Safety in Context: Risk Assessment Is More Than a Checklist
- Dr. Butch Losey
- Aug 17
- 3 min read
When a client expresses suicidal thoughts, thoughts of harming someone else, or other serious safety concerns, clinicians appropriately turn to risk assessment. We ask about thoughts, intent, plans, access to lethal means, previous behavior, protective factors, and other indicators of risk. Evidence-based assessment tools can provide important structure to this process. But effective risk assessment requires more than completing the right questions on a form.
Safety exists within a context, and understanding that context is essential
to understanding the person sitting in front of us.
A relational approach to risk assessment asks us to remain curious about the meaning of a client's responses. What relationships provide support—and which ones increase vulnerability? What cultural experiences shape how the client talks about suicide, violence, mental health, or asking for help? What happens when our recommendation to “contact someone you trust” is made to someone who has very few people they trust? A client's socioeconomic circumstances may also change what is realistically available to them. Transportation, housing instability, financial limitations, access to treatment, discrimination, and previous experiences with healthcare or other institutions can all influence both risk and the feasibility of our safety recommendations. A safety plan that cannot realistically be used in the client's life may look clinically sound on paper while providing very little actual safety.
Context becomes particularly important when circumstances are complex. A school-based clinician may have different responsibilities and resources than an outpatient therapist. A brief crisis interaction may require decisions before a strong therapeutic relationship can be established. Intimate partner violence requires careful consideration of whether seemingly reasonable safety recommendations could unintentionally increase danger. Access to firearms and other lethal means requires clinicians to be able to have direct, respectful conversations about reducing access during periods of elevated risk. Working effectively in these situations requires us to integrate structured assessment with clinical judgment, cultural humility, collaboration, and an understanding of the systems surrounding the client.
From Risk Assessment to Collaborative Safety Planning
Safety planning should therefore be more than a list of instructions we give a client before they leave our office. Whenever possible, it should be a collaborative conversation. What helps this particular person recognize that a crisis is developing? What has helped them survive difficult moments before? Who can realistically provide support? What places or activities increase safety? What barriers might prevent them from using the plan? What steps can reduce access to lethal means? And perhaps most importantly: Does this plan make sense in the client's actual life? When clients participate meaningfully in developing their safety plan, we have an opportunity to identify not only risks, but also strengths, values, relationships, resources, and reasons for living that can become part of creating safety.
Explore This Topic More Deeply
These questions are at the center of our upcoming training, Safety in Context: A Relational Approach to Risk Assessment and Crisis Planning. Designed for counselors, social workers, marriage and family therapists, students, and other mental health service providers, the workshop moves beyond simply identifying risk factors to examine how clinicians can conduct meaningful, evidence-informed conversations about safety.
Participants will explore suicide and homicide risk assessment, culturally responsive use of assessment tools, collaborative safety planning, and the particular considerations that arise in outpatient therapy, brief crisis encounters, school-based settings, and situations involving intimate partner violence. We will also address firearm safety, socioeconomic barriers, work with marginalized populations, and the ways systemic and institutional failures can influence both risk and access to safety.
The goal is not to abandon structured risk assessment. It is to place that assessment within the context of a person's relationships, culture, resources, strengths, values, and lived experience. Effective safety planning begins with assessing risk—but it becomes meaningful when
the plan we develop is one the person can actually use.
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