Crisis Intervention and Risk Management
What this domain tests
This domain tests whether you can assess, contain, and document acute risk, and escalate safely rather than rely on reassurance.
Core rules
- Structure the assessment: ideation, intent, plan, access to means, previous attempts, impulsivity, substance use, recent losses, and protective factors.
- Ask directly about suicide. Asking does not increase risk, and avoiding the word is a documented failure.
- No-suicide contracts are not evidence-based. Use a collaborative safety plan naming warning signs, coping strategies, people to contact, and means restriction.
- Match the level of care to acuity: emergency presentation means do not leave the person alone, arrange urgent psychiatric evaluation, involve collateral, and restrict access to means.
- For violence, use structured professional judgement combining static and dynamic factors rather than claiming prediction.
- Document the risk formulation and the follow-up arrangement, not just the patient's words.
Worked example
A 30-year-old reports active suicidal ideation, a specific plan using stored pills, recent job loss, and a prior attempt. Reasoning: ideation plus plan plus means plus prior attempt plus acute stressor indicates high acute risk. Action: remain with the patient, have family secure or remove the medication, arrange same-day psychiatric assessment, complete a written safety plan, and schedule contact within 24–48 hours.
Traps that cost marks
Relying on a denial of intent; discharging without means restriction; missing agitation or recent onset as escalation signals; failing to contact collateral; and writing "no suicidal ideation" without recording what was asked.