Crisis Intervention in Social Work – Psychosocial Crises and Suicidality

The question has been asked, and the answer has come: yes, the person is thinking of taking their own life. For many social work professionals, this is the moment when uncertainty is greatest. What happens now? Does the emergency number have to be called straight away, or is a follow-up appointment enough? How can the conversation continue so that the person feels taken seriously and, at the same time, more safety is created? This module follows directly on from raising suicidality openly and shows what comes next: a shared, structured evaluation of the current situation, the development of a written safety plan and a reliable onward referral to medical help, crisis services and counselling services. What matters here is not a technique but a professional stance: you act together with the person concerned, as part of a team and in line with your organisation’s procedures – and you know the limits of your role.

PART 1 – Introduction: the shared work begins after the subject has been raised

From noticing to acting

The previous module showed that suicidality can be noticed and raised openly – calmly, directly and without hesitation. But raising it is not an end in itself. It opens up a space in which you can work out together how pressing the thoughts are at the moment, what has kept the person alive so far and what support is within reach. The next steps follow from this clarification: sometimes a carefully developed plan with an agreed follow-up contact is enough, sometimes a prompt medical or psychiatric evaluation is needed, and in an acute situation of danger the emergency medical service must be called immediately. These three tasks – evaluating, planning and referring on – form the core of this module. They are closely interlinked and in practice are rarely dealt with one after another but usually within the same conversation.

The National Suicide Prevention Strategy underlines that these tasks matter particularly for social work. It stresses that, above all, members of professions who come into contact with people in suicidal crises should be made even more aware of the issue and trained in dealing with people at risk (Bundesministerium für Gesundheit [BMG; Federal Ministry of Health], 2024). Professionals in counselling services, in child and youth welfare services, in integration assistance for persons with disabilities (Eingliederungshilfe), in homelessness services or in hospital social services are often the first people someone turns to – not because they take over treatment, but because they are trusted and can build bridges into the support system.

Definitions

In this module, evaluation means a shared process of mutual understanding in which the professional and the person concerned look at the current situation in a structured way: How concrete are the thoughts of death? What protects and sustains the person? Who can be reached? The evaluation provides the basis for deciding whether, and how quickly, medical or psychiatric help is brought in. It is expressly not a diagnosis and not a measuring procedure – social workers do not make diagnoses and do not work with risk scales, but with their professional perception, the conversation and the team.

The safety plan is, according to Stanley and Brown (2012), a written, prioritised list of coping steps and sources of support that a person can draw on when a suicidal crisis intensifies. It is developed together, phrased in the person’s own words and is expressly not a promise not to harm oneself. The authors designed it as a brief intervention that can be fitted into a range of care settings (Stanley & Brown, 2012).

Onward referral means actively guiding a person to suitable support – medical care, crisis services, counselling and pastoral services. The National Suicide Prevention Strategy places early recognition of the need for help and onward referral in the field of action on health literacy and empowerment, and names crisis services and referral to support services as part of psychosocial counselling and support (BMG, 2024). This means more than handing over a telephone number: good onward referral makes sure that contact is actually made.

PART 2 – Professional and legal fundamentals

Evaluation as part of the relationship, not as a finding

Evaluation in social work differs fundamentally from medical or psychotherapeutic diagnostics. It is not based on standardised instruments but on an open, respectful conversation in which the person remains the expert on their own situation. There is a professional and an ethical reason for this. Professionally: suicidal crises are dynamic, and thoughts can grow or fade in intensity within a short time. A snapshot can therefore never be a reliable prediction. Ethically: people in suicidal crises often experience themselves as powerless and controlled by others. When the evaluation is carried out together, the person is addressed as an acting subject – an experience that can in itself bring relief.

From a social work perspective, evaluation is therefore more of a joint review of the situation than a judgement. It leads to a decision that is ideally made together with the person and backed up within the team: is joint planning with a binding follow-up contact enough, is a prompt medical evaluation necessary, or is there an acute danger that calls for immediate action? Those who do not have to make this decision alone act more calmly and clearly. Organisations are therefore well advised to provide fixed routes for consulting the manager or experienced colleagues, including outside regular working hours.

The concept of the safety plan

The safety plan according to Stanley and Brown (2012) follows a simple logic: in an acute crisis, people find it hard to think clearly and find solutions. What was worked out and written down together in calmer moments can then serve as orientation. The plan is built in six steps that lead from the inside outwards: first, personal warning signs; then one’s own coping strategies; then people and social settings that offer distraction; then people who can be asked for help; then professional services and crisis services; and finally making the environment safer (Stanley & Brown, 2012). The order is deliberate: the person should first be able to draw on their own resources and, where necessary, bring in further support step by step. In an acute situation of danger, however, the emergency number is always the right way to go – the plan is not a staircase that has to be climbed in full before help is sought.

Of particular importance is the distinction from the so-called no-suicide contract, in which a person promises not to harm themselves. Stanley and Brown (2012) expressly emphasise that the safety plan is not such a contract. The difference is not merely formal: a promise can create pressure, tempt people to keep thoughts to themselves and give professionals a false sense of security. The safety plan, by contrast, does not ask for a promise but for possibilities – it widens the room for action rather than narrowing it through an obligation.

The landscape of provision: crisis services, pastoral support, emergency number

Onward referral requires professionals to know the regional support system. In Germany this is diverse but inconsistent. The TelefonSeelsorge can be reached around the clock across the country: it is free of charge and anonymous, day and night, on 0800 1110111, 0800 1110222 and 116 123, also offers counselling by chat and email, and is run under the responsibility of the Protestant and Catholic churches (TelefonSeelsorge Deutschland, n.d.). In an acute threat to life, the emergency number 112 for the fire service and emergency medical service is to be called; it is free of charge and valid across Europe; the police can be reached on 110 (Land Niedersachsen, 2025).

Psychiatric crisis services, by contrast, are a matter for the individual states (Länder) and are developed to varying degrees. One example of a statutory basis is Bavaria: under Article 1 of the Bavarian Act on Help for People with Mental Illness (BayPsychKHG), the districts (Bezirke) set up and run crisis services consisting of control centres and mobile professionals; the control centres can be reached around the clock on a single, uniform telephone number (BayPsychKHG). This model cannot be transferred to other states – professionals therefore need to find out for themselves which crisis services exist in their region and when they can be reached. There is as yet no nationwide crisis service emergency number. The National Suicide Prevention Strategy recommends developing a concept for a central crisis service emergency number, available around the clock, with forwarding to the crisis services of the states (BMG, 2024). The ministerial draft bill for an act to strengthen national suicide prevention takes this up and provides, among other things, for a time-limited federal agency for suicide prevention, a concept for a central, free-of-charge and nationally uniform telephone number for people in crisis, a digital directory of support services and an expert advisory board (BMG, 2026). However, this draft is not in force.

PART 3 – Practice I: the shared evaluation

Three guiding questions for the conversation

In practice, it has proved useful to base the evaluation on three guiding questions that can be fitted into a conversation without standardised instruments. The first guiding question concerns the concreteness of the thoughts: Is it a general wish not to be here any more, or have the thoughts already taken a direction, for instance in the form of preparations or an intention? The purpose of this question is not to ask for details but to understand how close the person is to acting. The second guiding question concerns the protective factors: What has kept the person from following their thoughts so far? People are often named, along with responsibility for children or pets, beliefs, plans or simply the hope that things might get better again. These reasons are valuable because they can be taken up later in the safety plan. The third guiding question concerns the availability of support: Who can actually be reached today, tonight and at the weekend? Is there a family doctor, a friend, a neighbour, treatment already under way?

These three questions do not produce a scoring system or a classification into levels. They create a shared picture on the basis of which the next steps are agreed. Open, calm wording is helpful, for example: ‘You said that sometimes you don’t want to live any more. How is that today?’, ‘What has helped you so far to bear these thoughts?’ or ‘Who would know if things got worse for you this evening?’ It is important to give the person time, to bear silence and not to gloss over contradictions. If someone stresses that ‘it’s not all that bad’ but has previously described very concrete thoughts, it is appropriate to address this gently.

When medical or psychiatric help is brought in

The shared evaluation leads to the decision on whether medical or psychiatric help is brought in. Professionals do not make this decision on gut feeling alone, but in consultation with the team and in line with their organisation’s procedures. As a guide: the more concrete the thoughts, the less robust the protective factors and the harder it is to reach support, the more urgent a medical evaluation is. If clear uncertainty remains after the conversation, this too is a reason to bring in medical or psychiatric expertise – uncertainty is not a sign of lack of competence but a professional signal to be taken seriously. Where possible, this is done with the person’s agreement, for example by making an appointment together, by a telephone call made together or by accompanying the person in person.

Situations in which there is an acute threat to life are a special case, for example when a person announces an imminent act and can no longer engage with agreements. Then protecting life comes first: the emergency number 112 is called (Land Niedersachsen, 2025), the professional stays in contact with the person where possible and informs the manager. Decisions on involuntary admission are not made by social workers but by the bodies and courts responsible, in accordance with the legal requirements – this too is looked at in more depth in Module 6.

PART 4 – Practice II: creating a safety plan and referring on

The six steps at a glance

The following figure summarises the six steps of the safety plan. They are discussed one after another in the conversation and recorded in a form that is easily accessible to the person – on paper, as a card in a wallet or as a note on a mobile phone.

How the plan comes about: together and in the person’s own words

The value of a safety plan lies less in the completed sheet than in the process of creating it. Stanley and Brown (2012) emphasise that it is developed together and recorded in the words of the person concerned. In practice, this means: the professional asks questions, summarises and – if wished – writes things down, but does not dictate the wording. Instead of ‘do relaxation exercises when tense’, the plan might then say ‘go to the river with the dog’ or ‘listen to Sabine’s playlist’. Concrete, personal wording like this is easier to recall in a crisis than general recommendations.

For the warning signs (step 1), it helps to ask how the person themselves or the people around them notice that things are getting worse – for example sleeplessness, brooding in certain situations, social withdrawal or particular times of day. The own strategies (step 2) are about activities that the person can carry out without others. Steps 3 and 4 deliberately distinguish between contacts that simply offer company and distraction and people to whom the person can speak openly about their crisis. Both matter, because not every person close to someone is the right person to turn to in a crisis. For step 5, the professional services are entered together with when they can be reached: treating doctors, regional crisis services, the TelefonSeelsorge with its free telephone numbers (TelefonSeelsorge Deutschland, n.d.) and the emergency number 112 for an acute threat to life (Land Niedersachsen, 2025). Step 6 consists of thinking together about how the environment can be made safer in times of crisis – for example by involving a trusted person. No details about possible means are asked for or discussed; it is enough to clarify with the person what would help them feel safer in their surroundings.

At the end of the conversation, you discuss where the plan will be kept, who may know about it and when it will be looked at and adjusted together. If relatives or friends are involved, this happens only with the person’s agreement. A binding follow-up contact – an appointment, an agreed phone call – is an integral part of this. The plan is a living document, and reviewing and developing it is taken up in Module 8.

Onward referral that actually reaches its goal

People in suicidal crises often find it hard to get in touch with a new service on their own. A telephone number on a slip of paper is therefore often not enough. An accompanied transition is more effective: making the first call together, arranging an appointment while the person is still in the room, accompanying the person to the doctor’s practice or the hospital outpatient clinic or – with their agreement – involving a trusted person. The following table matches typical example situations with suitable actions and points of contact. It does not describe risk levels but is meant to aid orientation; the specific decision is always made case by case and within the team.

PART 5 – Critical perspective: limits, areas of tension, open questions

The limits of any evaluation

However carefully an evaluation is carried out: suicides cannot be predicted with certainty. People can conceal their thoughts, crises can intensify rapidly after an apparently stable conversation, and an effective safety plan does not guarantee that nothing will happen. For professionals, this insight is both a relief and a burden. A relief, because it makes clear that nobody can be expected to know everything; a burden, because it makes one aware of one’s own powerlessness. Professional practice therefore means acting to the best of one’s professional knowledge, coordinating within the team, documenting decisions in a traceable way and acknowledging one’s own limits. Those who are aware that responsibility for a person’s life does not rest with the professional alone can stay clearer and more attentive in crises.

The tension between self-determination and protection

Onward referral touches a fundamental area of tension in social work: respect for self-determination on the one hand and the protection of life on the other. Many people in crisis do not want relatives, doctors or authorities to learn of their thoughts – out of shame, fear of being admitted to hospital or because of bad experiences. Treating these fears with respect is a precondition for people opening up at all. At the same time, there are situations in which protecting life takes precedence. There is no simple rule between these poles. It helps to decide as much as possible together, to make transparent what the professional will do and why, and to limit steps taken against the person’s will to genuine emergencies – with consultation in the team and with regard to the legal limits explained in Module 6.

Gaps in provision and open questions

Another area of tension concerns the provision landscape itself. Good onward referral presupposes that services are available. In some regions there are well-developed crisis services, while elsewhere professionals depend largely on the emergency number, the out-of-hours medical structures and the TelefonSeelsorge at night and at weekends. The National Suicide Prevention Strategy names networking and coordination as a separate field of action and recommends developing a central crisis service emergency number (BMG, 2024). Whether and when such a number will come is an open question: the ministerial draft bill to strengthen national suicide prevention does contain a telephone number concept and a digital directory of support services, but it is not in force (BMG, 2026). For practice, this means not relying on future structures but knowing precisely the services available locally today.

Finally, there is the question of role clarity. Social workers can carry out evaluations, develop safety plans and build bridges – but they do not diagnose, do not treat and do not order involuntary admission. Particularly in fields of work where professionals are the only reliable contact people, the temptation can arise to take on more responsibility than the role can bear. A clear division of tasks with medical and psychiatric services protects clients and professionals alike.

Consequences for practice

Several practical consequences follow from these considerations. Organisations should have a written crisis protocol that names responsibilities, consultation routes and points of contact and is updated regularly. An up-to-date overview of regional crisis services and when they can be reached belongs in every team. Templates for safety plans can help, but should be designed so that there is room for the person’s own words. And finally, a culture is needed in which uncertainty may be voiced – because the willingness to bring in medical help or ask colleagues for advice in case of doubt is one of the most important safety resources an organisation has.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.