When a patient presents with signs of a mental health crisis, providers have an important responsibility to be proactive. In addition to nurse role in suicide prevention, other professionals (including counselors and clinicians) should follow proper protocols and best practices for detecting risk early, providing access to resources, implementing safety plans, and following up with other healthcare teams.
In fact, with the right crisis response measures in place, it just might be possible to save a life.
In clinical practice, handling crisis response in a structured manner is key to stabilizing patients while ensuring safety and focusing on the unique needs of the individual.
Following a structured approach is especially vital because it offers a clear roadmap for clinicians, making it possible to quickly identify any immediate risk factors while standardizing care and reducing the cognitive load of the clinician. All of this fosters better outcomes for patients.
In crisis work, some guiding principles include:
Clinicians are also under a crucial obligation to know both when and how to conduct a suicide risk assessment, as well as how to respond appropriately to a positive screen.
In general, clinicians are encouraged to conduct suicide risk screenings during initial patient contact and at regular interviews throughout a patient's course of treatment. An updated screening is also recommended anytime the patient presents with new behavioral health concerns, warning signs, or major life changes.
The Columbia-Suicide Severity Rating Scale (C-SSRS) is the most commonly used assessment tool by clinicians. However, C-SSRS suicide screening is far from the only option. Some other screenings and tools that may be considered include:
If a patient's screening comes back positive for suicide risk, clinicians should follow some important steps that include performing a suicide safety assessment, safety planning, and making plans for follow-up care. This may include ensuring the patient's environment is safe from harmful items, arranging for follow-up visits within 72 hours, and documenting actions in as much detail as possible.
Clinicians must use their own judgment, along with systemic processes and standardized tools, to identify and manage suicide risk among patients.
For example, clinicians should look closely at both core risk and protective factors when assessing a patient for suicide risk. Some examples of core risk factors that increase the likelihood of suicidal behavior include:
Meanwhile, protective factors reduce risk and may include things like:
Besides carefully contextualizing risk factors, clinicians rely on risk stratification to determine the proper level of care for patients. Grouping patients into low, medium, or high-risk categories allows for the delivery of appropriate, tailored care that corresponds to each patient's specific needs.
Crises can befall anybody, so clinicians must also know how to work with patients across different cultural backgrounds and identities. This means acknowledging cultural nuance in their work, and tailoring support as needed to ensure that every patient has access to the care that will best serve them.
Another important aspect of crisis intervention for social workers and counselors alike is collaborative safety planning, a step-by-step process that is tailored to a patient's unique needs and used proactively to prevent escalation.
Compared to a "no-harm" contract, which is an agreement where a patient pledges not to self-harm, safety planning is considered to be more practical and effective because a safety plan includes a personalized, step-by-step guide for managing crises proactively.
While no two safety plans will look exactly alike, it can be helpful for clinicians to study a basic safety plan template and get a sense for what these documents may include. Some examples of key components in a safety plan include:
Safety plans are usable for patients when they are:
In addition to mental health safety planning, lethal means counseling is another critical aspect of crisis management and response for clinicians.
Specifically, lethal means counseling refers to a collaborative approach to suicide prevention that involves sitting down with a high-risk patient and their family to discuss proactive methods for reducing the patient's access to lethal means (such as firearms, sharp objects, and medications).
Throughout this process, clinicians must maintain respectful and nonjudgmental conversations with all parties to empower families and patients. At the same time, clinicians need to carefully document all steps taken and follow up on means of safety measures to ensure successful implementation.
Speaking of documentation, clinicians who carefully and properly document patient interactions can support long-term safety and continuity of care.
Some important aspects to note in patient records include:
Clarity is key in documenting patient records. By using factual and objective language rather than subjective or opinionated language, other providers can receive the information they need while clinicians maintain a sense of respect and dignity for patients.
From a legal and ethical compliance standard, proper documentation also protects clinicians from potential issues down the road while ensuring accountability.
When patients are transitioning from one level of care to another, proper handoffs, follow-ups, and care coordination are key, particularly in high-risk transitions. When providers and clinicians ensure that other providers are on the same page during hand-off times, it is possible to ensure proper care coordination.
Meanwhile, regular follow-ups and check-ins can help clinicians confirm that patients are receiving proper care.
Even with all the proper care measures in place, suicide attempts still occur. Clinicians need to know how to respond and learn from these tragedies.
Primarily, it is essential to provide support and guidance to the family after an attempt. This may include proactively contacting the family to offer resources, including individual and group support.
When a suicide death occurs, clinics and local communities can be devastated, especially clinicians who may have worked with the patient directly. This is where offering peer and professional treatment/support options is so important, alongside creating safe environments for members of the community to mourn.
Following a suicide attempt or death, clinicians should debrief using the Critical Incident Stress Debriefing (CISD) model, which encourages careful reflection, symptom review, and potential learning opportunities that may be applied to future cases.
As challenging as crises are for patients, clinicians also face the long-term emotional impact of crisis work as part of their careers.
Over time, clinicians may suffer from compassion fatigue, secondary traumatic stress, and burnout from crisis work — all of which may be mitigated with supportive leadership, proper training, and professional support systems in place.
For clinicians, a supportive culture means not just strong and encouraging leadership that prioritizes staff well-being, but robust networks for peers to share their stories, mental health check-ins, and access to their own therapy/counseling services as well.
Some key components of building a crisis response pathway for clinicians include:
Unfortunately, no. Tools are a starting point, but they cannot paint the whole picture. They structure key questions and improve consistency — but clinical judgment, context, and collateral information are still essential to determining risk and level of care.
Today, most guidelines advise against relying on "no-suicide" or "no-harm" contracts because they do not reliably predict behavior and may actually create a false sense of security. Instead, collaborative safety plans that identify concrete coping steps and supports are preferred.
Safety plans should be viewed as living, breathing documents that require regular review and revision. Specifically, this should occur anytime risk changes, and after any crises, significant life events, or treatment shifts. Even without major life changes, plans should be reviewed and updated as needed at regular intervals.
If a patient refuses to engage, the best course of action is to explore the reasons with empathy. For many clients, refusal stems from fear, mistrust, or a general sense of hopelessness. Start by clarifying the purpose, then offer to start small. If refusal persists and risk remains high, consult supervisors, follow organizational protocols, and consider higher levels of care.
Following a crisis visit, it is essential to document key statements and behaviors, assessment findings, your rationale for risk level, any steps taken (consultations, safety plan, or means counseling), and follow-up plans. In documenting a crisis visit, aim for clarity and specificity while avoiding any unnecessary, stigmatizing judgment.
Higher levels of care (such as ED transfer or hospitalization) may be needed when a patient maintains persistent high intent, cannot identify any reasons for living, lacks a safe environment or supports, or refuses to collaborate.
Care teams should use structured, blame-free reviews that focus on systems, consisting of access, communication, documentation, transitions, and workload. Likewise, in these situations, it is crucial to focus on how processes can be improved rather than "who made a mistake?"
Proper mental health crisis training and safety planning can make all the difference in the lives of patients struggling with suicidal ideation and suicide risk factors. If you're looking to take your own training and education to the next level, it may be time to pursue a counseling degree or certificate at Indiana Wesleyan University.
Learn more about our many undergraduate- and graduate-level counseling degree options by getting in touch today, or take the next step by filling out an application for admission.
