Risk Manual
CareUK (ieso)
Introduction
This guide outlines the core procedures for assessing and managing clinical risk, including suicide, self-harm, and safeguarding concerns. All clinicians are expected to follow these best-practice protocols. Many will be familiar, but each is essential to delivering safe, consistent, and compassionate care.
Risk Assessment and Management
Risk assessment is an ongoing process that continues throughout therapy. Clinicians are expected to:
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Complete a full risk assessment at the initial session.
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Monitor and review risk at every subsequent session.
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Ensure suitability of the patient’s risk level for treatment within our service.
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Collaboratively create and agree a risk management or safety plan with the patient.
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Record clearly all risk concerns, decisions, and actions in each clinical note.
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Raise and review any risk issues in supervision.
While clinicians are expected to take all reasonable steps to assess and manage risk, please remember that we are not a crisis service. Patients are informed of this at referral, and it is helpful to remind them of this when risk is being discussed. Clinicians hold primary responsibility for assessing, managing and documenting risk.
Please familiarise yourself with the NHS guidance on assessing and monitoring risk: NHS England » Staying safe from suicide
Urgent risk support
For situations involving immediate and serious risk of harm, debrief support is available during normal working hours (9am - 5:30pm), evenings (5:30pm-8pm), and at weekends (8am - 8pm). This is provided via a same-day call-back service (during the working hours above) from a Clinical Supervisor.
All affiliate clinicians remain responsible for taking the initial actions when risk arises in patients. This includes contacting emergency services if there is an immediate threat to life or to others. Where the risk is not urgent but there are concerns around vulnerability, the affiliate clinician is expected to carry out a full risk assessment. Detailed risk assessment templates can be found below.
Detailed risk assessment templates and guidance:
Clinical supervision is available to debrief any risk situations that have been managed, to provide guidance on any further steps that may be required, and to support with the writing of rationales where needed. That said, it remains the clinician’s duty to act promptly in managing immediate risk. This includes calling emergency services when necessary, completing thorough risk assessments, agreeing safety plans with patients, obtaining consent, completing onward referrals and then discussing the case with the supervisor.
Process:
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If a patient is at immediate risk, always contact emergency services first to avoid any delay in care. It is important that you take all the necessary steps to manage any risk, including creating a safety plan and updating the patient's GP.
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Once the situation has been managed, if you feel you would benefit from discussing the case, please submit an ‘Urgent Risk Debrief’ task in iaptus. Use this to record the incident and request debrief support.
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The clinical team will monitor these tasks and, if appropriate, will contact you directly on the mobile number listed in the therapy room platform. You will receive a call back within working hours.
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If a crisis referral is made out of working hours please do not email referrals. All emails must be sent via the Patient Services Team (therapist@mindler.co.uk) secure NHS email. Please phone in any referrals and this can then be followed up with an email during working hours.
Guidance for Contacting Emergency Services/111 on Behalf of a Patient
Important: When phoning 999/111, always make it clear to the call handler that you are calling on behalf of a patient who is not in your area. You will need to be transferred to the emergency services/local crisis team covering the patient’s location to ensure they receive the right and timely support.
When you need to contact emergency services for a patient, it is essential that the call is handled clearly and effectively. Please follow the steps below:
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Dial 999 immediately.
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State clearly which service you require first – either ambulance or police.
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Advise that you are calling on behalf of a patient. Make it clear that the emergency is not at your location.
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Provide the patient’s location.
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Explain that the patient is in a different part of the UK from where you are calling.
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Ask to be transferred to the local emergency service department covering the patient’s area.
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Proceed with the request for support once connected to the correct local team, ensure you provide all relevant details about the situation and the patient’s location.
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Log everything within a non-MDS clinical contact, including any reference numbers.
In the event that the client or the clinician is abroad they are to call 112 (Europe-wide emergency number). The 112 operator can connect the clinician to the emergency services in the UK.
Risk identified outside of an appointment
Self-Referral WYSA Triage Form:
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Self-referring patients complete a WYSA triage form. Occasionally, risk concerns may be disclosed within this form. Please review the form details in the Clinical Contacts section of the patient’s iaptus record.
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Service referrals:
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The service assessments and risk assessment can be found within the Clinical Contacts section of the patients iaptus record.
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Clinicians are expected to review this information before the patient’s first session.
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If a patient has indicated possible risk before the session, please send the template for when risk is identified in a patients referral form
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If a patient has indicated possible risk and they do not attend their appointment, please message the patient in the therapy room, follow our usual DNA procedure but edit the message template to remind the patient of the helpline numbers.
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If they go on to drop out of treatment without engaging in an appointment, send a letter to their GP using the ad hoc risk template advising that risk was indicated but they have not been assessed. ​
Responding to patient messages indicating risk
Patients can send messages at any time once the therapy room has been activated, you will receive an email alerting you that a message has been sent. We do not expect you to check messages immediately, but please respond within 48 hours
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By the time you see the message, distress may have lessened. However, please always acknowledge the patient’s feelings and, if appropriate, ask if they can keep themselves safe until your next session. If there’s no response, use your clinical judgment to decide on further action based on the risk level
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For non-urgent risk, please remind patients in a compassionate way that Mindler is not a crisis service. Encourage them to reach out to their GP or national helplines, if they feel at risk between sessions. If a risk management plan has not yet been created, share the Noticing and Managing Suicidal Thoughts resource and let them know you will review it together at the next appointment.
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If you read a recent message indicating a significant and immediate high level of risk, you may need to:
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Call the patient using a withheld number. Document the call as a non-MDS clinical contact and delete the patient’s number from your call logs.
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Call 999 and follow the guidance above if emergency services are required.
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Call the out of hours G.P service (111)
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Log all actions taken in a Non-MDS clinical contact.
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Raise an urgent debrief task and include whether you require a call back.
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Please note: Urgent debrief call-backs are available during the following times:
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Urgent Debrief Risk tasks are monitored Monday to Friday, 9:00 am to 5:30 pm. Outside of these hours, debrief call-backs are available from 5:30 pm to 8:00 pm on weekdays, and 8:00 am to 8:00 pm on weekends. You may not receive an immediate call back, please ensure you prioritise actioning any risk management actions.
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Urgent risk letters and GP Communication
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GPs should be updated whenever a clinical risk such as suicide, self-harm, or safeguarding concerns are identified. Please refer to our ‘How to Guide’ for support on how to write to the GP appropriately.
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For urgent letters, you must email Patient Services directly to request that the letter is sent as a priority. Please email therapist@mindler.co.uk and put ‘Urgent/risk’ in your email heading.
Creating a Risk Management/Safety Plan
When to create a safety plan:
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If a patient presents with risk of suicide or self-harm
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If a patient presents with risk to/from others and/or there are safeguarding concerns
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Purpose of the plan:
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A safety plan does not guarantee safety, but it helps patients to:
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Identify their own strategies for managing difficult moments.
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Know when and how to reach out for further support.
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How to create the plan:
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Explain the purpose of the plan before completing it.
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Work through the plan collaboratively, checking at each step that the patient feels comfortable and agrees.
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The plan should be meaningfully adapted to the patient and their current circumstances, not a ‘tick box’ exercise.
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Ensure both clinician and patient have a copy. Clinician to upload a copy to IAPTus under the ‘documents’ tab where possible.
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Encourage the patient to keep their copy easily accessible (e.g. printed, saved on their phone).
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Signpost to useful tools such as the StayAlive app.
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Revisit the plan at each session. Check it remains useful, relevant, and acceptable to the patient.
Safeguarding concerns
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Please check the individual site protocols for their safeguarding processes.
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Read through the detailed safeguarding assessment and guidance
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Raise a non-urgent risk task and discuss with your clinical supervisor.
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For urgent safeguarding concerns please raise an urgent debrief call task.
Client safety
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The client must not be operating a vehicle during an ongoing call. If they are, ask the client to safely park and then continue the conversation or agree to reschedule.
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If a client is intoxicated or otherwise impaired, the conversation must not continue (unless risk issues require exploration first). The client may return in a sober state and go on to receive Mindler intervention or can be referred on to other services where appropriate (e.g. addiction support lines).
Recording risk on IAPTus
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A risk template is autopopulated in IATPus for every MDS clinical contact. Please ensure that all sections are completed at every session.
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If a patient scores on the PHQ9 Q9 this must be commented on. e.g. if it is scored in error this must be explicitly clarified in the risk section
Reporting a serious incident
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Email your supervisor and cc. therapist@mindler.co.uk
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In the subject heading, type: ‘SERIOUS CLINICAL INCIDENT/URGENT while under our Care: (*insert IAPTUs Case Ref and site).
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DO NOT include any patient identifiable information in the email.
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In IAPTus, add any clinical information to a non MDS clinical contact for your Supervisor and Patient Services to refer to.  
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Please log the incident by creating an ‘Urgent risk’ task to be picked up the same day. 
