Online Therapy and Suicidal Ideation: Special Considerations

In the last year and a half, online therapy has become the norm for mental health services. Overall, therapists and their clients alike are reporting high satisfaction with online therapy. It’s convenient, safe, and research shows it can be just as effective as in-person treatment for treating most populations and presenting problems.

Of course, there are special considerations for meeting with your clients online that should not go ignored. September is National Suicide Prevention Awareness month, so let’s take this opportunity to go over some important considerations for ensuring the safety of your online clients.

1. Know their location

When you’re meeting online, you might not always know exactly where your client is calling in from. It’s vital that you are aware of your client’s physical location at the start of each session in case you need to contact emergency services in their area and they are unable or unwilling to disclose where they are.

Keep your client’s address in their records. Any time they move, be sure to update their new address. If you start a session and they’re in a new place, ask them where they are and get an address if possible.

2. Have a backup plan for meeting in the case of internet connection issues

You don’t want to be in a situation where you are assessing for suicidality and you’re suddenly disconnected because of internet failure. Discuss with your clients ahead of time what you’ll do if this happens. For example, that you will call them on their cell phone.

3. Have an emergency contact person on file

In the case that the client needs to be transported to the hospital, having an emergency contact on file will ensure you know who to call and how to contact them to attend to your client. Even in the event that your client has agreed to take themselves to the hospital, it may still be necessary to get in touch with their emergency contact to better ensure the safety of your client.

4. Proceed through the risk assessment

Determine your client’s level of risk as you normally would in an office setting. Take into consideration things like risk and protective factors, whether they have intent, a plan, and/or means to attempt suicide. If you determine your client is at imminent risk of self-harm or suicide you can either direct them to a nearby hospital’s emergency department or refer them directly to an acute inpatient hospital. You may need to contact your client’s emergency contact person or their local police department to arrange transportation if your client is unable or unwilling to get themselves to the hospital. If your client is having suicidal thoughts but is at lower risk due to protective factors, subacute care facilities such as intensive outpatient programs may be a better fit for them.

If your client reports suicidal ideation but is lower risk, it’s still important to discuss a safety plan which can include things like phone numbers for local emergency services, a list of warning signs that they may be at risk of self-harm, a list of trusted people to contact when they are feeling down, a list of activities to distract them and boost their mood, and a list of reasons to keep going. It may also be necessary to make an agreement to remove any means for suicide from their home, and this agreement may need to include others within the household. You may choose to use the “share screen” feature on your video software so you and your client can collaboratively work on the safety plan together. Be sure to carefully document your risk assessment and treatment plan in the client’s records.