Crisis Plans For Therapists: Developing Safety Plans And Navigating Client Emergencies Effectively

For mental health professionals, client emergencies may arise unexpectedly, challenging their clinical skills and emotional fortitude. Ideally, crises can be prevented through proactive safety planning, effective treatment, and continuous monitoring. However, there may be times when you receive an urgent communication from a client that requires a well-coordinated response. 

Here, we will explore the basics of crisis planning for therapists, from pre-crisis safety planning and preparation to recognizing a crisis and intervening appropriately. You will also find some helpful tips for developing effective safety plans with your clients so that they can navigate mental health emergencies with resilience and clarity.

With this guide, you can build a framework for preventing and handling worst-case client scenarios, ensuring you’re equipped with the information, resources, and strategies you need to respond promptly and effectively.

Crisis Preparation For Therapists

As a therapist, it can be crucial to begin crisis preparation at the intake stage. Have your client fill out an intake form with emergency contact details, a home address, and any relevant information about their history as well as any acute issues they may be experiencing. It can be important for the initial assessment to cover any previous incidents of crisis, potential triggers, and helpful coping mechanisms, as well as other risk factors such as unhealthy relationships, substance use, past traumas, and current life stressors. 

With this information, you may have a clearer idea of what types of crises, if any, your client may be at risk for so that you can develop an appropriate intervention and emergency plan. It can also be beneficial to maintain a database of emergency services in your area of practice. For online therapists, consider keeping all relevant points of contact in the client’s file, including emergency and mental health services. This might also include trusted professional contacts who live locally and can offer in-person care in the case of a crisis.

Assessing Client Risk Level

Another essential element of crisis intervention is assessment. In your first sessions, aim to determine the type and likelihood of a mental health crisis, including any pertinent details related to the nature of any urges or ideations. It may also be helpful to establish early on which types of interventions might be possible, as some clients may be more receptive to certain strategies than others.

While some individuals are candid about their ideations or intrusive thoughts, there may be cases in which clinicians must rely on subtle cues and attempt to open a dialogue in a gentle, non-threatening way. The following indicators are examples of warning signs that a client may be in psychiatric distress:

• Statements about feeling hopeless, overwhelmed, or trapped
• References to not being around in the future
• Discussions about death or dying
• Signs of self-harm like cuts, bruises, or burns
• Increased substance use or risky behavior
• Self-neglect 

It may be helpful to proactively open a conversation about potential crises early on in your sessions to establish yourself as a safe person with whom the client can share sensitive or distressing thoughts. This may be especially important if the client’s family or cultural background has instilled beliefs or taboos around discussing mental health.

Safety Planning With Clients

Upon determining that a client could be at risk of harming themselves or others, your first clinical priority is likely to be creating a safety plan. The goal of a safety plan is to help clients stop and think during a time of crisis, which may then make it possible to implement healthy coping skills and seek the necessary help.

To create a safety plan, you might first help the client identify the warning signs of a mental health crisis, including thoughts, moods, or behaviors that may signal they are in danger or not thinking clearly. Discuss what types of situations or triggers typically incite or exacerbate distress, as well as any physical symptoms that may accompany feelings of anger or despair. 

This process can help both you and your client understand what a mental health emergency may look like. With this in mind, you can begin to create a comprehensive safety plan. Effective safety planning involves:

• Healthy coping strategies for active ideation: Coping strategies such as going for a walk, writing in a journal, or listening to music may be a positive first step for those experiencing intrusive thoughts or ideations. 
• Options for places to go or people to see: Spending time around others can help distract clients from active ideation. Have your client identify people or places that can serve as a safe space, such as being with a friend, at a local park, or in a coffee shop. 
• Loved ones who can help: Have the client brainstorm a list of people they trust and can call for help, such as friends, family members, mentors, or neighbors. 
• Professionals and agencies: Ensure the safety plan includes resources such as crisis hotlines and resources, mental health professionals from whom to seek guidance, and local public health services. Consider using a designated Voice over Internet Protocol (VoIP) number as an emergency contact line, being careful to establish clear boundaries to ensure it is used only for true emergencies.
• Personalized procedures: Adapt your plan to suit the client’s needs, triggers, and support system, as well as their comfort level with law enforcement, hospitals, and other entities that may become involved in a mental health crisis. 
• Client’s values: Identify anything that may stop the client from acting on their ideation and integrate them into the plan. Reminders of family, pets, ambitions, or other sources of love and meaning can help them stop and think, clearing the way for the possibility of self-regulation. For example, if their ideation involves a car, they might keep a family photo on their keychain.

Client Emergencies: When A Client Is In Immediate Danger

If a client reaches out to you in an emergency, swift and appropriate action can be crucial. Depending on the client and the type of mental health crisis they are experiencing, your approach to handling the situation may vary. For at-risk clients, it may be worth planning how you might appropriately respond to a crisis. The following steps may serve as a foundation for your crisis response plan:

1. Ensure immediate safety: If you believe the client is at immediate risk of harming themselves or others, you might need to contact emergency services right away.
2. Stay with the client: If you are physically present with the client, do not leave them alone. If communicating remotely, try to keep them on the line while you seek help on their behalf.
3. Contact local crisis teams: If available in the client’s area, contact a local crisis response team. They are specifically trained to handle mental health emergencies and can connect the client with appropriate resources and interventions.
4. Connect with emergency contacts: If possible, inform a trusted family member or friend who might be able to support the client or provide further information. 
5. Engage in active listening: While waiting for help, continue to listen to the client, offering comfort, reassurance, and understanding. 
6. Avoid making promises: Do not promise confidentiality in situations where the client is at risk. Safety is the priority in these instances, and it can be essential to be transparent about the limits of confidentiality in emergencies. Making promises that may not be able to be kept could harm the therapeutic alliance. 
7. Follow up: Follow up with the client, both in the immediate aftermath of the crisis and over the longer term. Ensure they are receiving the necessary care and support and create or revisit their safety plan to help prevent future crises.

Legal Considerations In Crisis Management

While client confidentiality may be critical to the therapeutic relationship, effective crisis management often necessitates third-party involvement. Therapists have a legal and ethical imperative to intervene when a client presents an immediate danger to themselves or others. It can be vital for clients to understand the limitations of confidentiality and to be informed of the legal responsibilities you have as their therapist. 

For clinicians administering online therapy, note that it may be more challenging to assess whether a client is at risk. As such, it can be especially important to establish an open dialogue about safety from the outset and gather emergency contact information and local crisis resources for each client.

Self-Care Resources For Therapists

Managing distressing client situations can take a toll on therapists’ mental health, making it crucial to establish a robust mental health routine. As a therapist, taking care of your own well-being can help you serve your clients more effectively. It can be important to establish clear boundaries regarding working hours, communication, and your caseload. Supervision and peer support can be valuable sources of guidance and advice when managing challenging client situations, and continuing education courses and training and development can help you feel more prepared and confident. 

With platforms like Therapists.com, you can access free CEUs and other helpful resources for mental health professionals like you. It may also be worth attending therapy yourself—particularly if you’ve recently dealt with a client emergency. For affordable short- or long-term therapy, consider connecting with your own therapist online. As a mental health professional, you may be eligible for a free month of therapy through BetterHelp.com. With BetterHelp, you can chat with a provider at a time and in a place that works for you, allowing you to maintain a healthy work-life balance while attending to your mental well-being. 

Takeaway

With a detailed crisis intervention plan, mental health professionals may be more equipped to help their clients prevent and navigate psychiatric emergencies. It can be vital to ensure you are prepared with the necessary client information, resources, and emergency contacts to ensure you can quickly mobilize the necessary services and support systems if necessary. For at-risk clients, a comprehensive, personalized safety plan can be a lifesaving tool, guiding them through challenging moments and offering a realistic pathway to seeking help. 

Taking care of others begins with prioritizing your own mental health. If you would like personalized support and guidance from someone who understands the demands of your career, consider connecting with a therapist online or in your local area.