We screen for suicide risk during client matching to help ensure the right level of care from the beginning. However, risk levels can change, and clients may not always disclose fully at first. So when a risk alert is triggered through the Intake Assessment or PHQ-9, it is an important signal to reassess safety and confirm that virtual outpatient therapy remains appropriate.

You, the therapist, are the clinical point person. The client will automatically receive support resources via email when a risk is identified via Intake Assessment or PHQ-9.

Once a client is assigned to you and a session is scheduled, you are the primary provider responsible for clinical assessment and for taking appropriate steps to ensure client safety. Leadership is available for consultation at any time when elevated risk is present and will assume care only if therapist is unable to respond, but your judgment guides safety decisions in the moment.

Below are recommended steps to consider when risk is identified with a client. These guidelines are intended to support you in providing safe and responsive care; however, you may use your professional judgment and utilize the approaches and resources you have been trained in and are familiar with.

Therapist Empowerment Commitment

You are trusted to act in the client’s best interest.

You do not need approval to call emergency services or involve a client’s emergency contact when safety is in question.

Leadership is here to support, not delay, life-saving actions.

Review:

Conduct a brief safety risk assessment. Some tools are:

Note 1: If you have already completed a safety plan with client and risk procedures have previously been discussed, please follow your protocol. We recommend you utilize this table for new risk or significant changes in level of risk.

Note 2: Please refer to Scripts for Outreach [link Scripts for Outreach] if recommended action is to connect with client or emergency contact.

You may utilize Stanley-Brown Safety Planner or any other safety plans you have available to you. Please insure your safety plan includes:

*Safety planning is not the end point — it informs level of care decisions.

If a client is unable to create or follow through on safety plan, recommended action is inpatient stabilization.

Utilize a 'Free Text' note and include the following:

Key question: Can this client realistically maintain safety between virtual sessions?

If no:

These steps can be taken during therapy sessions if risk level is managed following notification of risk.

Clients should not be discharged while under risk monitoring unless they have successfully admitted into a higher level of care (such as inpatient or a different providers care) or have successfully met with a different provider.

These are not therapy, they are brief safety check-ins.

Tone: brief, warm, direct.

“Hi [Client Name], it’s [Therapist Name] from Ruh Care.

I’m reaching out because I reviewed some of your questionnaire responses and I want to quickly make sure you’re safe today.

Are you currently having any thoughts about harming yourself or ending your life?

Have you had any thoughts about acting on those?

Are you safe right now?

Thank you for sharing that. We will talk more in our next session, but I just want to make sure you have the support you need today.”

Close with:

“If anything changes, please call 911 or your local crisis line right away. You’re not alone in this, we will stay connected.”

“Hi [Client Name], this is [Therapist Name] from Ruh Care. Please check your messages when you can. I’d like to confirm your safety today.”

“Hello [Client Name],

I reviewed your recent responses, and I want to check in to ensure you’re safe today.

Please reply to let me know if you are currently safe.

If you are not feeling safe at any point, please call 911 or the crisis line listed in your intake email.

I’m here and we will talk more in our upcoming session.”

Include specific timeframe for reply (e.g., “Please respond within 4 hours.”)

“Hello [Client Name], thank you for completing your assessments. I wanted to check in based on your answers about feeling down and having occasional thoughts of not wanting to be here.

Your safety is important, and we’ll spend time together in our next session talking about what’s been going on and what can help.

In the meantime, please reach out to crisis supports if your thoughts become stronger or you feel unsure about your safety. Looking forward to connecting on [date/time].”

“Hi, my name is [Name], and I’m calling from Ruh Care.

(pause)

You are listed as an emergency contact for [Client First Name].

(pause)

I’m reaching out because we’ve been unable to reach them and we want to make sure they are safe.

(pause)

Have you been in contact with them recently, or do you know whether they’re safe right now?”

If the emergency contact asks for more detail:

“What they shared suggested they may be having a difficult time and could benefit from additional support. We’re not able to go into full detail, but safety is our primary concern right now, would you be able to have them connect with me."

(pause)

If safety is unclear or concerning:

“If you’re unable to reach them, or if you’re worried about their immediate safety, we recommend contacting local emergency services to request a wellness check.”

(pause)

Close:

“If you’re able to reach them, please encourage them to contact me at [phone or platform] as soon as possible. Thank you for helping us support them.”

Note: If you are concerned about access to weapons or other lethal means, you may ask the emergency contact to ensure they are in a secure location that client can not access. Emergency contacts may also be contacted for additional support when emergency services are not required.