Does your practice have a crisis policy?

A client discloses imminent risk during a session. Do you know exactly what to do next? Who to call, in what order, and what you can legally share? For many therapists, especially those in solo or small group practices, the answers live in a gray area. This lack of a clear, written plan creates significant risks for your clients, your practice, and you.

Malpractice claims related to crisis response and confidentiality are often caused by poor communication. At the same time, national standards from organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA) are making documented crisis protocols a requirement for funding and demonstrating a standard of care.

Don’t wait for a crisis to figure it out. Learn why an emergency policy is essential and get a simple guide to build one in this blog post.

Why your practice needs a crisis policy

Having a formal policy for emergencies is a foundational element of ethical practice that protects everyone involved.

First, a crisis policy promotes client safety. A clear protocol ensures a swift, effective response during a client’s most vulnerable moments. With about 45% of individuals who die by suicide having seen a mental health professional within the month prior, your role in creating a safety net is critical.  When a client is in crisis, every second counts. Having a clear plan to connect them with the right crisis team and ensure follow-up care means they get help fast and don’t fall through the cracks. That immediate, ongoing support can make all the difference in preventing harm.

Second, having a plan reduces your liability. In a lawsuit, a primary question is whether you met the standard of care. A documented, evidence-based crisis policy shows you acted thoughtfully and in line with professional standards, rather than making panicked decisions under pressure.

Third, a crisis policy protects your business. How your practice handles a crisis impacts its reputation. A coordinated, professional response builds trust with clients, community partners, and payers. Conversely, a disorganized reaction can lead to poor outcomes and damage your professional standing.

Lastly, a crisis policy meets payer and grant requirements. Many insurance payers and grant-funding bodies, like those for Certified Community Behavioral Health Clinics (CCBHCs), now mandate that practices have documented crisis procedures to qualify for certain payment structures.

A written, trained, and regularly reviewed crisis policy is one of the most effective risk management tools you can have.

The core components of a strong crisis policy

A sustainable policy is one that is simple enough to be followed under stress. It should be built around three core pillars:

Collecting the right information: According to therapists.com, knowing what kind of crisis your client might face helps you plan ahead. When you understand the risks, you can create a response that’s faster and more effective.

 Defining clear actions: In an emergency, confusion slows everything down. People often assume someone else will step in, and that delay can put a client at risk. Your plan should spell out exactly what to do—who to call, what to say, and whether to keep the client on the line—so action happens immediately.

Ensuring compliant communication: In SAMSHA’s National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit, multiple case studies highlight that handing off the right information makes it easier to stabilize someone and keep them safe.  A clear communication process protects your client and keeps your practice compliant.

These are general guidelines, not to be confused with legal advice. Before finalizing your emergency policy, consult with qualified professionals (such as legal counsel, emergency services, and clinical supervisors) to make sure your plan is safe, compliant, and practical.

1. Emergency contact collection and verification

This is more than just a name and number on an intake form. Your emergency contact information must be accurate and actionable.

At intake, collect at least two emergency contacts (a primary and a secondary), their relationship to the client, and their phone numbers. Also ask for the client’s preferred hospital. A signed consent form authorizing you to contact these individuals in an emergency is crucial.

Involve your client. Ask about their preferences and past experiences. For example, are there hospitals or facilities they want to avoid, or ones they prefer? Have they been through a crisis before, and what worked or didn’t work? What worries them most about emergency care? Document these details and revisit them regularly. Collaborating on the plan makes clients more comfortable talking about emergencies and ensures your response feels safe, respectful, and effective.

Verify, don’t assume. A typo can render a phone number useless. Check the primary contact’s number during intake with a quick test call or text to confirm the number is correct and the contact is reachable.

For virtual sessions, the American Psychological Association’s (APA) 2024 guidelines stress the importance of confirming the client’s physical location at the start of every session. You should also have their local 911 dispatch number and the number for a local mobile crisis unit on hand, as these can differ from your own location.

2. Crisis response protocols

Your policy should include simple, clear decision trees for different types of crises. The goal is to minimize guesswork when stakes are high.

For suicidal ideation without a plan, use a standardized tool like the Columbia-Suicide Severity Rating Scale (C-SSRS) to assess risk. Co-create a safety plan with the client and schedule a follow-up appointment within 24 hours.

Imminent risk (like self-harm or harm to others) requires immediate action. The first step is to initiate a warm hand-off by calling the 988 Suicide & Crisis Lifeline and keeping both the client and the 988 operator on the line with you. If the threat is immediate, call 911. Your policy should clarify the protocol for engaging mobile crisis teams or pursuing an involuntary hold, along with documentation requirements.

For medical emergencies or overdose, call 911 immediately. If you’re trained, administer naloxone in a suspected opioid overdose. When speaking with emergency responders, HIPAA’s emergency disclosure rules and 42 CFR Part 2 (for substance use records) allow you to share necessary information to protect the client’s health and safety. Always document what information was shared, with whom, and when.

3. Communication and documentation

A clear chain of command prevents confusion and ensures proper oversight.

Solo practitioners have a direct escalation path: You -> 988/911 -> Emergency Contact. It’s also vital to consult with a supervisor or peer group after the crisis is stabilized to debrief and review your actions.

For group practices, the first call should be to the clinical director or on-call supervisor. This person can help coordinate the response, activate a crisis team, and ensure proper procedure is followed.

Document everything in clear, structured clinical notes. Record the date and time, the presenting risk, the specific interventions you took, and the clinical rationale for your decisions. New HIPAA Security Rule updates emphasize the need for detailed audit logs in your EHR, so ensure your system can track who accessed what information and when.

Navigating the legal and ethical landscape

Rules around confidentiality and a clinician’s duty to act can be complex and vary by state.

HIPAA allows you to share protected health information (PHI) with family or first responders if you believe it’s necessary to prevent serious harm. For clients with substance use disorder (SUD), the 42 CFR Part 2 rules make it easier to share information once a client provides broad consent, but they still require strict logging of any emergency disclosures. 

The duty to warn/protect is a state-level requirement. Currently, 28 states have a mandatory duty to warn potential victims of a threat, while 15 have a permissive one. Know your state’s specific law regarding what triggers this duty (e.g., an explicit threat against an identifiable victim).

Also known as “red flag laws,” Extreme Risk Protection Orders (ERPOs) are now active in 21 states. They create a legal pathway to temporarily remove firearms from an individual deemed a danger to themselves or others. Therapists may be involved in this process, so understanding your state’s ERPO statute is essential. But data is thin here: While professional organizations have provided guidance, there is very little case law that clarifies a therapist’s specific liability or immunity when participating in the ERPO process. This remains an emerging legal area.

Putting it all together: Your action plan

Building a policy from scratch can feel daunting, but you can make significant progress in just a few days. 

1. Draft your policy language: Start with a simple template. Define the policy’s purpose, who it applies to, and the core procedures for intake, crisis response, and after-hours coverage.
2. Create your tools: Update your intake packet with a detailed emergency contact form. Create a one-page crisis decision tree and a short script for staff to use during a crisis call. Post this flow chart in a visible location.
3. Train your team: A policy is only effective if people know how to use it. Hold a training session. Role-play different scenarios, like making a warm hand-off to 988 or contacting an emergency contact.
4. Build community partnerships: Don’t work in a silo. Reach out to your local 988 hub, mobile crisis team, and nearby hospital emergency departments. Sign a Memorandum of Understanding (MOU) to clarify procedures for warm hand-offs and information sharing.
5. Audit and revise: Schedule an annual review of your policy. Quarterly, pull a few crisis case files and audit the documentation. Did the clinician follow the protocol? Was the documentation complete? Use these audits to refine your policy and identify training needs.

Taking these steps will prepare you to act confidently and competently in a crisis, protecting your clients and your practice for years to come.