Concerns about risk in relation to mental illness relates to the management of potential harm. Here "harm" has several distinct meanings, depending on the form it takes and at whom it is directed. There are three broad categories of risk: risk to self, risk to others and risk to property. It is important to realize that the fear of people with mental illness is far worse than the evidence suggests it should be.

Major risks related to mental disorders and their risk assessment.

Risk	Risk assessment
Risk of suicide	Any mental disorder increases risk of suicide. Ask gently but directly about it
Risk of self-neglect	In this case, the person may not eat and drink enough or dress appropriately, wander the streets disregarding the weather, sleep rough and so on. Such self-neglect is more common with severe mental disorders. You can ask the family or the patient directly if they are eating enough and/or looking after themselves.
Risk of violence	Very uncommon. Ask what triggers the violence and explore past history. If there is a past history of violence, or if violence occurs for no obvious reason, this increases the risk of further violent behavior in the future. Also check if incidents of violence have been related to the misuse of substances such as alcohol or khat. Addressing this misuse may substantially reduce the risk posed.
Risk to children and other dependents	If children or other dependents (for example elderly or sick people) are living in a house alongside someone with serious mental illness, ask how they find living with this person. Specifically, ask if there are frequent conflicts, any assaults or times when they feel particularly threatened; try to involve the neighbors in answering these questions. If you find there is a risk to children or other dependents, ask what is being done to address it. Make sure the person is receiving the appropriate treatment.
Risk of abuse	Commonly, persons with SMI are likely to be the victims of abuse or violence. Many are stigmatized, insulted and even physically abused because of their condition. This risk is primarily tackled by educating the community about mental health issues.

Assessing the risk of suicide and self-harm

Assessing the risk of suicide is perhaps the most important part of risk assessment. Suicidal thoughts and behaviors (including suicide attempts and death by suicide) are commonly found at increased rates among individuals with psychiatric disorders, especially major depressive disorder, schizophrenia, Post-traumatic stress disorder (PTSD), anxiety and substance use disorders. A history of a suicide attempt is the strongest predictor of future suicide attempts, as well as death by suicide. Intentional self-harm (i.e., intentional self-injury without the expressed intent to die) is also associated with long-term risk for repeated attempts as well as death by suicide.

The main suicidal risk factors for someone with mental illness are:

Suicidal thoughts: if a person tells you they are thinking about suicide, you should take this very seriously; about 66% of those who commit suicide have previously told someone about their intention.
Severity of mental illness: the more severe the illness, the higher the risk of suicide. Someone young with a severe mental illness like psychosis may be at increased risk if they have developed awareness about how ill they are; this is particularly the case if they also develop depressive symptoms.
Substance misuse: the risk increases when the person also misuses substances like alcohol and khat.
Social isolation and lack of support: for example, when someone does not have a family to care for them, is single, and/or jobless.
History of suicide attempts or self-harm: the risk is increased if there have been previous attempts.
Family history of suicide.

When someone has already attempted suicide, their risk of suicide is about 100 times higher than that in the general population. This risk is particularly high in the first year after the original attempt. It is therefore, crucial that you closely monitor the risk of suicide after an attempt has been made. Be open with the patient, asking about the risk as a matter of fact.

Questions to help assess the risk of suicide in someone with a mental illness

How do you see the present or the future?.
Do you think things will get better for you?.
Have you had thoughts about taking your life?.
When did you have these thoughts and do you have a plan to take your life?.
Have you ever had a suicide attempt?.

If the person answers yes to any of the last three questions, you must refer them to a higher health facility for further assessment.