Clinical Observations and Risk Assessment

Inform clients that you are required to inform another professional in some instances but that you would address any concerns and actions with them first before telling anybody else.

Examples of where we would contact other professionals include:

  • Imminent risk of harm to you or someone else
  • Concerns about your safety or that of others
  • Any child protection concerns 
  • Disclosure of criminal behaviour

Ask the client for emergency contacts and preferred mode of communication. This information should be updated at the start of each session in case of any recent changes.

Alcohol intoxication

Look out for signs of alcohol intoxication such as:

  • Slurred speech
  • Clumsiness
  • Uncontrolled eye movement
  • Memory gap

You should discontinue the session if you find that the client is intoxicated.

Drug intoxication

Be vigilant for the appearance of a combination of the following signs at the beginning and during the session:

  • Enlarged pupils, bloodshot or glassy eyes
  • Increased energy and confidence
  • Loss of inhibitions
  • Loss of coordination
  • Aggressive behaviour
  • Tremor and twitches
  • Paranoia (being extremely suspicious)
  • Hallucinations (hearing or seeing things that aren't there)
  • Nausea and vomiting
  • Complaints of stomach cramps, blurred vision, headaches or dizziness
  • Complaints of exhaustion, fatigue or insomnia (being unable to sleep)
  • Irritability and moodiness
  • Anxiety symptoms like panic attacks, dizziness, sweating, dry mouth, muscle aches and headaches.

If you observed a combination of these signs, ask the client if they had recently consumed a psychoactive drug (ask them to specify the type of drug). Discontinue the session and give them information on where to seek help, e.g., the NHS helpline –

Please note that drugs can affect different people in different ways. You should discontinue the session if you find that the client is intoxicated.

Suicide ideation

Look out for any signs of suicide ideation.

  • Severe sadness or moodiness
  •  Hopelessness
  • Withdrawal – Social withdrawal and isolation
  • Sudden changes in personality or appearance
  • Dangerous or self-harming behaviour
  • Recent trauma or life crisis
  • Talking about how they don't have a purpose of living or how others would be better off without them
  • Talking about dying or wishing to die
  • Expressing sentiments of being empty, useless, or helpless in the face of current problems and circumstances
  • Expressing deep feelings of remorse and shame
  • Talking about giving away personal belongings and tying up loose ends

Explore the severity of ideation and determine if there are suicide plans. If there are plans, then develop a suicide safety plan.


Suicide - Safety plan

If you notice a pattern of warning signs that point to a suicide crisis, you should make a safety plan right away.

Reassure your client and divert their attention from suicidal ideas to de-escalate the situation.

Explore with the client if they have any plans.

Ask about the client's social support system, such as family and friends. Determine with the client who the best source of support is and obtain the client's consent to contact them.

Make an emergency call to LIVI Interim Clinical Lead – Mental Health or On-call GP (out-of-hours) explaining the crisis

Request the client's GP's contact information and permission to contact them.

Provide the client with emergency contact information, such as the Samaritan.

Explore with the client ways to limit access to lethal means of suicide, such as a stockpile of medication like paracetamol, and obtain authorization to contact a relative who can secure the deadly means.

Document the plan in EMIS and discuss it with your supervisor.

Ongoing monitoring

Conduct a suicide risk assessment at subsequent sessions and evaluate and revise your plan as needed.

Please refer to the Livi procedure for more guidance: