A counsellor in Hyderabad described to me what happened the night a client called her at 11pm reporting suicidal thoughts. The counsellor froze for thirty seconds. She’d never written down what she’d do in this situation. She did the right things eventually — helpline, family contact, follow-up — but they came from improvisation, not from a plan.
This post is the document she wished she’d written. Every Indian private therapy practice should have its version on file.
Why a written protocol
Crisis moments are not when you want to be improvising.
Three specific reasons:
1. Cognitive load. In an actual crisis, your working memory is occupied. A written protocol means you don’t have to remember; you have to read.
2. Consistency. The protocol ensures you respond the same way each time, with the same standards.
3. Documentation. If a crisis goes badly and is later reviewed, a written protocol shows that you had a system in place. This matters legally and professionally.
What the protocol should cover
A working protocol document covers:
1. Definition of crisis. What signals count as crisis for your practice?
2. Immediate response steps. In order.
3. Specific resources. Helpline numbers, hospital names, addresses.
4. Documentation requirements. What to record after.
5. Follow-up steps. What happens in the days after.
That’s the structure. A one-page document covers all of it.
A sample protocol
Below is a template you can adapt. Make it specific to your city and practice.
Crisis Response Protocol — [Practice Name]
Definition. A client situation is a crisis if any of the following are present:
- Active suicidal thoughts with specific plan or means
- Active homicidal thoughts toward a specific person
- Significant self-harm in progress or imminent
- Acute psychotic symptoms with risk
- Substance overdose
- Severe medical event during session
During a session, if crisis emerges:
- Stay calm. Maintain presence with the client.
- Assess directly. Ask specific questions: “Are you safe right now? Do you have a plan? Do you have the means?”
- Stay with them. Don’t end the session.
- If safety is in immediate question:
- Call the client’s emergency contact (collected at intake)
- Call an emergency service if needed (108 / hospital)
- If telehealth: get the client’s physical location, contact local emergency services
- Develop a safety plan together before ending the session.
- Schedule a follow-up within 24 hours.
- Document everything within 4 hours.
Between sessions (client contacts you):
- Respond within hours during work hours; refer to crisis path outside.
- Assess urgency:
- Active suicidal/homicidal: stay on the line; contact emergency services or family
- Distress but not immediate risk: brief intervention; book earliest possible session; helpline referral
- Document the contact.
Crisis resources to provide:
- iCall: 9152987821 (free, multi-language)
- Vandrevala Foundation: 1860-2662-345
- AASRA: 91-9820466726
- iCare: 1800-208-5333
- Sneha (Chennai): 044-24640050
- [Local hospital with emergency psychiatric services]
- [Local police if necessary]
Documentation after a crisis:
- Date and time of incident
- Nature of the crisis (what the client reported)
- Your assessment of risk
- Actions you took
- Safety plan agreed
- Follow-up scheduled
- Any third parties contacted
Follow-up after crisis:
- Session within 24 hours if possible
- Phone check within 48 hours if no session possible
- Re-assess at the follow-up
- If pattern of crisis: consult supervisor; consider referral to psychiatrist or higher level of care
Adapt this to your specifics. Print it. Keep it in your desk drawer and a copy on your phone.
Specific things to think through
A few preparation steps:
Your emergency contacts at the practice level.
- Your own supervisor’s contact (for consultation)
- A psychiatrist you’d refer to in crisis
- A specific hospital with emergency psychiatric services in your city
- Your client’s emergency contacts (collected at intake)
Your duty-to-warn position.
The Mental Healthcare Act and clinical norms support disclosure in situations of imminent harm. Know your position clearly before the moment arises. Document it as part of your written protocol.
Your telehealth-specific protocol.
If you do telehealth, your protocol needs explicit telehealth provisions:
- Client’s physical location at the time of session
- Local emergency services in their location
- Their emergency contact
- A backup phone number in case of video failure
What clients need to know
Crisis protocol affects intake disclosure. Specifically:
- Confidentiality and its exceptions, including imminent risk
- Emergency contact collected at intake
- Crisis resources provided to them in writing
Most of this is in the standard informed-consent paragraph. The crisis-specific addition is the named resources (helpline numbers, local hospital).
What to do after a crisis: the next 72 hours
Beyond the immediate response:
Day 1. Follow-up contact. Brief check-in. Confirm safety. Confirm next session.
Day 2–3. Next session. Process the crisis. Review the safety plan. Adjust treatment as needed.
Day 3–7. Consultation with supervisor about the case. Even if the crisis resolved well, supervision review is valuable.
Day 7–14. Review your own response. Did the protocol work? What could be improved? Update the protocol if needed.
The self-care dimension
A specific issue: crisis sessions are heavy for the practitioner. The protocol should include something for you:
- Acknowledge to yourself that this was a hard session
- Don’t see another client immediately if you can help it
- Talk to your supervisor or a trusted colleague briefly within 24 hours
- Do whatever your usual restorative practice is
- If a pattern of crises is occurring, consider whether your caseload composition is sustainable
What practice-management tools should support
A few specific things:
- Easy access to client emergency contacts (visible from the client overview screen)
- Quick documentation templates for crisis incidents
- Calendar integration for follow-up scheduling
- A crisis-incident log separate from regular notes
Most tools don’t have specific crisis features. A custom note template works.
A close
A written crisis protocol is the kind of document you hope you’ll never need but will be very glad to have when you do. An hour spent writing it now is the best time investment a private practice can make.
Keep it short. Keep it specific. Print it and keep it accessible.
For the operational side, our tool at mindmaster.modoware.com handles client records and follow-up scheduling. The protocol itself — the document, the resources, the practice — is yours to build before you need it.