GESTALT TREATMENT CENTER

SUICIDE PROTOCOL

ONCE YOU KNOW YOUR CLIENT IS A POTENTIAL SUICIDE RISK

1. Make sure you have two emergency contacts on file for the client.

2. Help the client come up with a safety plan using the Suicide Prevention Safety Plan
& Contract. Have the client sign the contract, promising that if s/he is planning to
harm themselves, they will call you first.

ONCE YOUR CLIENT IS ACTUALLY THREATENING SUICIDE

1. Contact the client’s psychiatrist, if possible.

2. Call someone to come and take the client to a psychiatric ER -- a family member or
friend. You might start with their emergency contacts.

It’s important that the client not go alone to the ER, if at all possible, because the
client needs support to get through the ER system.

3. If you can’t get someone to take the client to the ER, you will have to go.

Your going with the client may be healing for them. In addition, your presence can
be important because you are the best person to explain your concerns to ER
personnel. Your assessment to the person making the assessment is the best way
to secure a hospitalization. You can also do this by phone but it’s much more
effective in person.

(You might have to cancel your other clients, or leave a note on the door if you can’t
reach them.)

4. Call 911 only as a last resort. Explain that you are the therapist and that the client is
a danger to themselves and that they need to be transported to the ER. If you can
meet the client at the ER, state that to the 911 operator.

5. Report incident to your Supervisor, Executive Director and Medical Director.

6. Document everything you do, including all interventions used, all conversations and
all actions taken.

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 SUICIDE PREVENTION SAFETY PLAN & CONTRACT

This plan will help you to come up with ways to stay safe in advance of a crisis.

What are my warning signs (thoughts, feelings, images, mood, situation, behavior) that a
crisis might be developing.

What are my triggers (some of the things that make me angry, very upset or cause me to
have a crisis?)

What Coping Strategies do I have (things I can do to calm myself; what has worked
before?)

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Family, friends, significant others I can contact who will help if I need it.

Contract

I, , promise that if I am thinking

about doing any harm to myself, I will first call my therapist.

Name Date

Client’s signature Date

Therapist’s signature Date

Phone Numbers

1. Therapist’s Reach Numbers

2. Psychiatrist’s Reach Numbers

3. Suicide Hotline: 1 (800) 273-8255

4. Police and EMS: 911

5. Other