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Table 3

From: Accuracy of telepsychiatric assessment of new routine outpatient referrals

RAS (Risk Assessment Schedule)

Enter the RISK in terms of NIL, LOW, MEDIUM, HIGH & VERY HIGH Risk.

     

MENTAL STATE (RAS – 1)

N

L

M

H

V

Behaviour

     

• Dangerous or threatening actions

N

L

M

H

V

• Verbal/non-verbal risks

N

L

M

H

V

• Deliberate self harm

N

L

M

H

V

• Aggression

N

L

M

H

V

Affect

     

• Arousal, anger, hostility, irritability, suspiciousness, fear

N

L

M

H

V

• Low mood or elevated mood

N

L

M

H

V

Cognition

     

• Fantasies of deliberate self harm or harm to others

N

L

M

H

V

• Persecutory thoughts, delusions

N

L

M

H

V

• External control

N

L

M

H

V

• Confusion

N

L

M

H

V

• Preoccupation, obsession, jealousy

N

L

M

H

V

• Control over-ride

N

L

M

H

V

• Cultural beliefs

N

L

M

H

V

Perceptions

     

• Command hallucinations

N

L

M

H

V

• Misidentification

N

L

M

H

V

• Matakite

N

L

M

H

V

ENVIRONMENTAL/CURRENT FACTORS (RAS – 2)

N

L

M

H

V

Immediate stressors

     

• Substance use, intoxication or withdrawal

N

L

M

H

V

• Relationships

N

L

M

H

V

• Presence or absence of support

N

L

M

H

V

• Absence of treatment, non compliance

N

L

M

H

V

• Persecution or threats from others

N

L

M

H

V

• Arrest or criminal charges

N

L

M

H

V

• Loss including death of a peer

N

L

M

H

V

• Cultural transgression

N

L

M

H

V

• Financial stress

N

L

M

H

V

Access

     

• To weapons, pills, victims

N

L

M

H

V

Situation

     

• Referral from Prison, Police, Secure Unit

N

L

M

H

V

Individual's attitude

     

• Co-operation

N

L

M

H

V

• Refusal to co-operate or fear of compulsory treatment

N

L

M

H

V

HISTORICAL INFORMATION (RAS-3)

N

L

M

H

V

Illness and incidents

     

• Patterns of illness – Chronic active, Neurological disorder, H/O Head injury

N

L

M

H

V

• Psychiatric history – Serious mental illness, Multiple diagnoses, Treatment under MHA

N

L

M

H

V

• History of incidents (and context) – Repeated antisocial behavior

N

L

M

H

V

• Treatment and outcomes – Compliance and response of treatment given in past

N

L

M

H

V

• Features of past crises – Pathological intoxication, Episodic dyscontrol, Cruelty to animals, Blackouts

N

L

M

H

V

• Personal history – Criminal charges, Previous offenses, Forensic involvement

N

L

M

H

V

Personality

     

• Usual coping style – Loner, Displaced rage reaction, self mutilism, Impulsivity, denial, Blaming others

N

L

M

H

V

Family background

     

• Demographics – Single, Male, Poor, Low educational and vocational success

N

L

M

H

V

• Culture – Tolerance to antisocial behavior, Reluctance to disclose, Shame & Guilt

N

L

M

H

V

• Dynamics – H/O Violence, Contact of violent gangs, Intrafamilial violence

N

L

M

H

V

OUTCOME OF RISK ASSESSMENT

(Use knowledge & Information gathered from RAS-1, 2 & 3)

RISK TO SELF

N

L

M

H

V

1. Safety (including suicidal acts, deliberate self harm)

N

L

M

H

V

2. Health (incl. drug & alcohol abuse, physical & psychological harm)

N

L

M

H

V

3. Self neglect and vulnerability (incl. exploitation, sexual abuse, violence from others)

N

L

M

H

V

4. Quality of life (including dignity, social and financial status)

N

L

M

H

V

RISK TO OTHERS

N

L

M

H

V

1. Violence (including emotional, sexual and physical violence)

     

2. Intimidation/threats

N

L

M

H

V

3. Neglect/abuse of Dependants

N

L

M

H

V

4. Stalking/harassment

N

L

M

H

V

5. Reckless behavior (including driving)Property damage (including arson)

N

L

M

H

V

6. Public nuisance

N

L

M

H

V