Crisis session note and suicide risk assessment: template, structure and example

A crisis session note is the written record of a session in which a client is going through a crisis, especially a suicidal crisis. It sets out what was observed, the risk assessment, the decisions made and the referral.

This template is for psychologists, in private practice or in an institution. Write the note the same day, as soon as the session ends, even briefly if an emergency referral takes time. It ensures continuity with other professionals and keeps an accurate account of what was assessed and decided.

What a crisis session note is for

A suicidal crisis is a temporary state, but risk can change within hours. The note fixes the assessment at a given moment, with its date and time. It lets the practitioner who next sees the client, or the emergency service receiving them, know what was said and done.

When to use it

• When a client expresses thoughts of suicide or death, whatever their intensity.
• After a recent suicide attempt or risk-taking behaviour.
• When a client suddenly falls apart after an event (breakup, bereavement, job loss, violence).

The framework

The French code of ethics for psychologists (updated in 2021) states that psychologists are bound by professional confidentiality within the conditions and limits set by the Criminal Code (articles 226-13 and 226-14), as recalled in article 7. When a situation could harm the physical or psychological integrity of the person or of someone else, the psychologist carefully assesses what to do, respecting confidentiality and reporting obligations, and may seek advice from experienced colleagues (article 17).

• What to write. Facts, the client's words, the assessment, decisions and the people contacted.
• What to share. With other professionals, only the information strictly necessary for care (article 8). Seek the client's agreement before contacting their doctor or a relative, and note their answer.
• Who can read it. Clients have a right to access data that concerns them (article 15 of the GDPR). If the note goes into a record held by a French healthcare facility, article L1111-7 of the Public Health Code applies, with its own rules for psychiatry.

Outside France, follow your local rules on confidentiality and duty to protect. The assessment markers on this page are based on the French consensus conference "The suicidal crisis: recognition and care" (2000), published by the French health authority (HAS). It reminds clinicians not to hesitate to ask clients directly about suicidal thoughts.

The structure, section by section

1. Session details

Date, start and end time, place or phone, planned or urgent session.

2. Context and trigger

What brings on the crisis now, in the client's words. Conflict, failure, loss or a breakup are among the precipitating events listed by the consensus conference.

3. Suicidal thoughts

Presence, frequency, duration, intensity, whether there is a scenario. Report the exact answer to the direct question.

4. The six elements of dangerousness

The consensus conference suggests exploring six points. Level of distress (hopelessness, withdrawal, feelings of worthlessness or guilt). Degree of intent (scenario, seeking or refusing help). Impulsivity (tension, agitation, past acts). The precipitating event. Access to lethal means (medication, weapons). The quality of support from family and friends.

5. History and risk factors

Previous attempts, current care and treatment, substance use, isolation. Also note protective factors, such as dependent children, a plan for the future or a trusted relationship.

6. Level of urgency

Conclude on a level, low, moderate or high, using the consensus conference criteria. Low urgency when the person thinks about suicide with no precise scenario and is looking for solutions. Moderate urgency when a scenario exists but has been postponed. High urgency when the act is planned for the coming days, with immediate access to a means, or when the person seems emotionally cut off or highly agitated. A sudden, unexplained calm, or actions that look like goodbyes, should be taken as strong warning signs.

7. Safety plan

Built with the client, based on the Stanley and Brown safety plan. It has six steps. Personal warning signs. What the client can do alone to ease the tension. People and places that provide distraction. People to ask for help. Professionals and numbers to call. Making means less accessible. Note what was completed and whether the client leaves with a copy.

8. Resources given

In France, 3114 is the national suicide prevention line, free and available 24/7. It is staffed by healthcare professionals trained in suicide prevention, and takes calls from people in distress, their relatives and professionals seeking advice. In immediate danger, call 15 (SAMU) or 112. In Belgium, the Centre de prévention du suicide answers on 0800 32 123, free and 24/7. In Switzerland, La Main Tendue answers on 143, and 144 is the emergency number. Elsewhere, give the local crisis line and emergency number.

9. Referral and contacts

Decision taken and why (return home with a close follow-up appointment, contact with the doctor, accompanying the client to the emergency department, calling emergency services). Note who was called, at what time and what was agreed.

10. Next steps

Date of next contact, planned follow-up call, points to reassess.

Filled-in example

Fictional client. All details are invented.

Session details. Mrs D., 38, seen for five months for burnout. Planned session, 70 minutes from 2 pm, in person.

Context. Told she was being made redundant four days ago. Her partner moved out two months ago. "I can't see what I'm for anymore."

Suicidal thoughts. Asked directly. Daily suicidal thoughts for three days, mostly in the evening. Says she has thought of taking her medication, with no date chosen. "I won't do it while my daughter is around, but I think about it."

Dangerousness. High distress, feeling useless, withdrawn since the redundancy. Scenario mentioned but not planned, asked for help during the session. No agitation. A nearly full box of prescribed sleeping pills at home. A close sister, a 12-year-old daughter in shared custody.

History. No suicide attempt. Sleep medication prescribed by her GP. Alcohol use up since her partner left, two to three glasses in the evening.

Protective factors. Strong bond with her daughter, good alliance, accepts the help offered.

Level of urgency. Moderate. Scenario present but not planned, help sought, support available. No suspicious calm.

Safety plan. Completed together. Her warning signs are evenings alone and rereading messages from her former employer. To calm down, she can go for a walk. She can call her sister or a friend, then her GP, 3114 or 15. She agrees to give the sleeping pills to her sister tonight. Copy given to the client.

Contacts. With the client's agreement, call to the GP straight after the session to inform them and request an appointment within 48 hours, booked for the day after tomorrow. The client called her sister from the practice, who will spend the evening with her.

Next steps. Follow-up call agreed for tomorrow at 6 pm. Next session in three days. Reassess suicidal thoughts, alcohol use and removal of means.

Common mistakes

• Writing "no suicide risk" without stating the question asked and the answer.
• Forgetting access to means, even though making them less accessible is a concrete step.
• Not noting the time of the session and of the calls made.
• Writing the safety plan alone, in words that are not the client's.
• Contacting a relative or doctor without the client's agreement, or not noting their refusal.
• Not planning a close follow-up contact.
• Putting off writing the note until the next day.

Save time with Delta

Delta is the clinical assistant for mental health and allied health professionals. During the session, Delta transcribes what is said. After a crisis session, you can also dictate your observations and decisions, or add written notes. Delta then generates the session report (short summary, detailed summary, topics for the next session), taking into account your profession and approach, and updates the client record with a summary of the therapy and the goals being tracked. Data is hosted in France with an HDS-certified provider, the client's name and identifying details are pseudonymised before the AI, no audio file is kept and data is never used to train a model. Risk assessment and decisions remain the practitioner's. Learn more about Delta.

Read also

• First session intake, template and structure
• Mental status examination, template and example
• Psychologist's letter to the GP
• All clinical document templates

Sources

• Santé.fr, the national suicide prevention line, 3114 (in French)
• HAS (ANAES), The suicidal crisis: recognition and care, consensus conference, 2000 (in French)
• Santé Mentale, a safety plan against suicide reattempts, 2021 (in French)
• French code of ethics for psychologists, 2021 update (articles 7, 8 and 17)