CASC Risk Assessment Stations
Risk assessment is tested in virtually every CASC station. Master the frameworks that ensure you never miss a critical risk factor.
Overview
Risk assessment is arguably the most important clinical skill tested in the CASC exam. It goes beyond simply asking about suicidal ideation — examiners expect a nuanced, systematic approach that considers static factors, dynamic factors, and protective factors. Risk assessment skills are tested both in dedicated risk stations and integrated into almost every other station type.
Key Skills Assessed
- Structured suicide risk assessment (ideation, intent, plan, means)
- Violence risk assessment framework
- Assessing self-neglect and vulnerability
- Identifying and weighing protective factors
- Formulating risk as low/medium/high with clear rationale
- Developing a risk management plan
Recommended Framework
Set Context
Explain purpose, ensure privacy, use empathic transitional phrases to introduce risk questions
Suicidal Ideation
Passive death wish, active suicidal thoughts, frequency, triggers, duration
Intent & Plan
Strength of intent, specificity of plan, access to means, preparatory actions
Previous History
Past attempts (number, method, severity), previous self-harm, response to previous crises
Static Risk Factors
Male sex, older age, chronic illness, social isolation, family history
Dynamic Risk Factors
Current mental state, substance use, recent losses, hopelessness, command hallucinations
Protective Factors
Social support, children/dependents, religious beliefs, reasons for living, engagement with services
Formulation & Plan
Synthesise into low/medium/high risk with clear management plan and safety netting
Example Exam Scenarios
Assess suicide risk in a 35-year-old man following relationship breakdown
Evaluate violence risk in a patient with paranoid delusions about neighbours
Assess risk of self-neglect in an elderly patient with severe depression
Conduct a risk assessment following a serious suicide attempt
Common Mistakes to Avoid
- ✕Asking risk questions in a checklist manner instead of conversationally
- ✕Not asking about access to means
- ✕Forgetting protective factors — risk is a balance
- ✕Assessing risk without formulating a management plan
- ✕Being too afraid to ask direct questions about suicide
Examiner Tips
- Use natural transitions: "When people feel as low as you've described, they sometimes have thoughts of harming themselves..."
- Ask direct questions — research shows this does NOT increase suicide risk
- Always formulate risk level with your reasoning — "I would assess the risk as moderate because..."
- End with a clear safety plan: who to contact, when to seek help, follow-up arrangements
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