Risk assessment, management and safeguarding are important to consider when working with clients throughout therapy and coaching.

This policy outlines guidance on what to do if you become concerned about a client or a vulnerable person while working with Unmind Talk. It is an aid to decision-making only and does not replace clinical judgment or consultation with clinical or coaching supervisors. All Unmind Talk practitioners are expected to use clinical or coaching supervision to discuss risk and safeguarding issues. This policy does not replace guidelines written by practitioners’ regulatory authorities and professional bodies. This policy (and any other policies provided by Unmind) is in addition to such guidelines.

When in doubt, Unmind Talk practitioners should consult with the policies written by their regulatory bodies, and their clinical or coaching supervisor.

As a practitioner, you are responsible for assessing and managing risk. You are encouraged to familiarise yourself with crisis services, resources and laws in the locale(s) in which you see clients. We encourage you to keep crisis details on hand so it is easy to share them when needed. This policy details scenarios in which risk might arise, but is not exhaustive. It is expected that you use your clinical judgment to determine the most appropriate action in the case of any situations not covered in this policy.

Risk before you meet the client

Assessing and managing risk at initial and ongoing sessions

Safeguarding

Further considerations

Risk before you meet the client

When a client requests a session, they have the opportunity to input some free text with the prompt, ‘What topics or issues would you like to address during your session?’. This is sent to you along with the other details of the booking request and is designed to help you prepare for the initial session. Note that staff at Unmind do not see the content of the client’s message.

In the event that you receive a message that causes you immediate concern over a client’s safety, you must act in line with your duty of care.

If a client’s message causes you concern that they are unsafe, we urge you to make contact with the client stating the following:

• Validate their distress and let them know that you are concerned by the content of their message
• Encourage them to stay safe, to get to a place of safety, such as their local hospital, or to contact a trusted friend or family member.
• Provide them with an emergency number to call (see our list of crisis hotlines)
• Remind the client that Unmind Talk is not a crisis service.
• Arrange a session as soon as you can and, in your communications, remind the client of the above.

If you are unable to offer a session or decline to see the client, please inform Unmind as soon as possible but do not close the client or leave them without addressing the risk issues. There should be a clear handover regarding risk management.

If you do not hear back from the client, please use your professional judgment to take further actions in proportion to the risk indicated.

A client may score 1 or above on question 9 of the PHQ-9 in their Session Preparation (’How often have you had thoughts that you would be better off dead, or of hurting yourself in some way?’). Please consider carrying out a full clinical risk assessment in your next session or contact them before this if you have concerns or feel it would be better to assess them sooner.

Assessing and managing risk at initial and ongoing sessions

It is important to conduct a risk assessment as part of your first meeting with the client and when risk concerns arise. We encourage you to follow your risk assessment protocol, but you must include:

• Whether the client is having thoughts of suicide or self-harm.
• Whether the client is at risk of harm from anyone else.
• Whether the client is at risk of harming someone else.

If the client discloses risk to themselves, you must conduct a full risk assessment to assess:

• Nature/content of thoughts.
• Current plans or preparations.
• Intent to act.
• Means to act on thoughts.
• Past attempts.
• Triggers to escalation of risk.
• Protective factors.

You should take appropriate action depending on the level of risk identified.

We recommend you create a meaningful safety plan collaboratively with the client outlining:

• While you can offer support, you are unavailable to be contacted if they are in crisis.
• What steps they can take to reduce their risk of acting on thoughts of suicide or self-harm.
• Warning signs and triggers.
• What has helped in the past/ways of coping and soothing.
• Helpful self-talk.
• How others can help.
• Who they can contact:
  • Their doctor.
  • Friends/family.
  • Crisis helplines.
• Places of safety.
• Reminder of local emergency services and how to contact them.

A safety plan template can be found attached to this article (scroll to the bottom).

If you believe that the client is at risk of serious self-harm, or suicide, or in need of urgent support, it’s important to connect/refer them to crisis services to support them as soon as possible where appropriate.

We encourage you to consider notifying the client’s doctor or other healthcare provider, and/or their emergency contact, to alert them to your concerns.

It is important to continue assessing and monitoring risk throughout the time you are working with the client and to use supervision to discuss any concerns that you have.

Safeguarding

You must take appropriate action if you believe a vulnerable person is at risk of being harmed, neglected or abused.

Issues of concern could include any of the following (but are not limited to):

• Harm, abuse or neglect of a child or vulnerable adult.
• Financial abuse.
• Domestic violence.
• Elder abuse or neglect.
• Sexual exploitation.
• Radicalisation.
• Human trafficking.
• Female genital mutilation (FGM).

If you suspect a safeguarding issue, you must follow the guidance laid down by your regulatory or professional body, and consult with your supervisor to determine the appropriate course of action. You are required to follow local reporting guidelines, and this will vary depending on your location.

What information might you need to report a safeguarding concern?

For adults:

• Client's full name, address, and contact information.
• Date of alert and method of gathering the information.
• Verification of consent for information sharing.
• A detailed description of concerns, emphasizing the specificity.
• Identification of alleged perpetrator(s).

For children:

• Full details including name, address, and date of birth of the child/children.
• Contact information for parent/carer/professional involved.
• Assessment of the child’s/children’s needs and/or the extent and type of risk and/or harm experienced by the child.
• Assessment of the parent/carer's ability to meet these needs where relevant, considering external factors.
• Date of alert and its acquisition method.
• Specific details regarding concerns raised.
• Provision of assistance to address these needs for the enhancement of the child's wellbeing and, where necessary, safety measures.
• Confirmation of consent for information sharing.
• Identification of alleged perpetrator(s) if relevant.

Confidentiality and safeguarding reporting

Client consent

Practitioners should seek the consent of the client before acting, however, there may be circumstances when consent cannot be obtained because the adult lacks the capacity or possesses capacity but refuses to give it.

If obtaining consent would increase the risk to the adult or child, in these cases, the priority would be the safety of the persons involved. Therefore, confidentiality should be overridden and appropriate and relevant organisations and healthcare practitioners should be contacted. It would be advisable to seek guidance from your supervisor.

Reporting safeguarding concerns without client consent

A referral to local safeguarding authorities should be considered for all safeguarding concerns. This holds regardless of the client’s capacity or the absence of overriding public interest considerations.

It is recommended to document if the client has consented to or declined, and is aware of a referral, alongside their reasons and wishes for sharing or refusing consent.

If gaining consent would put the adult or child at further risk, then in most cases this referral ought to still be made without consent or knowledge but judgement is required. It is recommended that you document the decisions and actions made and the reasons behind these, a record of what information an individual is given.

Risk from others

In situations where individuals perceive a risk from others, immediate actions are essential to ensure their safety. The priority is to swiftly assess the immediate safety of the person and thoroughly document the details of the situation.

Some questions to consider if it is safe for them to answer can be:

• Do you feel in danger from anyone in your life at present?
• Are there any past incidents of violence or aggression from the person you are concerned about?
• Have there been any legal interventions or restraining orders in the past?
• Have there been attempts to control or limit your contact with friends and family?
• Have you shared your concerns with anyone else, and if so, what was their reaction?

If there are concerns:

• Encourage them to seek emotional support and continue therapy if it is safe to do so to address the impact of the perceived risk.
• It may be necessary to advise them to contact their doctor for additional assistance, especially if there are underlying mental health concerns.
• If they are unable to do so, then advise that you may have to break confidentiality to keep them safe.
• Provide emergency contact information, including local law enforcement and relevant medical services. Additionally, offer specific signposting based on the nature of the issue, guiding them to appropriate resources or professionals who can provide targeted help.

Risk to others

Similiary, if clients present a  risk to others, further investigation and actions would need to be taken to ensure the safeguarding of others. Some questions to consider can be:

• Have there been instances where you or others have noticed your behavior causing distress or concern to others?
• Are there any patterns in your behavior during conflicts that you think might be problematic?
• Have there been any legal interventions or restraining orders involving your behavior towards others?
• Have there been instances where substance use might have escalated tensions or conflicts?

If there are concerns raised:

• If an individual poses a risk to others, an immediate assessment is required, and all information is documented.
• Swift intervention measures need to be considered to safeguard those who may be at risk of harm. If the danger is imminent and there is a clear and present threat, it is crucial to consider contacting the police promptly. In such urgent cases, involving law enforcement may be necessary for the safety of all parties involved.
• Additionally, discussing the situation in supervision is essential to ensure a safe, coordinated and effective response. Regular supervision sessions provide an opportunity to share insights, strategize interventions and collectively contribute to the safety and wellbeing of individuals.

Further considerations

Planning ahead

It is important to discuss how you will communicate with your client between sessions, if you or the client is late to a session, or after any missed sessions, including what you will do if you become concerned about them.

Unmind provides practitioners with each client's name and email address, but we don’t collect telephone numbers or emergency contact information. We encourage you to collect emergency contact information and to discuss with the client the circumstances under which you’d contact their named person.

Loss of internet connection

If the session ends abruptly due to a poor internet connection, and you believe the client is in distress or danger, it is important to make contact with them to follow up on risk management. This can be done via email or any other pre-agreed means of contact.

If you are unable to make contact, you may use your own judgment as to whether to contact the client's emergency contact or designated healthcare professional.

At-risk client missing a session

If you are working with a client who you deem to be at risk and they do not attend their scheduled session with you, it is important to follow the below steps to protect their welfare:

1. Try to get in touch with the client via email or any other pre-agreed method of contact.
2. If you can’t get hold of the client, try their emergency contact.
3. If you can’t reach the named contact person, and you are concerned for their immediate safety, consider contacting emergency services.

Unmind's list of emergency hotlines

Unmind has a list of numbers that you can share with clients if you feel they need urgent support.

You may also wish to signpost clients to the ‘Urgent Help’ section of the Unmind Elevate platform which contains crisis information and helplines. Clients can find it by clicking the three lines in the top right corner and selecting ‘Urgent Help’ within the ‘Mental health resources’ section.

Note-taking

Practitioners must follow guidance from their professional bodies but we would encourage all risk concerns and actions to be documented and stored securely. Please see our article on session notes.