What do you do if you’re a therapist and your patient is high risk for suicide? After you’ve done the assessment, and they’re high risk.

The next step is you’re going to want to de-escalate them. Get them to be cooperative, if they’re having some sort of psychosis this might be difficult, but this is an important step. At that point if you have an emergency contact that can take them to the hospital great. That would be you breaking confidentiality, you let the emergency contact know this person needs to be taken to the er they need a 72-hour hold.

They’re taken to the er and evaluated there, then they’re taken to a 72-hour hold, at least that’s how it works my state. If there is no emergency contact maybe as a therapist, you are not totally comfortable even assessing this. There are mobile crisis teams that can come out and do this sort of thing for you.

If you are comfortable what’s the next step? You would call 911. Let them know you have a patient, and they are actively suicidal. In my state I have paperwork that I need to have filled out, if I don’t then police come, and they fill out the paperwork. They make sure the patient gets on the gurney.

Now you think about police coming to a situation where someone is immediately suicidal you may think they aren’t trained for this. In many states they are, they receive a 40-hour training by a therapist it’s a CIT certification (crisis intervention training). You can ask for a CIT officer, and that can help, meaning essentially the other police come to make sure no one is harmed and that everyone’s okay.

That officer is trained in de-escalating and getting them to be cooperative and get on the gurney safely. If you can do this ahead of time, de-escalate the client and get them to be on board with the fact that they can’t trust themselves. Stating we’re going to need provide immediate stabilization. We need to get you to the hospital and get some medication. This is so that you’re immediately feeling better because right now you’re such a high risk, and you can’t trust yourself.

If you can have this conversation and de-escalate your patient, and you can let the police know or over the phone when you call let them that the patient is cooperative. It’s going to be a much better and easier transition. What you can’t do and what you should not do is let your patient go if they’re immediately suicidal. You don’t want to neglect your patient when they are in their greatest time of need. You don’t want that on your conscience if they die.

Is going to a 72-hour hold super uncomfortable? Yeah, nobody loves it. Is having police come uncomfortable? Yeah, and nobody loves that. Are there instances where it kind of blew up and people got hurt? Yes, unfortunately this is why it’s important to de-escalate. This is why it’s important to communicate with a person on the phone and ask for a CIT officer. Let them know they’re de-escalated and they’re cooperative, let them know that they just need to be taken to the ER.

If there’s an emergency contact, you can bypass this and have them take the client to the ER. You can’t let them go alone; you’re going to want to make sure that they go. What the process looks like is the patient’s taken into custody by law enforcement or medical professionals. They’re usually taken in an ambulance, transported to the hospital.

There’s custody transport, then a medical exam where a patient is examined for medical problems. The patient is evaluated for potential harm to self or others again, they’re evaluated so not just by you or the police officer. They’re evaluated at the hospital then with that certification they are taken to a 72-hour hold. This is a psychiatric unit, and then they are admitted and then held for 72 hours, this is what it looks like in my state.

It might be different for you in your state, but it is important to de-escalate, it is important that you communicate what is going on, and that your patient is safe.

Hopefully this is helpful, if there is still resistance to calling 911 you have to work through that. You want to make sure that your patients are safe, and they don’t get hurt.

This is a way to make sure that they don’t die by suicide. There’s a legal and ethical obligation to make sure that your patients are safe. If you can do it another way that is ethical cool to do that, otherwise when you call 9-1-1 let them know de-escalated the patient. If they’re in psychosis let the police know they’re in psychosis. Sometimes that happens and sometimes it sucks but you want to make sure your patient is safe and not going to die by suicide. Ask for a CIT officer that’s going to make a big difference if the officer is trained, versus an officer that is not. You need to communicate on the phone what is happening, but you need to do something.

If you want to watch this video visit Preston Walker Guides Therapists, What to do if Patient is Actively Suicidal | Suicide Prevention – YouTube