Assessing risk to self and others

“Assess risk to self and others” (NBCC, 2027 task 2B.2)

Risk assessment is the structured evaluation of a client's likelihood of harming themselves or others in the near term. It guides immediate safety actions, level of care and legal duties. The exam tests risk and protective factors, how to ask directly, safety planning and lethal means counseling, and legal duties that vary by state.

Key points

Ask directly about suicidal thoughts; asking does not increase risk. Explore ideation, plan, intent, means, timeline, past attempts and preparatory behavior.
A prior suicide attempt is among the strongest risk factors; others include access to firearms or other lethal means, substance use, hopelessness, recent loss, chronic pain, social isolation and recent discharge from psychiatric hospitalization.
Protective factors include reasons for living, social support, connection to care, problem-solving skills, and religious or cultural beliefs against suicide.
Structured tools such as the Columbia Suicide Severity Rating Scale support, but do not replace, clinical judgment.
Safety planning (for example the Stanley and Brown Safety Planning Intervention) lists warning signs, coping strategies, people and places for distraction, people to ask for help, professionals and crisis lines such as 988, and steps to make the environment safer; no-suicide contracts are not recommended as a safety measure.
Lethal means counseling helps the client and family reduce access to firearms, medications and other means during high-risk periods.
For risk of harm to others, duty to warn or protect laws vary by state: some are mandatory, some permissive, and some states have none; counselors must know their own state's law and consult and document carefully.

In practice

A client mentions she has been thinking it would be easier if she were not here. The counselor asks plainly whether she is thinking about killing herself, learns she has a stockpile of pills, and works with her on a written safety plan that includes giving the pills to her sister that evening.

A client says he wants to hurt his former business partner and names where the partner lives. The counselor assesses intent and means, consults her supervisor, reviews her state's duty-to-protect statute, and takes the steps that statute requires, documenting each one.

Check yourself

Does asking a client directly about suicide increase their risk?

No, asking directly does not increase risk and is necessary for accurate assessment.

Why are no-suicide contracts not recommended?

They have no evidence of preventing suicide and can give false reassurance, while a safety plan gives concrete steps.

Is the duty to warn or protect the same in every state?

No, it varies by state: some laws are mandatory, some permissive, and some states have no such statute.

NBCC's knowledge and skills for 2B. Assessment

Knowledge of: Foundational knowledge of statistics; Diagnostic criteria - DSM-5-TR; Diagnostic Criteria - ICD-11; Symptoms of trauma; Medical diagnoses and symptoms that can contribute to mental health symptoms; Differential diagnoses, co-occurring diagnoses, and comorbidities; Risk assessment and risk factors or symptoms; Cultural idioms of distress; Cultural implications of diagnosis.

Skill in: Conducting a diagnostic assessment and evaluation; Conducting and interpreting assessments; Conducting formal assessments; Conducting informal assessments; Conducting lethal means restriction.

A study guide written by ExamDragon from NBCC's published task; not NBCC material and not part of the exam.