Transforming how crisis care systems respond to risk
More than half of people experiencing suicidal thoughts never tell anyone. When they do disclose, it’s rarely to professionals—and the reason is fear. Fear of hospitalization. Fear of losing control. Fear that asking for help will trigger the very crisis they’re trying to avoid.
This is the “Gotcha” trap that undermines crisis care systems nationwide.
During a recent Crisis Jam Fireside Chat with my friend, Dr. Jack Rozel, medical director of resolve Crisis Services of UPMC Western Psychiatric Hospital , titled “Beyond the Checklist: Engaging with Risk,” we explored a fundamental truth. People don’t need us to predict their destiny; they need us to partner with them so they are empowered to find their purpose. When someone shares thoughts of suicide (harm to self) or harm to others, they’re taking a profound interpersonal risk. Too often, fear of coercive responses keeps people silent.
Research supports this finding: A 2024 study published in Suicide and Life-Threatening Behavior found that about one in four adults who had experienced suicidal ideation had never disclosed them to anyone; most disclosures were made to personal connections rather than professionals. A 2023 meta-analysis in Clinical Psychology Review examined data from 94 studies involving more than one million participants and found that only about 45.9% of people who experience suicidal thoughts or behaviors ever disclose them to anyone. In other words, more than half remain silent.
Even among youth already receiving therapy, research suggests that nearly four in ten have not told their clinician about suicidal thoughts — often due to fears of hospitalization, loss of autonomy, or judgment.
As state mental health systems implement 988 crisis response infrastructure and invest in crisis care technology, this distinction becomes critical. The question isn’t just if we can predict risk—it’s whether our systems create the safety that allows people to share their truth in the first place.
The “Gotcha” Trap in Crisis Care Systems
Gotcha is about the coercive moment that hangs over disclosure in our country. It weighs on the minds of both the person in crisis and the people trying to support them.
For people in crisis: ‘If I admit suicidal thoughts, will I be locked up against my will?’
For crisis staff: ‘If I don’t hospitalize, and something happens, will I be blamed or liable?’
This dynamic fuels defensive practices: over-hospitalization, reflexive escalation, or avoiding deeper conversations about death and living altogether. Crisis care technology should support better decision-making, not reinforce these defensive patterns.
As Birtchnell wrote in The Samaritan (Autumn 1978):
“When faced with someone who has described to you a distressing situation – in other words, the car is skidding – you may be tempted to try to persuade him that it can’t be as bad as he is trying to make out, that he must be mistaken or that he is exaggerating. This is an example of turning the car sharply in the opposite direction. It has the effect of discrediting what the client has been trying to tell you and conveying to him that you don’t want to hear any more.”
Today’s ‘sharp turn’ is often minimizing, but even worse, can evolve into coercion: a forced admission, a locked door, a message that disclosure itself is unsafe. For 988 crisis response systems to succeed, they must move beyond this paradigm.
The “Got You” Stance: Leaning into the Skid
Got You means leaning into the skid with presence, validation, and collaboration. It shifts from predicting risk to engaging with the person’s “whys” for living or dying, mapping the “what’s” of risk to the “how’s” for safety, distinguishing between acute (newly escalating intent/means) and chronic (longstanding baseline) risk considerations so that care fits the person in front of us.
This aligns with Dr Rozel’s call to move beyond box-checking and toward relational, psychosocial engagement. In many ways, the “Got you” approach here is also experienced as “I’m with you,” and “You get me.”
What This Looks Like in Practice
Instead of: “Have you thought about suicide?” [checkbox] “Do you have a plan?” [checkbox] “Do you have access to means?” [checkbox] → Automatic hospitalization based on answers.
Try this: “It sounds like things have been really overwhelming. When you think about not being here anymore, what does that look like for you? What’s making life feel unbearable right now? And what, if anything, has kept you going even when things felt this hard?”
This person-centered crisis care approach:
- Acknowledges the person’s reality without minimizing
- Explores both pain and protective factors
- Distinguishes between chronic suicidal thoughts and acute escalation
- Creates space for safety planning that fits the individual’s life
- Maintains dignity while assessing risk
What 988 Implementation Requires: A Shift in Crisis Care Culture
The national rollout of 988 crisis response represents more than new phone numbers and call centers—it’s an opportunity to fundamentally transform how crisis care systems engage with people in their most vulnerable moments. However, technology and infrastructure alone won’t change outcomes if the underlying culture remains rooted in “Gotcha” dynamics.
State mental health commissioners and crisis system leaders face a critical choice: implement 988 as simply another routing mechanism for emergency services or use it as a catalyst for person-centered crisis care that prioritizes connection, safety planning, and appropriate care levels over reflexive hospitalization.
Crisis care technology plays a vital role in this transformation—not by automating decisions or replacing human judgment, but by supporting clinicians to engage more deeply while still meeting documentation requirements, tracking both acute and chronic risk factors, and maintaining continuity across the entire crisis continuum from initial 988 contact through mobile response, stabilization, and follow-up care.
The most successful 988 implementations we’ve observed share common characteristics: they’ve invested in training that emphasizes engagement over checklists, implemented crisis intervention software that captures nuance rather than forcing binary decisions, and created cultures where “staying with” someone in distress is valued over “passing them on” to the next level of care.
How Crisis Care Technology Enables “Got You” in Practice
Behavioral health documentation systems should support clinicians in staying present with people in crisis rather than getting lost in paperwork. Here’s how BHL’s crisis care platform enables the “Got You” approach:
Nuanced risk assessment categories (acute vs. chronic): Staff can capture trajectories of acute and chronic factors—including reasons for living—allowing disclosure to lead to opportunities for support and stabilization rather than a ‘red alert.’ The system distinguishes between someone experiencing a sudden crisis with new intent and access to means versus someone managing chronic suicidal thoughts with established coping strategies.
Documentation that stays out of the way: Conversational engagement comes first; the crisis intervention software handles structure in the background so clinicians can remain present while still capturing the important elements of desire, intent, capability, and the buffers that can keep them going. This means crisis counselors can focus on the person, not the screen.
Tailored care pathways: Risk context flows into suggestions for best practice incorporating person-centered care and the right fits while enabling good safety planning, lethal means access management, and connecting with other supports toward embracing the whole wellness of those served. The technology guides without dictating, supporting clinical judgment rather than replacing it.
Continuity across the 988 crisis response continuum: As we emphasized in our previous log on crisis care coordination, the same principles power Call Center → Mobile → Beds/Outpatient Referrals → Follow-Up. The story never resets; it carries forward to support safety and dignity throughout the continuum and tracks the fluidity of what is happening for the person. When someone calls 988 multiple times, responders see the full context, not just the current call.
Real-time coordination for mobile crisis teams: Mobile crisis response units can access the complete history and current safety plan before arrival, allowing them to engage as partners rather than starting from scratch. This reduces repeated trauma of retelling stories and builds trust through continuity.
Building Person-Centered Crisis Response Systems
Every day, providers face a choice: Gotcha (coercion, fear, silence) or Got You (partnership, dignity, safety). The research is clear: when people fear coercion, they stay silent; when they feel safe, they share—and sharing saves lives.
For state mental health systems implementing 988 crisis response, this represents both a challenge and an opportunity. The challenge is overcoming decades of liability-driven, defensive practices. The opportunity is creating crisis care systems that actually keep people safer by encouraging disclosure, supporting safety planning, and connecting people to appropriate care.
BHL’s platform is built to make “Got You” and “With You” the default—helping clinicians to engage as partners in conversations around creating safety in light of their reasons for remaining safe, understand acute vs. chronic dynamics, and keep documentation effortless and continuous across modules. When the car is skidding, our job is to lean in together, so no one has to navigate the next turn alone.
Frequently Asked Questions About Person-Centered Crisis Care
How do we balance liability concerns with person-centered crisis care?
The best liability protection is good clinical care. When documentation shows thorough assessment, collaborative safety planning, and appropriate clinical judgment, you’re in a stronger position than when records show only checkbox responses followed by reflexive hospitalization. BHL’s system captures the nuance and rationale behind decisions.
What training does crisis care staff need for this approach?
The shift from Gotcha to Got You requires both skill-building and culture change. Effective training programs include motivational interviewing, suicide risk assessment and management (not just prediction), safety planning, and techniques for engaging with ambivalence. Technology can support this training by providing real-time guidance and decision support.
How does crisis care technology support rather than replace human connection?
The right technology handles documentation and coordination so clinicians can stay present with people. Rather than staring at a screen filling out fields, counselors can maintain eye contact and active listening while the system captures what matters. Technology should serve the relationship, not interrupt it.
What about people who are truly at imminent risk and need hospitalization?
Person-centered care doesn’t mean avoiding hospitalization when it’s clinically necessary. It means distinguishing between acute crises requiring immediate intervention and chronic risk that’s better managed through community-based support. The goal is right-sized care: not too little, not too much, but what fits the person’s actual situation and needs.
Take the Next Step Toward Transforming Your Crisis Care System
If you’re working to implement 988 crisis response or strengthen your existing crisis care coordination, we’d welcome the opportunity to discuss how BHL’s platform can support your vision for person-centered, effective crisis intervention.
👉 Schedule a Discovery Call to see how our crisis care technology enables the “Got You” approach across your entire continuum of care.
About the Author
Dr. Charles Browning is a board-certified psychiatrist and CEO of Behavioral Health Link with over 20 years of leadership in crisis care systems and suicide prevention. He serves as Chief Medical Officer of Recovery Innovations and co-developed innovative models including the Fusion Model and agency-wide Zero Suicide implementation protocols. Dr. Browning is a frequent keynote speaker at national and international conferences and serves as a thought leader in integrating peer support with clinical care across behavioral health systems.