There are a number of things to keep in mind when a patient appears to be in a psychiatric crisis.
When possible, voluntary engagement is best. A willing, cooperative patient who understands their treatment goals and plan almost invariably has better outcomes than someone forcibly detained and transported involuntarily. If safe to do so, collaborate with patients on an appropriate plan that they find agreeable. The least restrictive, voluntary setting for crisis care should also be targeted in this way.
Err on the side of safety. Always choose the option that ensures your patient will safely reach the intended destination. It is far better to have temporarily involved police than to have an individual go missing, fail to arrive for treatment at the emergency program, or jump from a moving vehicle en route to help.
Do not overreact/use knee-jerk responses. Patients may talk about past thoughts or fantasies of dangerous behaviors. Do not immediately call 911 just because a patient says the word suicide or offhandedly mentions a thought of killing another out of frustration. Carefully explore what the person is saying before determining the need for referral to a higher level of care. Of course, always err on the side of safety.
Do not fear potential backlash. Therapists might be reluctant to engage emergency services or obtain an involuntary hold because they are concerned their patient will feel betrayed. Although an individual might initially be angry, in most cases, they will later be very thankful that you cared, intervened, and saved their life.
Upon initiation of treatment relationship, obtain signed consents from all your outpatients so you can stay involved during and after any crisis. It is a good idea to have all your patients sign a general consent allowing you to be informed of their assessment, treatment, and disposition within crisis services. A signed consent transmitted to a crisis program will allow that program to involve you in the care of your patient while respecting HIPAA privacy laws. However, it is important to note that the patient can always choose to rescind any previously signed consent.
Be familiar with your community/county resources before you encounter a crisis. Trying to determine resources in the heat of the moment is already far too late. Be aware of the voluntary and involuntary crisis services available in your community before you are faced with a crisis.