On the Action Plan you are asked one question about risk.
This unit covers what ACC is asking for in that field, how to approach it at the planning stage, and what to do when the answer is yes.
Start with what the question is mainly about. The field is worded broadly, and other risks belong in it, but the frequent one is risk of suicide or self-harm.
A risk assessment has parts, and it helps to name them. Two of them are things you do. The third is the one people expect of you and nobody can actually deliver.
Asking every client the same questions, whether or not anything in the referral suggests you need to. It is a first pass, not a conclusion: its job is to make sure nothing is missed by default, and to tell you whether a fuller assessment is needed. A screen that comes back clear is a finding in itself, and it is what you are reporting when you tick no.
What you do when the screen brings something back. It is an account of who is at risk of what, under what circumstances, and which factors raise or lower that risk for this particular person — what makes a bad evening more dangerous, and what protects against it. This is the part ACC is relying on you for, because it is the part that tells a reader what to watch and what to do.
Saying what will happen. This is the one everybody wants, and it is the one nobody can do.
What ACC is asking for is the first two. What you write in that field is what you asked, what you found, and what you are doing about it — not a forecast.
Everyone gets screened. Information about risk to self sometimes arrives directly and clearly. More often it comes as an aside on the way to something else, as an answer that doesn’t quite answer the question, or through what the client doesn’t say.
What the client says. Any current thoughts of being better off dead, of not wanting to wake up, or of ending things — whether or not there is a plan or intent attached. Hopelessness about the future, which carries more weight than low mood alone.
What is in the history. A previous suicide attempt is the single strongest indicator there is, and it stays relevant years later. Also previous mental health treatment, and self-harm at any point.
What is in the referral or the notes. Severe depression, a psychiatric history, current psychiatric medication, an ACC file that mentions any of the above. Read these before the first session rather than after it.
What the injury has cost them. Loss of work, particularly work that was an identity; loss of independence; loss of a relationship or a role in the family. Chronic pain and disrupted sleep. These are the risk factors this contract’s clients carry, and they are easy to hear as sad rather than as risk.
What is stacking up alongside it. Increasing alcohol or medication use, isolation, and living alone with little contact.
What you notice. Flatness, dismissiveness about the future, a shrug where you expected an answer. Something that doesn’t match the words.
When one of these is present, you should keep asking for the others.
These terms will help you put what you found into words ACC will understand.
These do not run in a neat line from mild to severe. A person with passive ideation and a recent loss, drinking heavily and living alone, may be in more danger than someone with a vague plan and a great deal to live for. What matters is the combination, which is what your formulation is for.
What they do give you is precision. “Some suicidal thoughts” could mean almost anything. “Passive ideation, no plan, no intent, no history of attempts” tells the next reader what you found.
Always, on every Action Plan — and you will have further opportunities to come back to it. Treatment gives you weeks with this person, and the reports that follow ask again: the Progress Report asks what is affecting progress now, and the Completion Report asks what might get in the way after the end of treatment. Risks that were there at the start can settle, and new ones can appear. You report what has changed as you go rather than holding it to the end.
And separately from any form: if there is an imminent threat to the safety of your client or to you, that is dealt with now, not in a report. What that looks like in practice is at the end of this unit.
Your clients come to you through a physical injury. Here are some potential risks you may encounter.
Some of your clients will experience loss following their injury. It can be that their work, independence or sense of themselves has gone, and they might not be able to see it coming back.
A physical risk that your treatment plan directly affects, because exposure work means asking someone to do the thing they are avoiding.
Pain, poor sleep and time at home make a combination worth asking about plainly. Under these circumstances people may become at risk of turning to harmful ways for relief.
Worth a question when anxiety, medication or concentration are in the picture and the person is still driving.
Most of what you will know about someone’s risk comes from what they choose to tell you. What they choose to tell you depends on whether they trust you. Trust takes time.
ACC asks for the assessment at the planning stage. So the risk assessment you are doing here is not the one you would do with a client you know for a year. It is closer to what happens in an emergency department: direct questions to someone who doesn’t know you yet, answered as honestly as a stranger can manage, plus whatever is on file and whatever you can see in front of you.
“No risks to self or others identified on direct questioning across two sessions” says what you did and the real limitations of the assessment.
The Action Plan is not the last time you will address risks. The Progress Report and the Completion Report are additional opportunities to report on any developments around the risks.
When rapport is thin, the other sources matter more than they will later. The referral and the clinical summary. What the GP has recorded, if you have it. What the client says about who is around them and how things are at home. What you can see: how they present, what they avoid saying, what changed between the first session and the second.
It is easy to experience these questions as an obstacle to building rapport — something administrative you have to get through before the real work starts.
They aren’t. Asked well, they do the opposite. A person who has been managing something frightening on their own, and who watches you ask about it directly and not flinch, has just learned something useful about what this room is for.
The planning sessions are where the relationship starts. The risk conversation is part of how it starts, not an interruption to it.
A risk assessment is something you do with your client, not to them. Three things follow.
Say what you are doing before you do it. A sentence is enough: that you ask everyone about this, that it is part of understanding how the injury has affected them, and that it is not because of anything they have said. Clients who are told why a question is coming answer it more openly than clients who are ambushed by it.
Ask directly. Indirect questions get indirect answers, and the worry that asking about suicide plants the idea is not supported by the evidence. Asking plainly, and being able to sit with the answer, is the thing that helps.
Be clear about where it goes. Your client knows the report goes to ACC — you confirm that on the declaration. If something they tell you is going to appear in the Action Plan, they should hear that from you at the time, not discover it later. And they should know the limits: what you would do if you were worried about their immediate safety, and who you would contact.
When risk is present, what ACC wants to see is that there is a plan and that it is real.
What a usable plan contains, in plain terms: what tends to lead up to the difficult periods, what the person can do first, who they can contact, what to do when that isn’t enough, and what has been done about access to anything that would make an impulsive act easy.
There is room here for how you work. Every psychologist has their own questions, the ones they ask comfortably and naturally, and those are usually the ones that work best.
Some of us arrive at them through what the person in front of us is describing, following the symptoms into the territory. Others prefer to say plainly that there are a few questions they ask everyone about risk to themselves, and then ask them. Neither is more correct than the other.
If you already use a brief symptom measure, it may carry an item about thoughts of being better off dead. Treat a positive response there as the start of a conversation rather than as the finding.
Where there is something to plan for, a written safety plan is worth doing properly rather than from memory.
For Māori clients in particular, a holistic frame — te taha hinengaro alongside tinana, whānau and wairua — often gets at what is actually happening better than a symptom checklist does.
Active suicidal ideation is a different matter, and it is worth being clear about the limits of this service. A PSY60 block exists to treat psychological difficulty that is getting in the way of recovering from an injury. Someone who is acutely at risk needs more than that, and sooner than an Action Plan can deliver it.
If that is what you are seeing, contact us before you write the plan. We will raise it with the Recovery Partner, and the conversation is not only about risk management — it is about whether this referral, as it stands, is the right service for this person right now.
Alongside that, the clinical route is the usual one: the GP, and the crisis team where it can’t wait.
The form asks for three things when the answer is yes: the risks, the duty of care actions taken, and how the risk will be managed.
“Duty of care actions taken” is the form’s phrase. It means what you did, not what you concluded — actions, in the past tense.
At the Action Plan stage, for most clients, that is a short list: you asked, you discussed it with the client, you agreed what would happen if things got worse, and you told the RP and us.
ACC’s published materials for this contract do not set out a risk protocol. What the contract does require is that ACC is told immediately where there is an imminent threat to the safety of a client or a provider, and that is handled through us.
A low-risk case, and the answer is still specific. It says what was asked and what was found, and it names the one real risk that the treatment plan itself has to work around.
Paul is 48. He fell off a roof eighteen months ago and his back has not recovered enough for him to return to the work he has done since he was seventeen. In the second planning session he says he is not sleeping, that he feels useless around the house, and that he has been wondering what the point of it all is. He has no plan and says he would not act because of his kids. He is drinking most evenings.
If you are worried about someone’s immediate safety, that is not a reporting question.
This is the ordinary state of affairs rather than a failure, and there are three places to take it.
Your supervisor. The obvious place, and the one people skip, because raising it can feel like admitting you should already know. An uncertain risk picture is exactly what supervision is for.
Us. Tell us early. We would far rather hear about an uncertainty while it is still one than read about it in a Completion Report. Some of what you are weighing up is our side of the work anyway — whether the referral still fits, and whether the Recovery Partner needs to know.
PractiSpace Providers Group. You are not the first person in this network to sit with this question, and the group is a good place to think out loud about how others have handled something similar.
The risk field on the ACC266 is asking whether you looked, what you found when you looked, and what you did about it.
As psychologists, we know that inviting someone to hand over part of what they are carrying can be the moment a relationship starts. A risk assessment, asked well, is a hand held out.