According to the 2024 State of Mental Health in America report, 23 percent of adults, or nearly 60 million Americans, experienced mental illness in 2021-2022, and more than five percent of the U.S. adult population (12.8 million) had serious thoughts of suicide. While slight decreases in suicide deaths were reported in 2019 and 2020, the number of individuals who died by suicide in 2022 was the highest ever recorded in the U.S.
Counselors play a pivotal role in managing mental health crises; however, it is unreasonable to expect 24/7/365 availability. Therefore, counselors must be equipped with the necessary tools and policies to provide effective crisis intervention without compromising their own well-being. This article offers practical strategies to navigate mental health crises while preserving professional boundaries.
Safety planning with clients
Effective crisis management begins before an actual crisis arises, and one of the first steps is safety planning with clients. Designed to help individuals manage mental health crises, a safety plan acts as a guide for clients to follow when experiencing emotional distress or a crisis situation.
Safety plans are developed collaboratively between the client and counselor, providing a clear, step-by-step approach to manage triggers and prevent harm. Involving clients in the creation of their plan ensures that it reflects their unique needs and preferences. It also empowers clients by giving them a sense of ownership over their own coping strategies, increasing their confidence to handle difficult situations.
While the specifics will depend on the individual client’s needs, an effective safety plan includes several key components.
- Warning signs/triggers: Work with clients to help them understand when the safety plan should be used. What are the warning signs that a crisis may be developing? Use the client’s own words to create a list of warning signs/triggers that are easily understood and recognized.
- Internal coping strategies: Help clients identify techniques or activities that they can use to manage distress and de-escalate a crisis before reaching out for external help. Some examples include deep breathing exercises, positive self-talk, and physical activity. Get as specific as possible.
- Social and familial support: If internal coping strategies don’t resolve the crisis, ask the client to identify individuals or social settings that can help them take their mind off the situation. The safety plan should also include family and friends to ask for help in a crisis scenario. Also include several people or social settings in case the first option is unavailable.
- Professional support: In cases where professional support and guidance are needed, identify mental health professionals that clients can reach out to. List the names, numbers, and locations of clinicians, urgent care, and other resources.
- Making the environment safe: During a crisis, particularly one related to suicidal ideation, the counselor and client should have a discussion regarding safety. Does the client own a firearm? What other lethal means do they have access to? Together, they should identify ways to secure their environment.
Throughout the safety planning, check in frequently with the client and ensure you are creating a plan that they are likely to follow when a crisis occurs. Role play and rehearsal can be a useful tool when developing a safety plan.
As a client’s situation and mental health evolves, their safety plan must be adapted accordingly. Regularly reviewing and updating the plan guarantees that it remains a relevant and reliable resource for the client in times of need.. This allows for adjustments based on changes in the client’s triggers, coping mechanisms, or support system.
Policies and procedures for managing clients in crisis
Crisis situations can be emotionally and physically draining, and without established guidelines, counselors may find themselves overextended, leading to burnout or compromised care. By setting clear boundaries and adhering to structured crisis management protocols, counselors can provide effective support while preserving their own mental and emotional health.
When a client is in crisis, the first step is triage. This begins by assessing the level of risk and determining the appropriate response, whether it be de-escalation, involving other professionals, or arranging emergency care. If the crisis occurs during a virtual/telebehavioral health session, HHS recommends already having the following information documented: the client’s location; emergency numbers for that location; a local emergency contact or support person; and contact details for the client’s other healthcare providers. It is also critical to have a plan for what to do if the telehealth visit is disconnected during an emergency.
Counselors cannot always be available, even during business hours. In such cases, it is important to have a delegation system in place. Staff should be trained to handle crises when the primary counselor is unavailable, and backup plans, such as on-call systems, should be established. Similar protocols should be utilized for crises that occur outside of normal business hours. Automated messages, on-call services, and emergency contacts can be used to make sure clients receive appropriate help at the time of crisis. The safety plan should outline what steps a client can take if they need support.
Additionally, counselors must have clear emergency contact procedures in place. This may involve providing clients with crisis hotline numbers or on-call services. On-call systems should also have defined response times, so clients know when they can expect help. Clear communication with clients about unavailability and emergency protocols will help manage their expectations.
After a crisis, protocols for follow-up care are essential. Proper documentation of crisis situations and responses is not just good practice, but a legal and ethical necessity. Thorough record-keeping ensures that crisis interventions are well-documented and follow-up actions are clearly outlined.
Conclusion
A structured approach to crisis management that includes personalized safety plans and clear professional boundaries is critical for the overall well-being of both clients and counselors. It’s also imperative to regularly review and update crisis management plans and policies. Finally, counselors should engage in ongoing professional development to refine their crisis intervention skills to better manage the complexities of client crises while also maintaining professional boundaries and protecting their own mental health.
Key Elements of Crisis Management
| |
Description |
Implementation |
Benefits for Client |
Benefits for Counselor |
| Client Safety Plans |
Personalized plans to guide clients through crises |
Collaboratively identify triggers, coping strategies, emergency contacts, and actionable steps |
Clients feel empowered and prepared to manage crises |
Reduces frequency of immediate crisis calls and relieves counselor burden |
| Clear Communication of Boundaries |
Setting expectations for client communication during and outside business hours |
Establish office hours, automated messages, and emergency contact information |
Clients understand when and how to seek help; increases transparency and trust |
Protects counselor’s personal time and mental well-being |
| Emergency Contact Procedures |
Systems for handling after-hours emergencies |
Provide clients with crisis hotlines, on-call support, and emergency response steps |
Clients have access to critical support during emergencies even outside of session times |
Reduces counselor stress by ensuring clients have alternative sources of immediate support |
| Triage and Crisis Assessment |
Immediate evaluation of client needs during a crisis |
Use a structured approach to assess risk and determine appropriate interventions |
Clients receive timely, appropriate responses to crises |
Provides counselors with a process to handle crises effectively |
| Follow-Up and Documentation |
Thorough record-keeping and post-crisis care |
Maintain detailed notes of crisis incidents and follow up with clients to ensure stability |
Helps clients feel supported beyond the immediate crisis |
Reduces legal and ethical risks; ensures continuity of care and accountability |
| Regular Plan Review |
Periodic evaluation of client’s safety plan |
Schedule consistent reviews and updates of the safety plan as the client’s situation evolves |
Keeps safety plans relevant to the client’s changing needs |
Ensures that interventions are always aligned with current client needs |
Resources
Mental Health America. Quick Facts and Statistics About Mental Health.
https://mhanational.org/mentalhealthfacts
Mental Health America. The State Of Mental Health In America.
https://mhanational.org/issues/state-mental-health-america
Suicide Prevention Resource Center. Safety Planning Guide.
https://sprc.org/wp-content/uploads/2023/01/SafetyPlanningGuide-Quick-Guide-for-Clinicians.pdf
Substance Abuse and Mental Health Services Administration (SAMHSA). National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit.
https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf
Patient Safety Plan Template.
https://988lifeline.org/wp-content/uploads/2017/09/Brown_StanleySafetyPlanTemplate1.pdf
Psychiatric Times. Safety Planning: An Essential Feature of Cognitive Behavior Therapy for Suicide Prevention.
https://www.psychiatrictimes.com/view/safety-planning-an-essential-feature-of-cognitive-behavior-therapy-for-suicide-prevention
Creating an emergency plan for telebehavioral health.
https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-behavioral-health/preparing-patients-for-telebehavioral-health/creating-a-telehealth-emergency-plan