Supporting a Patient in Crisis During a Telehealth Session

A CALM-Informed Approach to Responding with Compassion and Clarity

At Rula, we know that crisis moments can be some of the most intense—and also some of the most meaningful—parts of a client’s healing journey. When someone shares active danger to self, danger to others, medical risk, or other life-threatening concerns, it calls for more than clinical decision-making: It calls for human connection, grounded presence, and a sense of shared strength.

You’re not alone in these moments, and your client doesn’t have to be either.

This guide introduces the CALM approach, a research-informed, trauma-responsive framework to help you feel anchored and supported when a client is in crisis. CALM stands for:

• Connect
• Assess
• Limit risk
• Mobilize supports

CALM: A Step-by-Step Response to Client Crisis

C – Connect: Begin with Relationship and Regulation

When someone discloses risk, your presence -calm, clear, and caring- can become a lifeline. Before moving into assessment or planning, take a breath and re-center in the relationship.

If you feel fear, panic, or even paralysis- you’re not alone. These moments are intense. Your steady presence is one of the most powerful tools you have.

Here’s how you can ground yourself and co-regulate with the client:

• Take one slow, steady breath. Let your own nervous system settle.
• Anchor in your role. You’re not here to fix everything; you’re here to stay connected and move toward safety together.
• Lead with compassionate structure. When we bring both empathy and clarity into the room, clients are more likely to stay engaged and feel safe (Jobes et al., 2023).

You might say:

“Thank you for sharing this with me. I care about your safety, and we’re going to figure this out together.”

A – Assess: Understand the Risk with Curiosity and Care

Once you’ve created a space of connection, gently shift the focus of the session to safety.

“Right now, your well-being is our priority. Let’s slow down and talk about what’s going on, together.”

Start with a few key reminders:

• Always confirm the client’s location (exact physical address) at the start of the interaction. If it was missed, ask now. If the client reports being in a vehicle, document the exact location, cross streets, and vehicle make, model, and color.
• Be direct and compassionate. Clients often feel relief when their provider can hold the weight of the conversation without judgment.

Ask About Risk:

• Thoughts: “Have you been thinking about ending your life?”
• Frequency and Intensity: “How often are those thoughts showing up for you?”
• Plan: “Have you thought about how you might do it?”
• Means: “Do you have access to what you’d need to complete this?”
• Intent: “Do you feel like you might act on those thoughts soon?”

The Columbia-Suicide Severity Rating Scale (C-SSRS) can be useful if you’d like additional data (Posner et al., 2011). The ASQ can also be helpful in further illuminating risk, in the case of danger to self.

The Historical, Clinical, Risk Management (HCR-20) can be used if you’d like additional assessing for risk of violence or danger to others.

Explore Contributing Factors:

• Risk factors: past attempts, recent psychiatric hospitalization or discharge,  self-harm, grief/breakups, substance use disorders and acute intoxication, diagnoses (e.g. Major Depressive Disorder, Bipolar Disorder, PTSD, SUD), medication changes, chronic pain, and history of high risk behaviors
• Protective factors: meaningful relationships, reasons for living , effective clinical care and access, coping tools, faith or values

“What helps you feel grounded or connected, even a little, when things get really hard?”

Match Your Next Steps to the Level of Risk:

Stay collaborative—avoid threatening language. Try:

“My goal is to help you feel safe enough to keep going. Can we make a plan together to get through this?”
 

Your clinical judgment is essential. These conversations aren’t about following a script; they’re about knowing the person in front of you and understanding what safety means for them.

L – Limit Risk: Help the Client Stabilize and Reduce Immediate Danger

Once you understand the level of risk, the next step is to contain the moment and guide the client toward emotional and physical safety. Many clients are emotionally flooded during a crisis; it’s hard to access logic, memory, or hope. Helping them emotionally regulate- even a little- can make space for collaboration. 

“Would it be okay if we took a moment to do something together to slow things down, just enough so we can keep talking and thinking clearly?”

Evidence-Based Skills to Reduce Emotional Intensity

Soothing the Body (Somatic Coping):

Soothing the Body (Somatic Coping):

• 5-4-3-2-1 grounding
• Holding ice or splashing cold water
• Box breathing (4-4-4-4)
• TIPP skill (Temperature, Intense exercise, Paced breathing, Paired relaxation)

Working with Thoughts (CBT/ACT):

• “I’m noticing I’m having the thought that…” (defusion)
• “What’s another way of looking at this?” (reframing)
• “What helped last time this came up?” (planful coping)

Behavioral Activation:

• “What’s one small thing you could do after a session that might help you through tonight?”
  • Examples: texting a friend, turning on a light, stepping outside, taking a shower
  • Share the Rula Crisis Hotline (800-307-8999) and other 24 hr resources with the patient and encourage their use.

M – Mobilize Supports: Bring In Help and Build a Circle of Care

Social support is one of the most protective factors against suicide risk (Chu et al., 2017). When people are surrounded by care- both professional and personal- they're more likely to stay safe and engage in ongoing treatment. Explore ways to involve support people the client already trusts.

You might ask:

• “Is anyone with you right now?”
• “Is there someone you trust we can call together, just so you’re not alone after this session?”
• “Would it feel okay to stay with someone tonight?”

With permission:

• Loop in a trusted person via phone.
  • Share your concern, and what they might expect.
  • Share the safety plan and clearly explain their role and actions.
  • Ask them to reduce access to means.
  • Encourage follow-up care or a visit to the ER together.

Clients often feel shame; frame support people as “part of the care team” rather than “babysitters” or “monitors.” Try this: 

“This isn’t about monitoring—it’s about helping you feel cared for and not alone.”

If the client is at high risk and cannot or will not collaborate:

“I care about you. If we can’t make a plan together, I’ll need to reach out to someone to help make sure you’re safe.”

• Call 911 (if local) or search for emergency services in the client’s area.
  • If you’re not in the client’s same jurisdiction:
    1. Find the Non-Emergency Number
       Search online for the non-emergency or administrative number for the law enforcement agency, sheriff’s office, or dispatch center in the city or county where the emergency is occurring (e.g., “Springfield non-emergency police number”).
    2. Call and Explain
       Call the number and explain you’re reporting an emergency at a specific address in their area, even though you’re calling from out of state. They can dispatch local emergency services.
    3. If You Can’t Find the Local Number
       Search for the state police or highway patrol number. They can often connect you with the appropriate local agency.
• Use the location you confirmed earlier.
• Stay with the client until help arrives.

After the Crisis: Continue the Work, With Care

Crisis work doesn’t end when the moment passes. Following up matters: both for your client and for you.

• Schedule a follow-up session within 24–72 hours
• Offer referrals to higher levels of care, if appropriate
• Encourage ongoing connection to social supports
• Document the event clearly and thoroughly in the patient's chart (see an example here)
• Submit an Adverse Event or Incident (AEI) Report (option A) if appropriate. An AEI report is required whenever a patient currently or previously under care at Rula experienced an event—whether expected or unexpected—that has caused, or has the potential to cause, harm or an adverse outcome. If you are unsure an AEI report is needed, erring on the side of caution is advised.
• Debrief and consult: You can always submit a Patient Safety Service Request (option B) to talk through what happened with a fellow licensed clinician. In addition to supporting your own well-being, it can be helpful to consult with a fellow licensed clinician about next steps in care for this client. 

You Are Not Alone—And Neither Is Your Client

These moments in care are difficult—but they’re also moments where something powerful can begin to shift for your client. Your presence, your steadiness, your belief that safety is possible—it matters more than you know!

Together, we stay CALM. Together, we lead with care.

Updated March 05, 2026 15:52