Rula Therapist H.E.L.P. Resource Guide to Support Clients Experiencing a Crisis

This article details the Rula Therapist H.E.L.P. process, which is designed to support clients experiencing a mental health crisis such as thoughts of suicide, self-harm, or harming others, sudden and dramatic changes in mood, and/or a loss of touch with reality such as hallucinations or delusions.

Therapist H.E.L.P. Guide for Clients in Crisis

H.E.L.P. stands for:

H - Hotlines that provide 24-hour emergency services. As soon as you suspect a client might be experiencing a crisis, such as thoughts of suicide, provide them with this critical resource. Also, immediately provide your practice after-hours resources and client 24-hour emergency services information. This is an important liability protection step!

Here are some emergency resources:

• If your client is experiencing a mental health crisis, they can use the following resources for immediate help:

• • National Suicide and Crisis Helpline: Clients should call or text 988 to be connected with the 24-hour Suicide and Crisis Helpline
  • Local Emergency Services: If this is a life-threatening emergency, clients should call 911 or go to the nearest emergency room.

E - Engage the client and assess the level of risk. Your immediate engagement efforts are expected practice; you can follow the SAMHSA ATC Model. Recommended assessment tools for suicidal ideation (SI) and homicidal ideation (HI) include:

• Suicidality/Danger to Self - Columbia-Suicide Severity Rating Scale (C-SSRS)
• Homicidality/Danger to Others - HCR-20

L - Locate the client and authorities, only if needed. If you're concerned about your client's immediate safety or the safety of others due to a threat of imminent danger, you may be required by state law to warn potential victims and/or contact the authorities. These situations are not common, but they can include welfare checks, child/elder protective services, teen runaway/endangerment, and similar emergent situations.

To assist first responders, determine the client’s current location. If you do not know, ask the client if they are at home or where they are currently located. Once you have the client’s location, use the PSAP Map (below) to call the correct 911 dispatcher:

• PSAP MAP
• How to use the PSAP MAP

P - Post-crisis steps. After the crisis has passed, take some time to debrief and review the steps you took. This is best done as soon as possible, while the events are still fresh in your mind. Doing so will help you ensure all details are accurately documented and identify any areas for improvement in your crisis management approach for future situations. 

Suggestions include:

1. Inform Rula Patient Safety Leadership of the situation by submitting an Adverse Event Report
2. Review any missing pieces to ensure the following are completed:

• • Risk Assessment is complete and in the client record.
  • Ensure there is clear documentation of the event placed within the client chart.
  • Session notes and/or psychotherapy notes. When documenting clinical crisis management events, details are important such as time, place, who, what, when, where, how, etc.
  • Assessments completed. Be sure to place within the client chart any and all risk-level assessments completed, such as the C-SSRS or HCR-20.
  • Client Safety Plan is complete and placed within the client chart. This is also an important liability protection step! If you were not able to complete a safety plan, document the reasons why. 
    • • For example, your client is hospitalized as a result of a clinical crisis and they are safe, but you haven't yet had the opportunity to complete a safety plan with the client. Simply document that you'll require a safety plan upon the client’s return to your care.
  • Make note of any reports that you received and ensure the information can be located within your chart notes. Examples of report information include police reports, CPS reports, Elder abuse reports, and protection reports.

3. Self-care. As compassionate professionals, managing a clinical crisis situation can be emotionally draining, connected with heightened anxiety, and stressful. Remember to care for yourself. 

Here are some suggestions:

• Use your self-care strategies
• Seek consultation and/or a crisis debrief from Rula or your professional consultant/supervisor. It is okay to ask for help!
• Reschedule your day as needed. By far, the majority of clients understand that when a clinical crisis occurs, you may be pulled away and require some re-scheduling of your day. 
• When dealing with a clinical crisis situation, remember to take a breath. 
• Trust the H.E.L.P. guide to reduce your anxiety and stress. Know that you have the tools and resources to follow. Manage the things that you can do and focus on what is within your control, not things outside of your control.