Clinical Skills Class 2: Risk Assessment in Practice: The WOKE of Working with Risk

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Introduction
Suicide risk assessment remains one of the most anxiety‑provoking aspects of mental health practice, particularly for practitioners working in brief, high‑volume services such as Talking Therapies. Historically, risk assessment has relied heavily on checklists, stratification, and prediction, despite a growing evidence base showing that such approaches are unreliable and potentially misleading. Recent UK guidance, including NICE NG225, calls for a decisive shift away from prediction and towards collaborative, formulation‑based psychosocial assessment.

This session introduces WOKE as a practical and ethical framework for working with suicide risk: Willingness, Openness, Kindness, and Explicitness. Drawing on NICE guidance, recovery‑oriented thinking (CHIME), and contemporary psychological theory, the presentation aims to reduce practitioner anxiety while improving clarity, safety, and professional confidence. The focus is not on eliminating risk, but on understanding how risk and protective factors interact dynamically within the person’s context.

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Content
This session explores how suicide risk assessment can be undertaken in a way that is NICE‑aligned, recovery‑oriented, and appropriate to the MHWP role. Participants will review current national guidance emphasising formulation over prediction and examine why common practices such as risk stratification and reassurance‑based documentation are problematic.

The session introduces the CHIME framework (Connectedness, Hope, Identity, Meaning, Empowerment) as a structured way to assess and evaluate protective factors, moving beyond simple lists toward an understanding of strength, accessibility, and fragility under distress. 

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Learning objectives

By the end of this session, participants will be able to:

• Describe current NICE guidance on suicide and self‑harm risk assessment and its implications for MHWP practice

• Explain why prediction‑focused and stratification‑based approaches are discouraged

• Use the CHIME framework to evaluate protective factors in a structured and defensible way

• Recognise cognitive fusion and values‑based action as mechanisms influencing risk and protection

• Apply the WOKE framework to communicate risk clearly, compassionately, and ethically in practice and documentation

Key References
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Hare‑Duke, L., Charles, A., Slade, M., Rennick‑Egglestone, S., Dys, A., & Bijdevaate, D. (2023). Systematic review and citation content analysis of the CHIME framework for mental health recovery. Journal of Recovery in Mental Health, 6(1), 38–44.

Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. British Journal of Psychiatry, 199, 445–452.

National Institute for Health and Care Excellence. (2022; reviewed 2024). Self‑harm: Assessment, management and preventing recurrence (NG225). https://www.nice.org.uk/guidance/ng225

NHS England. (2025). Staying safe from suicide: Best practice guidance for safety assessment, formulation and management.

Tak, J. H., Cho, S.‑E., Cho, S.‑J., Kang, S.‑G., Bae, S. M., & Na, K.‑S. (2025). Effectiveness of acceptance and commitment therapy for suicidality: A systematic review and meta‑analysis. Acta Neuropsychiatrica, 37, e66.