06 Crisis Intervention

Purpose and priorities

Crisis intervention is short-term, focused support intended to reduce immediate danger and distress, restore the person’s ability to cope, and connect them with appropriate ongoing care. Priorities are safety, respectful communication, timely assessment, and the least restrictive effective response.

The response should match the assessed risk and the person’s needs. Reassess as circumstances change, and escalate care when danger or medical need is imminent.

Assess immediate needs and risks

Begin with a Crisis assessment for urgent medical needs. Check responsiveness, breathing, injuries, overdose or intoxication, withdrawal, and signs of an acute medical condition. Activate emergency medical help when indicated; do not automatically assume that a behavioral change has a psychiatric cause.

When possible, assess in a safe, private setting. Use calm, direct questions and simple language to explore:

• What happened and what the person needs right now.

• Thoughts or plans of suicide or self-harm, intent, access to means, and recent or past attempts.

• Thoughts of harming someone else, access to weapons, and immediate threats.

• Severe agitation, confusion, hallucinations, substance use, or inability to meet basic needs.

• Available supports, reasons for living, coping strategies, and the person’s preferences.

Ask directly about suicide; clear questions support assessment. Do not rely on a screening score alone to determine safety or disposition. Current suicidal thoughts, a feasible plan with access to means, or another imminent threat requires urgent clinical evaluation. Follow local emergency procedures, maintain observation, and do not leave a person at imminent risk alone while help is arranged.

Reduce distress safely

De-escalation aims to lower distress and reduce danger without increasing confrontation. When it is safe and consistent with workplace policy:

• Have one staff member speak, using a calm voice, respectful tone, and brief, concrete statements.

• Give the person space, keep a clear exit route, and avoid sudden movements, crowding, arguing, threats, or unwanted touch.

• Reduce noise, audience, and other stimulation, and allow time for the person to respond.

• Acknowledge feelings without endorsing unsafe behavior. For example: “I can see this feels overwhelming. Let’s work out what would help you feel safer.”

• Offer realistic choices and explain what will happen next.

If danger escalates, prioritize the safety of the person and others, summon the appropriate response team, and follow organizational policy. Use the least restrictive safe approach. Do not attempt physical intervention beyond your training, authority, and policy.

Choose an immediate response

Match immediate intervention to the assessed risk and the person’s needs. Possible responses include first aid or emergency medical care, continuous observation, urgent psychiatric evaluation, crisis-team support, or a quieter and safer environment.

Explain actions in plain language, preserve dignity and privacy, and involve the person in decisions whenever possible. Reassess safety as the situation changes, and communicate key findings and actions to the care team.

For immediate, life-threatening danger or a medical emergency in the United States, call 911 or use the local emergency response system. For mental health or substance-use crisis support in the United States, people can call or text 988; a 988 counselor can help assess needs and identify support options. Mobile crisis services may be available locally.

Create a usable safety plan

When appropriate, use Safety planning to develop a practical plan collaboratively with the person. It is not a promise or “contract” to remain safe. A written plan can include:

1. Personal warning signs that a crisis may be worsening.

2. Coping strategies the person can try independently.

3. People or places that provide safe distraction or connection.

4. Trusted people to ask for help.

5. Clinicians, crisis services, and emergency contacts.

6. Steps to reduce access to lethal means, such as arranging safe storage or temporary removal of dangerous items with appropriate support.

Make the plan specific, accessible, and realistic. Ask the person to explain how they would use it, and update it as circumstances change.

Connect to follow-up care

Agree on the next step and, when possible, make a Warm handoff: contact the service with the person, confirm how and when they will be seen, and address practical barriers such as transportation, language access, or cost. Refer according to need to behavioral health care, substance-use treatment, primary care, community supports, or specialized services. Give clear instructions for what to do if risk increases before follow-up.

Document the person’s statements, observed behavior, assessment, actions, consultation, referrals, and response objectively, following privacy rules and organizational policy.

The overall sequence is to assess immediate medical and behavioral risks, communicate calmly and respectfully, intervene at the least restrictive safe level, collaborate on a usable safety plan, and connect the person to timely follow-up. Reassess and escalate care when danger or medical need is imminent.