Crisis Response Planning

Domain II · Behavioural & cognitive · Bryan, Rudd · 2010

What it is

CRP is a single, brief, collaborative intervention, not a full therapy. Patient and clinician first reconstruct the story of the most recent suicidal crisis. They then write a short personalised plan on an index card in the patient's own handwriting: warning signs, things to do alone, reasons for…

Format

• CRP has no multi-session phases of its own. It is one session with a fixed internal sequence. It can stand alone (emergency or walk-in behavioural health visit, ED, primary care, intake), or it can open a longer treatment such as BCBT.
• Format. One clinician, one patient, face to face. In the trial it was delivered in an emergency behavioural health appointment, before a blinded clinician decided on hospitalisation. Session length was not stated in any source. Allow roughly 30–60 minutes, including the narrative assessment.

Who practises it, and how they are trained or regulated

• Current training decks put reasons for living in as a standard step, so the eight-step sequence here includes it.
• Version followed: the Bryan–Rudd crisis response plan (CRP) as delivered in the Fort Carson trial (Bryan et al., 2017; standard CRP and enhanced CRP with reasons for living) and as taught in Craig Bryan's and his colleagues' training decks (eight-step sequence preceded by a narrative assessment). In those decks CRP is the Session 1 component of Brief Cognitive-Behavioral Therapy for suicide prevention (BCBT; Bryan &…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The card is never used. See Section 5.
• Privacy worries about others seeing the card; discuss discreet headings.
• A gap between the crisis visit and the next contact. Schedule within days where possible.
• Reluctance to call crisis lines (fear of police, career or hospital consequences). Explore it and offer text or chat alternatives.
• Uniformly high ratings given to please. Ask "what might get in the way?" It is working when the patient can explain when they would use each part.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.