Lesson 7 - Risk and Safeguarding
1. Lesson Overview
Risk or safeguarding information may emerge during any patient contact. This can happen even when the appointment is only intended to support completion of a form.
The assistant practitioner is not responsible for conducting an independent clinical risk assessment or safeguarding investigation. Their responsibility is to recognise possible concerns, respond calmly, take immediate action where necessary and pass the information to an appropriate clinician or safeguarding lead.
The practitioner must never ignore a concern because it falls outside the purpose of the appointment. Safety takes priority over completing the form.
Suggested duration: 90 minutes
Delivery method: Self-directed learning followed by supervised case discussion
Practical requirement: Role-play involving risk and safeguarding disclosures
Additional requirement: Completion of the relevant WMI Psychiatry safeguarding training
2. Learning Outcomes
By the end of this lesson learners should be able to:
Recognise common indicators of risk and safeguarding concerns.
Explain the limits of the assistant practitioner’s role.
Respond safely when a concern is disclosed.
Distinguish an immediate emergency from a concern requiring prompt escalation.
Avoid promising secrecy.
Record the person’s words and the action taken accurately.
Follow WMI Psychiatry escalation procedures.
Recognise when emergency services may be required.
Maintain contact safely while responsibility is transferred.
Reflect on the emotional impact of receiving difficult information.
3. The Lecture
What is risk?
Risk refers to the possibility that harm may occur.
During an information-gathering appointment the practitioner may hear information about possible harm to:
The patient.
A child.
Another adult.
A family member.
A member of the public.
A member of staff.
Possible concerns include:
Thoughts of suicide.
Plans or intentions to end one’s life.
Recent self-harm.
Thoughts or plans to harm another person.
Abuse or neglect.
Severe deterioration in mental health.
Marked confusion or unusual behaviour.
Serious medication side effects.
Accidental overdose.
Substance-related harm.
Domestic abuse.
Exploitation.
An immediate physical health emergency.
A person being unable to care safely for themselves.
A child being left without appropriate care.
The assistant practitioner does not need to decide whether the overall level of risk is low, medium or high. A qualified clinician should make that judgement.
The practitioner needs to recognise that the information may be important and seek help.
What is safeguarding?
Safeguarding involves protecting a person’s health, wellbeing and rights so they can live free from harm, abuse and neglect. CQC: Safeguarding people
Safeguarding is part of everyone’s role. The assistant practitioner is not expected to investigate concerns or decide the final safeguarding response. They must recognise possible concerns and follow the WMI Psychiatry safeguarding procedure.
Safeguarding children
A child is anyone under the age of 18.
Safeguarding children includes:
Protecting children from maltreatment.
Preventing impairment of their physical or mental health.
Preventing impairment of their development.
Ensuring that children receive safe and effective care.
Taking action when a child may be at risk of harm.
Current multi-agency safeguarding expectations in England are set out in Working Together to Safeguard Children 2026.
The practitioner does not need proof before reporting a concern. A reasonable concern based on something reported, observed or documented should be escalated.
Safeguarding adults
Adult safeguarding may apply when an adult:
Has needs for care and support.
Is experiencing or is at risk of abuse or neglect.
Is unable to protect themselves because of those needs.
This framework is set out in Section 42 of the Care Act 2014 and the accompanying statutory guidance. Care Act 2014: Section 42
Not every adult who makes an unwise decision is experiencing abuse or neglect. The assistant practitioner should not attempt to determine whether the legal threshold is met. They should share the concern with the safeguarding lead or responsible clinician.
Types of abuse and neglect
Safeguarding concerns may involve:
Physical abuse.
Emotional or psychological abuse.
Sexual abuse.
Neglect.
Financial abuse.
Domestic abuse.
Discriminatory abuse.
Organisational abuse.
Modern slavery.
Exploitation.
Self-neglect.
Online abuse.
Child criminal exploitation.
Child sexual exploitation.
Forced marriage.
Female genital mutilation.
Fabricated or induced illness.
The practitioner does not need to label the type of abuse during the appointment. They should record what was reported or observed and pass it to the safeguarding lead.
Possible indicators in a child
Possible indicators may include:
Unexplained injuries.
Injuries with an unclear or changing explanation.
A child appearing frightened of a particular person.
Developmentally inappropriate sexual knowledge or behaviour.
A sudden change in behaviour.
Significant withdrawal.
Persistent hunger or poor hygiene.
Inadequate supervision.
Repeated unexplained absence from school.
A child being responsible for care beyond what is appropriate for their age.
Threats, humiliation or intimidation within the home.
A child witnessing or experiencing the effects of domestic abuse.
A child reporting that they do not feel safe.
A parent preventing the child from speaking.
A child describing physical punishment or sexual contact.
Evidence of exploitation or coercion.
A caregiver failing to obtain necessary medical care.
An indicator does not prove that abuse has occurred. It is a reason to remain attentive and seek safeguarding advice.
Possible indicators in an adult
Possible indicators may include:
Unexplained injuries.
Fear of a partner, carer or family member.
Another person controlling communication.
Restricted access to money.
Pressure to change a will or transfer money.
Poor living conditions.
Lack of food, medication or necessary care.
Sexual contact without consent.
Threats or intimidation.
Coercive control.
Exploitation.
Forced labour.
A person being prevented from attending appointments alone.
Serious self-neglect.
A carer appearing overwhelmed or unable to meet the person’s needs.
A person stating that they do not feel safe.
The practitioner should avoid confronting the alleged abuser or attempting to investigate.
Mental health risk
Risk information may appear in response to questions about:
Mood.
Self-harm.
Suicidal thoughts.
Hopelessness.
Anger.
Psychotic experiences.
Substance use.
Sleep.
Medication.
Relationships.
Recent stressful events.
A patient may make a direct statement such as:
“I intend to end my life tonight.”
The information may also be less direct:
“Everyone would be better off without me.”
“I cannot do this anymore.”
“I have been collecting my tablets.”
“I am frightened that I will hurt somebody.”
“The voices are telling me to do something.”
“I do not feel safe going home.”
The practitioner should not dismiss indirect language. They should pause and seek clinical support.
Physical health concerns
Some disclosures require urgent medical rather than psychiatric attention.
Examples include:
Chest pain.
Severe breathing difficulty.
Collapse.
Loss of consciousness.
A seizure.
Symptoms of a severe allergic reaction.
A suspected overdose.
Severe confusion.
A serious injury.
Sudden weakness or difficulty speaking.
Severe medication reactions.
The assistant practitioner should not attempt to diagnose the problem.
If there appears to be an immediate threat to life or serious harm they should contact 999 and follow the WMI Psychiatry emergency procedure.
Three levels of response
The practitioner can use the following framework to guide action.
Immediate emergency
Examples include:
A person is in immediate danger.
A suicide attempt is taking place.
A person has taken an overdose.
A person has an immediate suicide plan and access to the means.
Somebody is being seriously assaulted.
A child is currently in an unsafe situation.
There is an immediate threat to another person.
A serious physical health emergency is occurring.
The practitioner should:
Call 999 or arrange for somebody present to call.
Contact the supervising clinician or senior team member immediately.
Keep the person connected where it is safe to do so.
Confirm the person’s location during a remote appointment.
Follow instructions from emergency services.
Record what happened and the action taken.
Complete the required incident documentation.
NHS guidance advises calling 999 where there is a serious risk to life. Urgent mental health support that is not immediately life-threatening can be accessed through NHS 111 and the mental health option. NHS: Where to get urgent help for mental health
Urgent clinical concern
Examples include:
Recent suicidal thoughts.
Recent self-harm.
A marked deterioration in mental health.
New unusual experiences.
Significant medication side effects.
A person feeling unable to cope safely.
Thoughts of harming another person without an immediate act taking place.
A concerning disclosure that is not clearly an immediate emergency.
The practitioner should:
Pause the routine form.
Contact the supervising clinician promptly.
Keep the person connected while advice is obtained where appropriate.
Do not leave the concern for routine review.
Follow the clinician’s instructions.
Record the concern and action clearly.
The clinician decides what further assessment or intervention is required.
Safeguarding concern without immediate danger
Examples include:
A child describing past or ongoing physical punishment.
A patient disclosing domestic abuse.
Concerns about neglect.
Financial exploitation.
A child being exposed to harmful behaviour.
A vulnerable adult being controlled by another person.
An allegation involving a member of staff.
The practitioner should:
Listen calmly.
Avoid investigating.
Explain that the concern must be shared.
Contact the WMI Psychiatry Safeguarding Lead or senior clinician promptly.
Follow the safeguarding procedure.
Record the disclosure accurately.
Complete any required safeguarding or incident documentation.
A concern should not be left until the next routine supervision session.
The assistant practitioner’s role
When a concern arises the assistant practitioner should:
Recognise that the information may be significant.
Pause the normal appointment.
Listen.
Ask only the questions needed to understand what has been said and determine whether immediate help is required.
Reassure the person that they have done the right thing by speaking.
Explain that the information must be shared.
Contact an appropriate clinician or safeguarding lead.
Follow instructions.
Document the facts.
Remain involved until responsibility has clearly transferred.
They should not:
Conduct a full risk assessment.
Grade the level of clinical risk.
Decide that no action is needed.
Investigate an allegation.
Interview witnesses.
Confront an alleged abuser.
Promise secrecy.
Advise the person to gather evidence.
Contact family members without advice.
Make a safeguarding referral independently unless the WMI Psychiatry procedure specifically requires this.
Delay escalation until the form is complete.
Responding to a disclosure
A helpful immediate response is:
“Thank you for telling me. I am sorry that this has happened. I need to share this with the appropriate clinician or safeguarding lead so that we can consider how to keep you safe.”
The practitioner should remain calm and avoid showing shock or disbelief.
They should not say:
“Are you sure?”
“Why did you not tell somebody sooner?”
“That person would never do that.”
“I promise I will not tell anyone.”
“Everything will be fine.”
“I do not think this is serious.”
“You must report this to the police.”
“Tell me every detail.”
Asking limited clarification
The practitioner may need enough information to communicate the concern safely.
Useful questions include:
“Can you tell me what happened?”
“When did this happen?”
“Is this happening now?”
“Are you safe at this moment?”
“Is anyone else at risk?”
“Where are you now?”
“Is the person you are concerned about present?”
“Do you need immediate medical help?”
“Is there a safe adult with you?”
Questions should remain open and limited.
The practitioner should not conduct a detailed interview or repeatedly ask the person to describe traumatic events.
Detailed questioning may:
Increase distress.
Influence the person’s account.
Create inconsistencies.
Interfere with a later safeguarding or police investigation.
Move beyond the practitioner’s competence.
Suicide and self-harm disclosures
If a person discloses suicidal thoughts or self-harm the practitioner should not attempt to decide independently that the person is safe.
They should establish whether there appears to be an immediate emergency and contact the supervising clinician.
Questions required for immediate safety may include:
“Are you in immediate danger?”
“Have you already done anything to harm yourself?”
“Do you need urgent medical help?”
“Where are you now?”
“Is somebody safe with you?”
“Do you have access to anything you may use to harm yourself?”
These questions do not replace a clinical risk assessment. They help the practitioner identify the need for immediate emergency action while obtaining clinical support.
Risk of harm to others
A patient may describe thoughts of harming another person.
The practitioner should:
Remain calm.
Avoid arguing or challenging the person.
Establish whether anybody appears to be in immediate danger.
Contact the supervising clinician immediately.
Contact 999 if there is an immediate threat.
Record the person’s words accurately.
Avoid contacting the potential victim without clinical advice unless directed by emergency services.
The clinician will consider confidentiality, public protection and any further action.
Domestic abuse
A person may disclose controlling behaviour, threats, physical violence, sexual abuse or financial control.
The practitioner should:
Listen without judgement.
Avoid blaming the person.
Check whether they are in immediate danger.
Consider whether children are present or affected.
Avoid confronting the alleged perpetrator.
Avoid sending information to a shared device without agreement and clinical advice.
Escalate the concern promptly.
Follow the safeguarding procedure.
During remote appointments the practitioner should consider whether the alleged perpetrator may be listening.
A neutral question may be:
“Are you able to speak privately at the moment?”
If the person cannot speak safely the practitioner should avoid asking detailed questions and seek immediate advice.
Allegations involving a staff member
A patient may raise a concern about a WMI Psychiatry staff member or another professional.
The practitioner should:
Listen calmly.
Record the concern accurately.
Avoid defending or confronting the staff member.
Avoid discussing it with unrelated colleagues.
Inform the Safeguarding Lead, Registered Manager or Nominated Individual according to policy.
Use an alternative senior contact if the concern involves the usual person responsible for receiving reports.
Follow the incident and safeguarding procedures.
The practitioner should not investigate the allegation themselves.
Confidentiality and safeguarding
Confidentiality is important but it is not absolute.
Information may need to be shared to protect:
A child.
An adult at risk.
The patient.
Another person.
The public.
The practitioner should share the concern only with people who need the information for a legitimate safeguarding or clinical purpose.
They should not discuss it casually or share it with family members without advice.
A suitable explanation is:
“I will treat this information respectfully. I cannot keep information about serious safety concerns secret. I need to share it with the appropriate clinical or safeguarding professional.”
Consent to share safeguarding information
Where it is safe and appropriate the person should be told what information will be shared and with whom.
The practitioner should not delay urgent action because the person does not consent to sharing.
Decisions about sharing information without consent should be made by an appropriate clinician, safeguarding lead or emergency service unless immediate action is required to protect life.
The practitioner should record:
Whether the person agreed to the information being shared.
Whether they objected.
What explanation was given.
Who made the decision to share.
What information was shared.
Why it was shared.
Remote appointments
Risk can be more difficult to manage remotely.
Before a remote appointment the practitioner should know:
The patient’s telephone number.
The address recorded on the system.
How to contact the supervising clinician.
What to do if the connection fails.
The emergency escalation procedure.
If a serious concern arises the practitioner should confirm:
The patient’s current location.
Whether they are alone.
Whether another safe person is present.
Whether the person causing concern is nearby.
A telephone number for reconnecting.
Whether emergency services are required.
If the call disconnects during an immediate concern the practitioner should contact the supervising clinician and follow the emergency procedure without delay.
Do not leave the person unsupported
Where there is an urgent concern the practitioner should not simply tell the patient to contact another service and end the appointment.
They should remain connected where safe while:
A clinician joins.
Emergency services are contacted.
A safe adult becomes involved.
Another agreed handover takes place.
The practitioner’s responsibility continues until there has been a clear transfer of responsibility.
Recording a risk or safeguarding concern
The record should include:
The date and time.
Who was present.
What prompted the disclosure.
The person’s words where important.
Relevant factual observations.
Limited clarification obtained.
Whether there appeared to be an immediate emergency.
Who was contacted.
The time they were contacted.
Advice or instructions received.
What action was taken.
Whether emergency services were involved.
When responsibility transferred.
Any follow-up requested.
Whether an incident or safeguarding form was completed.
The practitioner should avoid conclusions such as:
“Low risk.”
“No safeguarding.”
“Not genuine.”
“Attention-seeking.”
“Safe to go home.”
“No further action needed.”
These are clinical or safeguarding decisions.
A suitable record might state:
“At 15:10 he stated ‘I have been thinking about ending my life tonight.’ The routine form was paused. He confirmed that he was at his home address and that his mother was in the property. The supervising clinician was contacted at 15:12 and joined the video appointment at 15:16. Responsibility for further clinical assessment was transferred to the supervising clinician. The assistant practitioner remained present until instructed that they could leave.”
Reporting concerns promptly
Concerns should be reported without unnecessary delay.
The practitioner should not wait because:
The appointment is nearly finished.
They are worried about upsetting the family.
They do not have proof.
The alleged event happened in the past.
The patient asks them not to tell anyone.
The practitioner is unsure whether the concern is serious.
The supervising clinician appears busy.
The practitioner fears that they may be wrong.
Uncertainty is a reason to seek advice. It is not a reason to ignore the concern.
If the usual person is unavailable
The WMI Psychiatry safeguarding procedure should identify alternative contacts.
The practitioner should know how to contact:
The supervising clinician.
The WMI Psychiatry Safeguarding Lead.
The Registered Manager.
The Nominated Individual.
Emergency services.
The relevant local safeguarding service where instructed.
If the concern involves the person who would usually receive the report the practitioner should use the alternative route set out in policy.
After the incident
After responsibility has transferred the practitioner should:
Complete the clinical record.
Complete any incident documentation.
Confirm that the relevant senior person is aware.
Preserve any relevant messages or documents.
Avoid discussing the event with unrelated staff.
Attend a debrief where offered.
Reflect during supervision.
Seek support if affected by the disclosure.
Receiving information about suicide, abuse or neglect can be upsetting. Staff should not be expected to manage this emotional impact alone.
4. Clinical Perspective
Clinical pearl: You do not need proof to escalate
The practitioner’s role is to pass on a reasonable concern. Investigation and decision-making belong to appropriately trained professionals.
Clinical pearl: Safety takes priority over the form
A risk disclosure should never be postponed until the questionnaire is complete.
Clinical pearl: Ask enough to act but do not investigate
The practitioner needs enough information to understand the immediate concern and communicate it. Detailed exploration may be harmful and is outside the role.
Clinical pearl: Exact words can matter
Direct wording can help the clinician understand the seriousness and context of a disclosure.
Clinical pearl: Handover must be clear
Sending a message does not always mean responsibility has transferred. The practitioner should know that an appropriate person has received the information and taken responsibility.
Common pitfall: Offering reassurance too quickly
Statements such as “I am sure you will be fine” may minimise the disclosure. Acknowledge the information and obtain help.
Common pitfall: Promising confidentiality
The practitioner cannot promise to keep safety information secret.
Common pitfall: Deciding the concern is low risk
A calm presentation does not prove that a person is safe. Clinical assessment is required.
Common pitfall: Contacting family without advice
A family member may be involved in the concern. The practitioner should seek clinical or safeguarding advice before sharing information.
Common pitfall: Waiting for supervision
Risk and safeguarding concerns require prompt action. They should not be saved for a routine supervision meeting.
When immediate escalation is required
Immediate escalation is required when:
There is a threat to life.
Serious self-harm has occurred or is taking place.
An overdose is suspected.
A person has an immediate plan to harm themselves or another person.
A child appears to be in immediate danger.
Serious abuse is occurring.
A patient is acutely confused or medically unwell.
A serious medication reaction is reported.
The practitioner believes that ending the contact may leave someone unsafe.
5. Case Examples
Case Example 1: Suicidal thoughts
An adult states:
“I have been saving my tablets and I am going to take them tonight.”
The practitioner should pause the form and establish the person’s current location. They should contact the supervising clinician immediately and call 999 if there is an immediate threat to life.
They should not attempt to complete a full suicide risk assessment alone.
Case Example 2: Child safeguarding disclosure
A child states:
“My stepfather hits me when he gets angry. Please do not tell him I said anything.”
The practitioner should listen calmly and avoid detailed questioning. They should not promise secrecy or confront the stepfather. They should contact the safeguarding lead immediately and follow the safeguarding procedure.
Case Example 3: Domestic abuse during a video appointment
An adult states quietly that their partner controls their money. The partner is sitting elsewhere in the room.
The practitioner should avoid asking detailed questions while the partner may be listening. They should consider immediate safety and seek safeguarding advice through an approved safe route.
Case Example 4: Historical disclosure
A patient describes sexual abuse that occurred during childhood many years ago.
The practitioner should not assume that no safeguarding action is required because the event is historical. The alleged perpetrator may still have access to children or other vulnerable people.
The concern should be escalated for safeguarding review.
Case Example 5: Possible harm to another person
A patient states that they intend to attack a named person after the appointment.
The practitioner should establish whether there appears to be an immediate threat and contact the supervising clinician immediately. Emergency services should be contacted where there is immediate danger.
The practitioner should not contact the named person independently unless directed by an appropriate professional or emergency service.
Case Example 6: Medication concern
A parent reports that their child developed chest pain and collapsed after taking medication.
The practitioner should treat this as a potential medical emergency and follow the emergency procedure. They should not advise the parent to wait for a routine medication review.
Case Example 7: Concern about a staff member
A patient states that a member of staff sent them personal messages and asked them to keep the contact secret.
The practitioner should record the disclosure and report it through the safeguarding and management procedures. They should not confront the staff member or investigate the messages themselves.
6. Summary
The assistant practitioner must:
Remain alert to risk and safeguarding information.
Pause the routine appointment when a concern arises.
Listen calmly.
Avoid judgement.
Ask only limited questions needed for immediate safety and escalation.
Avoid promising secrecy.
Contact the appropriate clinician or safeguarding lead promptly.
Call 999 where there is an immediate threat to life or serious harm.
Maintain contact where safe until responsibility transfers.
Record the disclosure and action accurately.
Complete required incident documentation.
Seek supervision and support afterwards.
The assistant practitioner must not:
Conduct an independent full risk assessment.
Grade the level of risk.
Decide that no action is needed.
Investigate abuse.
Confront an alleged perpetrator.
Contact relatives without appropriate advice.
Delay escalation.
Minimise a disclosure.
Promise confidentiality.
End an urgent contact without a safe handover.
7. Further Reading
WMI Psychiatry Safeguarding Children Policy
WMI Psychiatry Safeguarding Adults Policy
WMI Psychiatry Risk Assessment and Escalation Procedure
WMI Psychiatry Emergency Procedure
WMI Psychiatry Incident Reporting Procedure
WMI Psychiatry Whistleblowing Policy
WMI Psychiatry Information Sharing and Confidentiality Policy
8. Reflective Exercise
The learner should consider:
How would you respond if a patient asked you to keep a disclosure secret?
What is the difference between clarifying immediate safety and conducting an investigation?
How would you respond if a calm patient described an immediate suicide plan?
What would you do if the supervising clinician did not answer?
How would you manage a disclosure when an alleged perpetrator may be listening?
Why might historical abuse still need safeguarding review?
What information should be documented after responsibility transfers?
How might receiving a difficult disclosure affect you personally?
Where can you obtain support after a distressing appointment?
Who are the alternative escalation contacts if the usual safeguarding lead is unavailable?
The learner should discuss their responses with their supervisor.
9. Practical Competency Activity
The learner should complete supervised role-plays involving:
A disclosure of suicidal thoughts.
An immediate suicide plan.
A child reporting physical harm.
A disclosure of domestic abuse during a video appointment.
A historical abuse disclosure.
A threat towards another person.
A possible medication-related medical emergency.
An allegation involving a staff member.
A failed video connection during an urgent concern.
An unavailable supervising clinician.
The learner should demonstrate that they can:
Pause the routine form.
Respond calmly.
Avoid judgement or disbelief.
Explain the limits of confidentiality.
Ask only necessary safety questions.
Identify an immediate emergency.
Contact the correct person.
Use an alternative escalation route where necessary.
Maintain contact until responsibility transfers.
Document the concern and action clearly.
Complete required incident documentation.
Seek supervision and emotional support afterwards.
Competency should not be signed off until the learner can respond safely to both an immediate emergency and a non-immediate safeguarding concern.
10. Knowledge Check
Complete the short knowledge check below to consolidate your learning and check your understanding of the key principles covered in this lesson. You can review the lesson content again before submitting your answers.
