Crisis Intervention in Social Work – Psychosocial Crises and Suicidality

When an acute crisis subsides, a feeling of relief often sets in: the client can be reached again, the young person is safe, the call on Friday evening has had a good outcome. It is precisely at this moment, however, that it is decided whether the support will have a lasting effect. This module is devoted to the often underestimated ‘second half’ of crisis intervention: aftercare and continuity, careful documentation, shared reflection in the team and the question of how professionals themselves stay healthy and able to work – even when a crisis has not ended well. In doing so it ties together the content of the previous modules and turns the focus to quality, responsibility and resilience.

PART 1 – Introduction: when the acute crisis is over

Crisis as a process – not as an event

Sonneck et al. (2016) describe the psychosocial crisis as a loss of emotional balance that a person experiences when confronted with events and life circumstances they cannot cope with at that moment. This definition contains a pointer that is central to aftercare: the overload exists ‘at that moment’. Crises are time-limited states whose course is open. That an acute peak has been overcome therefore does not yet mean that the person has regained their balance. Often the triggering circumstances – a separation, the loss of a home, a diagnosis – are still there, while the attention of those around them, and sometimes of the support system too, is already fading.

From this perspective, crisis intervention is not a one-off response but a process that merely enters a new phase once the situation has stabilised. In this phase, the aim is to bring the agreements made during the acute contact to life, to shape transitions into further support reliably and to record what has happened in a way that other professionals can pick up. At the same time, the focus turns to the helpers themselves. For professionals too can be temporarily thrown off balance by a distressing incident – for example after a conversation with a person in a suicidal crisis or after the news that a client has taken their own life. The definition by Sonneck et al. (2016) therefore applies not only to clients but can also help you understand your own reactions without interpreting them as personal failure.

Key terms in this module

In this course, aftercare means planned support after an acute crisis: agreed follow-up contacts, the review and adjustment of agreements, and referral on to support that goes beyond your own remit. Documentation means the prompt, written and traceable recording of the trigger, professional evaluation, agreements and decisions – including the question of what information was passed on to whom, and with whose consent. Peer consultation refers to structured consultation among professionals of equal standing without external facilitation, whereas case discussion usually takes place in your own team with a view to further case planning. Supervision is reflection on professional practice facilitated by an external, suitably qualified person. By postvention we mean all measures that support the bereaved, others affected and professionals after a suicide or suicide attempt. Self-care finally, covers conscious care for your own physical and mental health as a precondition for professional practice – a task that professionals do not carry alone but that also concerns teams and provider organisations (Träger).

PART 2 – Professional and legal fundamentals

Continuity and referral on as part of suicide prevention

The National Suicide Prevention Strategy of the Federal Ministry of Health (BMG) sees suicide prevention as a task that extends across several fields of action (Bundesministerium für Gesundheit [BMG; Federal Ministry of Health], 2024). Two of them are especially significant for aftercare: the field of action of psychosocial counselling and support expressly includes not only telephone and online counselling and crisis services but also referral on to further support services. The field of action of networking and coordination aims to ensure that the various bodies in the support system work not side by side but together (BMG, 2024). For social work, this means: the contribution of a counselling service, a social service or a residential group does not end when an acute situation has been defused but includes the question of how the person concerned will be reliably accompanied in the coming days and weeks.

Particular attention is due to transitions – for example discharge from a hospital, the end of a programme, a change of responsibility, holiday periods or the weekend. At such interfaces, support can drop away unnoticed because every body involved assumes that another is taking care of it. Aftercare therefore also means clarifying responsibilities explicitly: who contacts whom, and when? What happens if an agreed contact does not take place? And what information does the next service need so that the person does not have to tell their story all over again?

The safety plan as the common thread of aftercare

If a safety plan was developed during the acute contact, it forms an obvious bridge into aftercare. Stanley and Brown (2012) describe the safety plan as a written, prioritised list in six steps: personal warning signs, own coping strategies, people and social settings for distraction, people who can be asked for help, professional services and crisis services, and measures to make the environment safer. What matters is that the plan is created together and in the words of the person concerned and is expressly not a no-suicide contract (Stanley & Brown, 2012). It therefore does not require a promise but provides options for action.

From this character it follows that the plan is not a closed document. In follow-up contacts it is worth taking it up again together: which warning signs have appeared since? Which strategies helped, which did not? Were the named trusted people actually reachable? Have new contacts or points of contact emerged, for example after referral to a counselling service or to medical help? Aftercare thus turns the safety plan into a learning instrument that grows with the person – and shows the person that their experiences with the plan are taken seriously.

Professional confidentiality as the framework for all documentation

In social work, documentation and the disclosure of information operate within a clear framework of criminal law. Under Section 203(1) no. 6 of the German Criminal Code (StGB), state-approved social workers and social education workers commit an offence if they disclose without authorisation another person’s secret that was entrusted to them in that capacity or otherwise became known to them; the penalty is imprisonment of up to one year or a fine. Crisis conversations in particular contain especially sensitive content – suicidal thoughts, experiences of violence, family conflicts. Two things follow for documentation: first, careful consideration is needed of what actually has to be recorded for the professional work. Second, every disclosure must be noted together with its basis.

The first and primary route to disclosure is the consent of the person concerned, which ideally states specifically what information may go to whom. Only exceptionally can disclosure without consent be justified under Section 34 StGB – where there is a present danger to life or limb that cannot be averted in any other way, the protected interest substantially outweighs the one impaired when weighed up, and disclosure is an appropriate means. This weighing-up is always a decision in the individual case, made in line with the organisation’s procedures and, wherever possible, in consultation with the manager. Documentation makes it traceable afterwards: what danger was seen, which milder routes were tried, who was involved?

Postvention: the crisis of the bereaved

A suicide attempt or suicide among clients is a profound event for everyone involved. If the concept of crisis from Sonneck et al. (2016) is applied to this situation, it becomes clear that relatives, housemates, fellow clients and professionals themselves can enter a crisis: they are confronted with an event that they cannot cope with at that moment. Postvention therefore means applying the principles of crisis intervention to the bereaved. The BELLA mnemonic according to Sonneck et al. (2016) – build the relationship (Beziehung aufbauen), grasp the situation (Erfassen der Situation), relieve symptoms (Linderung von Symptomen), involve people (Leute einbeziehen), approach to problem-solving (Ansatz zur Problembewältigung) – offers a helpful structure here too, in aftercare: who is affected and how? Who needs to be approached now, who needs peace, who needs further help? Which people and services can be involved?

PART 3 – Practice I: shaping aftercare and documenting crises

Agreeing follow-up contacts that are binding

Aftercare begins as early as the end of the acute contact. A vague ‘Get in touch if anything happens’ leaves the initiative precisely to the person who, in a crisis, lacks strength and orientation. A concrete agreement is more helpful: when will the next contact take place, by what means – in person, by phone, by message – and who takes the initiative? An agreement on what happens if contact does not take place is just as important. Many organisations specify that the professional gets in touch actively and – where there is corresponding concern and in line with internal procedures – initiates further steps. Such agreements should be discussed transparently with the person so that they are experienced not as control but as an expression of reliability.

The following illustration summarises one possible course of aftercare. It is not a binding requirement but an orientation that has to be adapted to the field of work, the remit and the organisation’s procedures.

Referral on to further support

In a crisis, social work can relieve, provide structure and build networks, but it replaces neither medical nor psychotherapeutic treatment. Aftercare therefore includes the question of which support beyond your own remit makes sense: medical or psychiatric evaluation, psychotherapeutic services, specialist counselling services, regional crisis services, self-help groups or services for relatives. A mere list of addresses is often not enough in a crisis. An accompanied referral is more effective: calling together, making an appointment, accompanying the person to the first contact if they wish and – with consent – passing the most important information to the receiving service. In addition, low-threshold services can be included in the safety plan. The TelefonSeelsorge is free of charge, anonymous and available day and night on 0800 1110111, 0800 1110222 and 116 123 and also offers chat and email (TelefonSeelsorge Deutschland, n.d.). In an acute threat to life, the emergency number 112 is to be called (Land Niedersachsen, 2025).

What good crisis documentation does

In everyday work, documentation is often experienced as a tiresome duty. In crisis intervention, however, it fulfils several professional functions at once. It ensures continuity, because colleagues on late or weekend shifts and cover staff need to know what was agreed. It creates traceability, because decisions – for example about bringing in medical help or disclosing information – can be justified afterwards. It supports reflection, because writing things down creates a first distance from what was experienced. And it serves the protection of clients and professionals alike, because it makes careful practice visible.

The requirements of the respective provider organisation (Träger) determine the form and scope of crisis documentation. Regardless of form, some principles have proved their worth: write promptly, while the memory is fresh; separate observations from interpretations; record the person’s statements as literally as possible and mark them as quotations; do not formulate diagnoses but describe what was perceived; and minimise data, that is, record only what is actually needed for further work. The documentation itself is to be treated confidentially and stored so that only authorised persons have access.

PART 4 – Practice II: peer consultation, postvention and self-care

Reflection formats compared

Crisis intervention is teamwork. Distressing incidents should not be carried alone but reflected on together – not only for relief but also for quality assurance: what went well? Where were there uncertainties? What do we learn as a team for future situations? The National Suicide Prevention Strategy stresses that 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 (BMG, 2024). Reflection formats are an important place where such knowledge stays alive in everyday work. Three formats can be distinguished that complement one another:

Peer consultation typically follows a clear sequence: the presenting professional describes the situation, the group asks clarifying questions, the presenter formulates their key question, the advisers develop hypotheses and ideas for action while the presenter listens, and at the end the presenter gives feedback on what they take away. This structure prevents the consultation from sliding into blame or general complaints. For all formats: even in the team, only the information needed for professional reflection is discussed; cases are, where possible, presented in pseudonymised form. Whether and to what extent supervision is offered is regulated by the respective provider organisation; it is all the more important to raise the need for it actively after distressing incidents.

After a suicide attempt or suicide: accompanying the team, fellow clients and relatives

Postvention begins with information and orientation. After a suicide attempt or suicide, team members need reliable, factual information promptly to prevent rumours – without sharing more detail than is necessary for the work. Details of circumstances or means do not belong in team conversations with fellow clients. After that, the question is who is particularly affected: the professional who last had contact, the person who found the individual, housemates who were close to them. Following Sonneck et al. (2016), accompanying these people can be understood as crisis intervention – with an offer of relationship, grasping the individual strain, relief and involving further support. Sympathy towards relatives is important; what information may be passed on is to be clarified within the framework of professional confidentiality and in consultation with the manager.

Self-care: professional limits and relief

Working with people in crises is moving. That thoughts of a conversation linger in the evening is at first a sign of commitment and empathy, not of weakness. It becomes problematic when the strain continues: when sleep suffers, brooding does not stop, irritability or withdrawal increase or enjoyment of the work fades. Self-care therefore begins with attention to your own signals. Helpful are transition rituals between work and leisure – for example consciously closing the documentation, a short walk or a regular chat with a colleague before the end of the working day –, sufficient breaks, exercise, reliable private relationships and permission not to be reachable at all times.

Self-care also includes a realistic understanding of your own responsibility. Professionals act as part of a team and in line with their organisation’s procedures; they are neither solely responsible nor all-powerful. Those who know that decisions were coordinated, documented and shared by the team find it easier to let go after an incident. And anyone who notices that the strain extends beyond the professional sphere may – like anyone else – seek support for themselves.

The organisational level: a crisis protocol for the organisation

Whether aftercare, documentation and self-care succeed depends not only on individual professionals but crucially on the organisation. A crisis protocol for the organisation creates confidence in action, especially in situations where decisions have to be made under pressure. It can, for example, set out who is informed in a crisis, how the manager can be reached outside core hours, which regional points of contact and emergency numbers apply, how consent to disclosure is obtained and documented, how follow-up contacts and handovers are organised and what aftercare services staff receive after distressing events. Such a protocol does not replace professional evaluation in the individual case, but it brings relief, because not every professional has to think everything through anew in the acute situation. It should feed into the induction of new colleagues, be discussed together in the team and be updated regularly – for example after every major crisis, when it becomes clear what has worked and where there are gaps.

PART 5 – Critical perspective: limits, areas of tension and consequences

Documenting between covering yourself and the relationship

Documentation serves continuity and the protection of everyone involved – but it can also tip in a defensive direction. If writing is done mainly to cover oneself against possible reproaches, the danger grows that files become bloated, clients are described mainly as a risk and their resources drop out of view. At the same time, every additional piece of information is in tension with professional confidentiality under Section 203 StGB and with the requirement of data minimisation. Professionally good documentation is therefore not the most extensive but the kind that records the essentials clearly, respectfully and traceably. A helpful yardstick is the question of whether the person concerned could read the entry without feeling belittled.

Self-care is not a private matter

The term self-care carries a risk: it can suggest that professionals themselves are responsible for compensating for structural strain – staff shortages, high caseloads, missing cover arrangements – through private mindfulness. Individual strategies are important, but they do not replace good organisation. Time for debriefing, access to supervision, realistic responsibilities and a culture in which strain may be voiced are tasks for managers and the provider organisation (Träger). When professionals voice their needs, this is not a sign of unsuitability but part of professional responsibility.

Limits of responsibility and looking back

After a suicide or suicide attempt, teams almost inevitably ask whether it could have been prevented. This question is important because it can be learned from – but it is also dangerous because, in hindsight, connections seem clearer than they were in the situation at the time. Suicides cannot be predicted with certainty, and even careful crisis intervention cannot influence every course of events. A good debriefing therefore separates the question of possible improvements in the process from the question of personal blame. The aim is a learning team, not a search for one responsible individual.

Gaps in provision and open questions

Aftercare depends on a functioning support system, and this is developed very differently from region to region. 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) – no such nationwide number exists as yet. Professionals therefore need to know the services in their region and keep this knowledge up to date. In addition there are waiting times for further support, which have to bridge precisely the sensitive time after a crisis. For practice this means: aftercare should not depend on the availability of individual services but rest on several pillars – reliable follow-up contacts of your own, a jointly maintained safety plan, low-threshold points of contact and a team that supports one another. This course provides professional orientation knowledge for this; it replaces neither induction into the procedures of your own organisation nor does it establish any special authority to carry out crisis intervention.

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.