Client Crisis Response - Quick Decision Flow & Guide

In this article, we will explain how to help a patient in crisis by utilizing one of two protocols: C.A.L.M. and H.E.L.P. 

Are you currently with the client in a live session (e.g., video, in-person, on a phone call)?

  • YES Client is Live with You → Use the C.A.L.M. Protocol
    (e.g., you are in a video session, phone call, or in-person visit with the client)
    • You are the lead responder.
    • You must assess and act in real-time.
       
  • NO Client is NOT Live with You → Use the H.E.L.P. Protocol 
    (e.g., client reached out via text, portal message, or another indirect method but you become aware)
    • Provide resources and document outreach.
    • Use clinical judgment to escalate if risk is evident.

C.A.L.M. Protocol — Client is Live / In Session

Step Action Clinical Purpose
C – Connect Connect with presence and empathy. Ground the session with emotional safety. Stabilize and de-escalate the moment
A – Assess

Assess risk with clear tools. Ask direct, specific questions about the patient’s thoughts, plan, intent, and access to means of self-harm or harm to others.

If the patient is at imminent risk of harming themself or others, proceed to L

 Determine acuity and immediate safety needs
L – Locate

Locate the Patient & Emergency Responders

  • Locate the patient’s current physical location
  • Determine if the patient is alone or if there are others present who could support.
  • If risk to life is imminent, call emergency responders in the client’s location by calling State Police or searching online for 'city/county dispatch center phone number' (not your local 911).
 Ensure real-time safety response
M – Maintain

Maintain Connection. It is essential to stay connected with the patient until additional emergency support arrives and:

  • A safe transfer of care occurs
  • Risk to life is sufficiently de-escalated
 Ensure continuous support during escalation
Post CALM: Documentation Fulfill legal, clinical, and ethical obligations

REMEMBER:

Responding to a crisis is a clinical intervention. Your clarity, presence, and documentation matter.
 

  • Obtain and document the patient’s current location/address at the start of session
  • Remember that you will need to locate the phone number for emergency services in the patient's current area and cannot just dial 911 from your home location.
  • The Rula Crisis Line (Protocall ) is not a replacement for live provider management of an in visit crisis.
  • If your patient is experiencing an acute mental health crisis in session, action is NOT optional.

 

H.E.L.P. Protocol — Client is Not Live / Between Sessions

Step Action Clinical Purpose
H – Hotlines

Share hotlines that provide 24-hour emergency services

  • Rula Crisis Line: +1 (877) 371-5488
  • National Suicide and Crisis Helpline: + 988
  • Local Emergency Services
  • Include your practice’s after hours info — it’s essential for client safety and liability protection.
 Ensure 24/7 access to emergency support
E – Engage

If appropriate, engage the client and assess the level of risk. Your immediate engagement efforts are expected practice. Some helpful tools include:

 Evaluate urgency and response needs
L – Locate (if needed)

Locate the client and authorities if needed. If you believe your client poses an imminent threat to themselves or others, state law may require you to contact authorities to ensure safety. 

  • If contacting authorities becomes necessary, call the State Police or search online for 'city/county dispatch center phone number' (not your local 911).
 Enable emergency response (e.g., welfare check, mandated report)
P – Post-crisis
  • Document all actions
  • Complete a safety plan if applicable
  • Submit an Adverse Event Report
  • Practice self care
 Support client safety, continuity of care, and risk reduction.
Documentation Record outreach attempts, responses, risk assessments (if any), and follow-up steps Ensure appropriate risk management and tracking

REMEMBER:
 

  • When a client expresses distress outside of session, your response is still a clinical intervention in alignment with applicable laws, ethical standards, and organizational procedures.
  • This may include providing crisis resources, conducting outreach, or initiating emergency intervention if warranted.
  • Use available tools (e.g., C-SSRS, HCR-20) to support your decisions.
  • Thorough documentation and timely reporting are essential to ensure appropriate care and risk management.
Need more details? Click here for the full H.E.L.P. protocol.

Updated

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