Important. This is the highest-consequence page in the manual. Read it before your first client contact, and know where it is. If a client’s life is in immediate danger, call 911. Everything else on this page comes after that.
The principle
Your job in a crisis is to keep the client, and anyone they’ve threatened, safe for the next hours and days, and to document what you did. You are not alone in it. Helen is your backup, and the practice would always rather you over-consult than under-respond.Emergency resources
Keep these where you can find them in seconds.
There is no after-hours clinical backup. Outside business hours, a client in crisis goes to 988 or 911, and you tell Helen the next business day. See Emergency and after-hours coverage.
Suicide risk
Assess every time it comes up. Any mention of suicide, wanting to die, hopelessness that worries you, or a change that raises your concern gets a direct assessment in that session. Use the practice’s assessment tool (the Columbia protocol or the tool designated in PracticeOS). Ask directly. Asking doesn’t plant the idea. Assess ideation, plan, means, intent, and timeline. Also protective factors, history, and what’s changed. Then act on the level of risk:- Low risk (ideation without plan or intent, protective factors present): collaborate on a written safety plan, review means safety, schedule a follow-up within a week, document, and inform Helen at the next check-in.
- Moderate risk (plan or intent without immediate timeline, or significant risk factors): safety plan, means restriction planning with the client and, with consent, a support person, increased contact, consult Helen the same day before the client leaves if at all possible, document.
- High or imminent risk (plan, means, intent, and near timeline; or you believe the client cannot stay safe): the client does not leave alone. Stay with them. Call Helen. Arrange evaluation: emergency department, mobile crisis team, or 911 if the client won’t cooperate or the danger is immediate. Document everything the same day.
Threats of harm to others
If a client communicates an actual threat of physical violence against a clearly identified or reasonably identifiable person, Utah law (Utah Code § 78B-3-502) creates a duty, and tells you how to discharge it. The details are in Mandatory reporting. The short version: warn the person and notify law enforcement, both, and call Helen immediately. If the threat is imminent, 911 first.Abuse disclosures
Disclosures of child abuse or vulnerable adult abuse trigger a mandatory report, immediately. See Mandatory reporting.Welfare checks
Request a welfare check when a client you’re concerned about can’t be reached and you have specific reason to believe they’re in danger: missed sessions after a high-risk contact, a concerning message, a disconnected telehealth session during a crisis. Call the Utah Crisis Line or the non-emergency police line for the client’s location, give the minimum information needed (name, address, reason for concern), and document. Consult Helen first when there’s time.After the crisis
- Document the same day. What the client said, what you assessed, what you decided, what you did, who you consulted, what the plan is. Use the crisis note template.
- Tell Helen the same day if you haven’t already.
- Follow up with the client within 24 to 48 hours, or as the plan says.
- Take care of yourself. Crises are hard on clinicians. Debrief with Helen or your supervisor. You don’t have to be fine.
When a client dies
If you learn that a client has died, by suicide or otherwise, tell Helen immediately. Don’t contact the family, don’t post anything, and don’t discuss it outside the practice. The practice will manage the response, including support for you.What you’re never expected to do
- Manage a high-risk situation alone when Helen can be reached
- Physically restrain a client
- Transport a client in your own vehicle
- Keep a client from leaving by force
- Decide alone whether to break confidentiality when there’s time to consult
Why. Most of this protocol is about two things: assess directly every time, and don’t be alone with a high-risk decision. Everything else follows from those.