Online peer support and crisis text services

Domain IX · Biomedical, neuro & digital

What it is

These are not a psychotherapy but a group of services that people can reach without a referral: crisis lines run over text, chat or messaging; and moderated peer communities where members support one another under staff oversight. A psychotherapist does not deliver them. The therapist's work is to…

Format

• Phase B. Assessment (first sessions; repeat when risk changes). Goal: understand the client's current suicide and self-harm risk using your service's standard risk-assessment practice; how they already seek help online (crisis lines used, forums, social media, AI chat); exposure to self-harm or…
• Phase C. Collaborative planning (usually one session, part of safety planning). Goal: the client chooses one or two crisis services and, if wanted, one moderated peer space; these are written into the safety plan with numbers, opening hours and what to expect; the confidentiality and escalation…

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?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• 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

• clients expecting ongoing support (it is single conversations); clients outside the UK.
• eligibility (depends on local commissioning); over-reliance; distress from others' posts.
• perfectionism about wording; drafts that minimise risk. Working: the client sends the message more readily when needed.
• avoidance of all future help-seeking after a distressing response; minimising. Working: the client remains willing to use some crisis pathway.
• expecting a therapist or instant answers; disappointment if the first exchanges are automated. Working: the client can describe what will happen.

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.