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National Suicide Prevention Lifeline

Best Practices

Best Practices

The Lifeline Network strives to create and uphold best practices in assessing suicide risk and imminent risk. All Lifeline centers follow these high standards for helping suicidal callers.

Suicide Risk Assessment Standards

Following SAMHSA-funded evaluations that indicated the need for more consistent, uniform suicide risk assessment practices for crisis call centers, Lifeline assembled its Standards, Training & Practices Subcommittee (STPS) of nationally and internationally recognized experts in suicide prevention and tasked this group with developing policies, standards, guidelines and recommended practices for its network of crisis centers. The STPS developed evidence-informed Suicide Risk Assessment Standards in 2006 (Joiner et al., 2007). Lifeline adopted these standards as policy, and verified full network membership adherence with these standards in September 2007.

The Suicide Risk Assessment Standards focus on four core principles: Suicidal Desire, Suicidal Capability, Suicidal Intent and Buffers along with the subcomponents for each. Click here for a review of the suicide risk assessment standards and three example prompt questions with rationale for incorporating them into a call. 

Imminent Risk Policy

In February 2011, the Lifeline released a new Policy for Helping Callers at Imminent Risk of Suicide. This policy, developed over the course of several years, is a result of extensive work by the Lifeline to provide network centers with unified parameters for assisting our highest risk callers. It contains significant contributions from participating centers, researchers and trainers in the field of suicide prevention and represents consensus expert opinion in this central domain of crisis hotline work. Since April 1, 2012, all Lifeline centers have successfully incorporated this policy into ongoing practice.

The Lifeline Policy for Helping Callers at Imminent Risk of Suicide is a logical sequel to the Lifeline Risk Assessment Standards. The Imminent Risk Policy essentially focuses on three core areas:

  • The use of Active Engagement, which requires that hotline staff make reasonable efforts to collaborate with callers at imminent risk to better secure their safety.
  • The use of Active Rescue, which requires that staff take all action necessary to secure the safety of a caller and initiate emergency response with or without the caller’s consent if they are unwilling or unable to take action on their own behalf.
  • A focus on Collaboration with other community crisis and emergency services towards better assuring the continuous care and safety of Lifeline callers determined to be at imminent risk of suicide.

Click here to read the full policy [PDF]

Crisis Center Follow-Up

Research indicates that follow-up with hotline callers and people recently discharged from an emergency department (ED) or inpatient setting has positive results for both consumers and providers of mental health services. Given that suicide risk is highest one week after discharge from an inpatient setting, the 24/7 availability of crisis centers' services are invaluable. For medium to h​igh risk callers, studies show that centers help to minimize ideation, hopelessness, and psychological pain. Further, crisis center follow-up before a service appointment is associated with improved motivation, a reduction in barriers to accessing services, improved adherence to medication, reduced symptoms of depression and higher attendance rates. Follow-up by crisis centers is also cost effective; it reduces utilization of emergency services and offers diversion to more appropriate services for patients who do not require admission to the hospital.

In a 2015 review of crisis center practices, of 134 centers sampled, 91% (122) provided some form of follow-up service. Programs ranged from follow-up services for frequent callers, monthly check-ins for high risk callers, ED/inpatient discharges, high risk callers, and third party calls.​

The following documents have been developed to assist crisis centers in the development of follow-up programs:

Lifeline Recommendations for Crisis Center Follow-Up:  Created in 2012 and revised in 2014, includes recommendations for following up with Lifeline callers as well as those​ referred for follow-up from Emergency Departments and Inpatient settings. It also includes crisis center examples.​​

2015 Follow-Up One page Summary: This document underscores the importance of Crisis Center follow-up.