FACE Risk Profile MH Adult

RA

Confidential

This form is to be completed following the assessment and/or review of risk, in accordance with local Clinical Risk Management Standards.
Written details of current and past risks/behaviour should be provided on p.2/3. This form must be photocopied onto gold coloured paper

Assessment summary
Surname:

Risk history

First name:

Is there any evidence of a history of

significant risk behaviour?

Alias::

Involvement in serious incident in past 3 months?

Gender:

No

NHS number:

Current risk status (rate using the following scale):

Title:

Care co-ordinator/Lead Professional details:

Base:
Yes

Not known

1 = Low apparent risk. No current indication of risk, but

persons history and/or warning signs indicate possible risk.
Required precautions covered by standard care plan i.e. no
special risk prevention measures or plan required.

Name:

CPA (circle)

SUI

No

0 =No apparent risk. No history/warning signs indicative of

risk.

Date of birth:

Tel:

Near miss

Yes

No

N/A

3 = Serious risk. Substantial current risk. Circumstances are

such that a risk management plan should be / has been drawn
up and implemented.

Agencies involved: (tick)

Health services

Probation services

Social Services

Police

Voluntary sector

Other (specify)

2 = Significant risk. Persons history and condition indicate the

presence of risk and this is considered to be a significant issue
at present. Requires a contingency risk management plan.

4 = Serious and imminent risk. Persons history and/or

warning signs indicate the presence of risk and this is
considered imminent. Highest priority to be given to risk
prevention.

Legal status upon assessment: (tick)

Risk of violence to others

None

On leave

Risk of suicide

Informal

s117

Risk of self-harm

Detained

Guardianship

Risk of accidental harm to self

Assessment details

Risk of severe self-neglect

Assessed by:

Risk related to physical condition

Designation:

Risk to child / vulnerable others

Date of assessment:

Risk of abuse / neglect / exploitation by others

Location of assessment:

High Risk of relapse?

Yes

No

Assessment type (tick):

Potential risk to staff members?

Yes

No

Yes

No

Initial

Review

Risk management plan developed?

Discharge

Follow-up

Further action(s) recommended/required: (tick)

Assessed in crisis situation?

Yes

Signed:

No

No further action at this stage

Further risk assessment
Discussion with RMO / team members

Date:

2000-3 FACE Recording & Measurement Systems

Date of next review:

DMHST Records Management Approved Clinical Document

Nov 2010 page 1 of 4

Service user name:

NHS number (d-o-b if not known):

Risk factors and warning signs

Time frame for all Current warning signs = past month. For all sections if No to History and Current, leave boxes in that section blank. Otherwise
place a in all boxes which apply and an X in boxes that do not apply. Enter 9 if not known or unable to assess (where risk is indicated in any
section, do not leave any boxes blank). Under Notes give brief details of recency, severity, frequency, pattern, ideation and intent.

Clinical symptoms indicative of risk

History

Current

No

No

History

Current

No

No

Notes

Early warning signs of relapse

Ideas of harming others
Ideas of self-harm/suicidal ideation
Delusions
Command hallucinations
Morbid jealousy
Impulsivity / lack of impulse control
Other

Behaviour indicative of risk

Physical harm to others
Threats/intimidation
Preparation to harm others inc. carrying weapons
Evidence of targeting (children/females/males)
Child protection issues
Suicide attempts
Plans or preparations to commit suicide
Self-harm
Domestic risk (falling, unsafe use of appliances, fire risk)
Drug/alcohol abuse
Fire-setting
Reckless or unsafe behaviour (e.g. unsafe driving)
Severe self-neglect
Absconding
Wandering

Treatment-related indicators

History
No

Current
No

Discontinuation of medication
Failure to attend appointments
Unplanned disengagement from services
Compulsory admission
Supervised discharge
Restriction order
Conditional discharge

Forensic history

History
No

Current
No

Conviction for violent or sexual offences

Special hospital
Admission to Secure unit
Admission to intensive care ward
Other involvement suggesting risk (e.g. injunctions)

Personal circumstances indicative of risk

History
No

Current
No

Family history of suicide

Physical problems/frailty (e.g. risk of falling, bed bound)
Recent severe stress
Concern expressed by others (relatives, carers)
Recurrence of circumstances associated with risk
behaviour
Abuse/victimisation by others
Social isolation
Rootlessness

2000-3 FACE Recording & Measurement Systems DMHST Records Management Approved Clinical Document Nov 2010

page 2 of 4

Service user name:

NHS number (d-o-b if not known):

Persons potentially at risk (tick as appropriate and detail below)

None

Self

Partner/spouse

Staff member

General public

Child

Parent

Group (specify)

Other (specify)

Summary of main risks identified

Have actions been taken in the past to reduce risk? (Detail, including effectiveness)

Yes

No

Unclear

No

Unclear

Service users view of risk (Give details, including persons view of what is needed to reduce risk)
Is the service user aware of possible risks?

Yes

Protective factors

2000-3 FACE Recording & Measurement Systems DMHST Records Management Approved Clinical Document Nov 2010

page 3 of 4

Service user name:

NHS number (d-o-b if not known):

Relapse and Risk Management Plan

Risk alert applied (state IT system)
Service user informed:

Agreed by:

Date applied:

If not, state why:

Review date:

Trigger signs, symptoms, behaviour suggestive of possible risk/relapse to be addressed by plan

Steps to be taken if service user fails to attend or meet other commitments (tick, detail below)

None

Send further appointment

Discuss with RMO

Contact GP

Contact care co-ordinator

Contact care manager

Contact nominated carer

Telephone

Visit home

Other (specify)

Action to be taken in the event of risk behaviour/relapse

Information sources available / accessed in completing risk profile (Tick all sources used)
Service user
Copies sent to: (tick)

Case notes
Date

Carer/relative

Other (specify)

Copies sent to: (tick)

File

GP

Care co-ordinator

Social services

User

Other

Plan completed by:

Signed:

Designation:

Date:

Signature of service user:

Date:

2000-3 FACE Recording & Measurement Systems DMHST Records Management Approved Clinical Document Nov 2010

Date

page 4 of 4