For the depression code in Lena's example, see F33.2.
Blank mental health risk assessment template
- Client, date, time, clinician:
- Reason for assessment now:
- Sources of information (client, collateral, records, screening results with date):
- Current suicidal thoughts: onset, frequency, duration, passive or active:
- Plan, intent, preparatory behavior or rehearsal:
- What has stopped the client acting:
- Past attempts, self-harm and previous crises:
- Access to means (firearms, medication, other) and actions taken:
- Current risk factors and recent changes:
- Warning signs:
- Protective factors and reasons for living:
- Self-harm without suicidal intent:
- Thoughts of harming others:
- Self-neglect, and risk from others:
- Mental status at assessment:
- Formulation (why risk is at this level now, and what would change it):
- Plan: safety plan, means counseling, session frequency, contacts with others, referral or higher level of care:
- Crisis contacts given (988, local emergency number):
- Consultation with supervisor or colleague:
- Next reassessment:
- Clinician signature:
Common mistakes
- Writing "denies SI" and nothing else. Record what you asked, what the client said in their words, and what you observed.
- A risk level with no reasoning. "Low risk" tells the next clinician nothing. The formulation should explain the level and what would raise it.
- Asking about means and not acting on it. If the client has access to the method they've thought about, the plan needs a step for it.
- Skipping collateral. With the client's consent, a family member often knows about drinking, giving things away or a stockpile of pills that the client didn't mention.
- Not reassessing. A risk assessment describes one point in time. Set the next one in the plan.
HIPAA allows a covered entity, consistent with applicable law and standards of ethical conduct, to disclose protected health information when it believes in good faith that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, and the disclosure is to someone reasonably able to prevent or lessen the threat (45 CFR 164.512(j)). Duty‑to‑warn and duty‑to‑protect laws vary by state, so know yours before you need it, and document the reasoning for any disclosure in the assessment.
Documenting risk with Twofold
Twofold drafts notes from the session conversation, and a custom template can hold the sections above. Read a risk assessment draft line by line before signing: the client's exact words about intent and plan matter, and the formulation and plan are your clinical decisions to write.
Use alongside: the safety plan, mental status exam checklist and substance use assessment form. For a fuller evaluation, see the behavioral health assessment and psych eval templates. Follow‑up sessions go in progress notes.
Reviewed and updated October 2026.
