Assessing risk of suicide during online assessment

The initial contact for most employees accessing Uprise is through direct referral from a colleague or supervisor. However, some employees enter Uprise via an online assessment (called a Wellness Check), using a clinically validated questionnaire to elicit the overall level of wellbeing (the WHO-5).


Employees additionally complete a questionnaire battery when they commence an Uprise digital program, and can commence a program either after completing a Wellness Check or after signing up directly with Uprise after being referred by a colleage or supervisor. Both the wellness checks and the initial pre-program questionnaire battery contain the WHO-5.


Employees who score below a clinical cut-off on the WHO-5 trigger an on-screen alert that is visible to Uprise clinical staff. The employee receives information that encourages personal safety and provides contact details for the company EAP as well as crisis and emergency services. The clinical cut-offs are determined by recommendations from research studies that indicate the likely presence of depression or suicidal risk. Every person who completes an assessment and scores below the cut-off is then contacted by an Uprise therapist with the results of the self-assessment followed by a risk assessment. The follow up contact is made by both email and phone.

Once the Uprise therapist calls the employee whose score indicates that they are at risk employees are asked to answer questions designed to identify the presence of suicidal thoughts, plans and intent. These questions include whether they have thoughts that life is not worth living, and whether they plan or intend to end their lives. Those responding with yes to both of those questions are commenced into a risk management process whereby the therapist verbally administers a structured risk assessment which asks in more detail about suicidal thoughts and behaviour, risk factors, previous suicide attempts, access to lethal means of suicide and the imminence of any plan. These questions are based on those used by the New South Wales Health framework for suicide risk assessment and management (http://www.health.nsw.gov.au/mhdao/publications/Pages/ suicide-risk.aspx) and are consistent with the standards set out in the National Quality Framework for Telephone Counselling and Internet Based Support Services (http:// www.health.gov.au/internet/main/publishing.nsf/Content/ mental-pubs-q-quatel).


The risk assessment procedure includes the completion of a crisis summary report, which summarises the risk and protective factors, reports on referrals or other actions taken in response to the assessed risk, and records the results of those actions. Those employees who report immediate risk, in that they are unable to guarantee their safety for at least 24 hours, or who the therapist has reason to believe is at imminent risk, are referred for urgent assessment by a mental health crisis team or are referred immediately to emergency services.


After the risk assessment all employees who do not require immediate support are then asked to develop a safety plan based on existing or potential support networks. This plan identifies at least three people or services the person agrees to contact if symptoms return or worsen. All employees are provided with the contact details for Lifeline and a 24 hour suicide call back service as part of the feedback. Details of the Safety Plan are documented in the Assessment Report, which is sent to the employee. Similar risk assessment procedures are followed with employees engaged in one of the digital programs offered at Uprise. Triggers for administration of the structured risk assessment for employees in treatment include the employee reporting that they have developed suicidal intention or plan in the course of conversations with their coach or via low wellbeing scores on the WHO-5, which is automatically administered each month or when the employee completes Uprise. The emergence of suicidal thoughts, or elevations in scores, trigger automated alerts that inform the Uprise coach and senior Uprise clinical staff, and are followed by attempts to contact the employee.


Clinical governance, supervision and training

All Uprise therapists receive competency-based training in administration of risk assessments, as well as training in how to engage with crisis or emergency services when referring employees for immediate support. The shift supervisor and other senior clinical staff, are alerted by therapists whenever a risk assessment is conducted and support the therapist during the assessment by providing immediate clinical supervision and support in identifying and contacting relevant mental health crisis and emergency services near the employee. Each crisis summary report is checked and confirmed by the senior therapist on duty (Shift Supervisor).




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Risk Management 

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