Risk does not always present clearly or directly. It may emerge gradually through subtle changes in a client’s thoughts, behaviors, emotions, or engagement in treatment.
Pay attention to changes from the client’s baseline and explore changes or concerns when they arise. Early recognition and assessment can support timely intervention.
Common Risk Indicators
Verbal indicators
Clients may communicate increased distress directly or indirectly. Always explore statements within the context of the client’s overall presentation.
Examples include:
- Expressions of hopelessness
- Feelings of being a burden
- Passive thoughts of death or disappearance
- Statements expressing overwhelm or an inability to cope
- Threatening or violent statements
For example, a client might say:
“I just can’t take it anymore, it’s too much.”
A statement like this should be explored rather than interpreted in isolation.
Behavioral changes
Changes in behavior may reflect increased distress, reduced ability to cope, or increasing symptom severity.
Look for:
- Withdrawal from activities, relationships, or treatment
- Increased irritability, agitation, or impulsivity
- Changes in sleep, eating, hygiene, or other daily routines
- Risk-taking or self-destructive behaviors, such as reckless driving or unsafe substance use
Emotional and cognitive changes
Potential indicators include:
- Intense or rapid mood changes
- Dissociative symptoms
- Difficulty concentrating or making decisions
- Rigid, hopeless, or all-or-nothing thinking
- Changes in judgment, insight, or behavioral control
From Warning Signs to a Clinical Crisis
A warning sign does not necessarily mean that a client is experiencing an acute crisis. Assess the overall clinical picture, including:
- Nature of the concern
- Severity
- Progression
- Immediacy
A clinical crisis is a situation involving acute distress, dysregulation, or other safety-related concerns that require timely intervention to support stabilization and reduce the likelihood of harm.
Crises are dynamic and context-dependent. Severity, urgency, and presentation can vary, and not all crises are emergencies—but they do require a prompt response.
Examples of clinical crises may include:
- Suicidal ideation or behavior
- Self-harm urges or actions
- Risk of harm to others
- Acute mental health decompensation affecting safety, judgment, or behavioral control
- Significant intoxication, withdrawal, overdose risk, or another acute substance-related concern
- Inability to meet basic needs or maintain personal safety