Clinical Protocol: Responding to Suicide Disclosures
Aligned with NICE NG225 & BACP Ethical Framework

1. Core Principles

✅ No "Risk Ratings": Avoid labels (e.g., low/high risk). Focus on understanding the person’s unique context.
✅ Collaborative Approach: Partner with clients to co-create safety plans.
✅ Autonomy & Transparency: Respect the client’s agency; involve them in decisions unless immediate danger overrides this.
✅ Trauma-Informed: Prioritize safety, trust, and empowerment.

2. In-Session Disclosures

2.1 Immediate Response

• Listen with curiosity: "Tell me more about what’s brought you to this point."

• Validate distress: "It makes sense you’re feeling this way, given what you’re going through."

2.2 Exploratory Dialogue

Ask open questions to understand:

• Context: "What’s happening in your life that makes these thoughts feel present now?"

• Intent vs. ideation: "Are these thoughts more about escaping pain, or do you have plans to act on them?"

• Protective factors: "What’s helped you cope before? Who or what feels supportive right now?"

2.3 Safety Planning (Collaborative)

Co-create a plan addressing:

• Triggers: "What situations make these thoughts more intense?"

• Coping strategies: "What has helped you get through similar moments?"

• Supports: Names/numbers of trusted people, crisis lines (Samaritans, GP).

• Environmental safety: "Is there anything we can do to make your space/access to means safer?"

2.4 Urgent Scenarios

Only breach confidentiality if:

• The client cannot engage in safety planning (e.g., disorganised, intent + plan + no supports).

• There is imminent risk (e.g., "I’m going to take the pills tonight").

Actions:

1. Discuss first: "I’m really worried about your safety. Can we call your GP together?"

2. If refusal/no capacity: Contact emergency services (document rationale).

2.5 Documentation

Record:

• Key disclosures (verbatim where possible).

• Safety plan steps agreed.

• Actions taken (e.g., referrals, contacts made).

3. Out-of-Session Disclosures

3.1 Email/Text Response Template

"Thank you for reaching out. I’m really sorry to hear that things feel so difficult right now. You're not alone, support is available. As this is not a crisis service, I encourage you to contact one of the following for immediate support: Samaritans 116 123 / 999 in an emergency / your GP. I hope we can talk more about this in our next session. Sending some steadiness and care your way."

3.2 Imminent Risk

If a message suggests active intent (e.g., "Goodbye" + plan):

1. Attempt to contact the client directly.

2. If no response, call emergency services (provide client’s address from records).

4. Ethical & Supervisory Considerations

4.1 Contracting

• Initial agreement: Clarify limits of confidentiality and crisis protocols.

• Pre-trial therapy: Follow CPS guidelines (avoid evidence contamination).

4.2 Supervision

• Reflective questions:

  • "How did power dynamics affect my response?"

  • "Did I prioritise collaboration over control?"

• Consultation: Seek specialist input for complex cases (e.g., psychosis, cross-border clients).

4.3 Self-Care

• Debrief: After high-stress disclosures, use peer support or personal therapy.

• CPD: Regular training in safeguarding and suicide prevention (e.g., NICE updates, trauma-informed approaches).

5. Resources for Clients

Provide in writing:

• Crisis lines: Samaritans (116 123), SHOUT (85258).

• NHS options: 111 (urgent care) or 999 (emergency).