Think back to a difficult time in your life. Maybe you reached out to someone—a friend, a loved one—and they were there. Maybe they listened. Maybe they helped. But what happened next?
A day or two later, maybe you got a message: “Just checking in—how are you doing?” And that simple gesture—that moment of unexpected care—meant the world. In crisis care, that’s what we call a caring contact. A follow-up. And yet, despite its power, it’s often the most overlooked element of crisis services.
At BHL, we know crisis care is built around what SAMHSA calls the three pillars: someone to talk to, someone to respond, and a safe place to go. But there’s a fourth, quiet pillar—someone to follow up. Not an afterthought. Not an extra. A core element of effective, humane crisis care.
Why Follow-Up Matters
Follow-up isn’t new. In fact, it’s rooted in decades of evidence, and it all began with a psychiatrist named Jerome Motto, who served during WWII. When he was stationed near the front lines in Belgium, what gave him strength weren’t grand gestures—they were letters. Quiet, mundane, caring letters from a woman named Marilyn back home. Not romantic. Just human. They grounded him.
Years later, as Dr. Motto worked with suicidal patients in San Francisco, he remembered those letters. From 1969 to 1974, he tested a radical idea: what if we sent similar letters to people after psychiatric discharge? The result? A nearly 50% reduction in suicide deaths among those who received them.
Since then, studies have echoed the same truth: follow-up saves lives. Whether it’s postcards from Iranian emergency departments, texts in France, or calls from the Lifeline network here at home—this work works. People who receive follow-up care report feeling safer, more hopeful, and more connected. Many say those calls saved their lives.
But Here’s the Catch
Despite mountains of evidence and years of recommendations from groups like the Joint Commission and the National Action Alliance for Suicide Prevention, follow-up isn’t standard practice. Only a third of hospitals actually do it. In the behavioral health world, where budgets are thin and the work is urgent, it’s easy to see why something that happens “after” the crisis might get dropped.
But we can’t afford to let that happen. Consider this: within three months of discharge, individuals recently hospitalized for suicidal ideation are up to 100 times more likely to die by suicide than the general population. The week after hospitalization? Try 300 times more likely.
What’s more, follow-up doesn’t just reduce suicide risk. It improves care connection. It strengthens safety plans. It’s the bridge that keeps people from falling through the cracks.
Follow-Up Isn’t a Checklist. It’s a Relationship.
At BHL, we believe follow-up must be deeply human—and also structured and consistent. That’s why we’ve embedded follow-up best practices directly into our platform, ensuring:
- A full view of prior contacts
- Ongoing suicide risk assessment
- Dynamic safety plan review
- Barrier resolution to care connection
- Real-time client feedback and outcome tracking
We’re not just asking “Did someone answer the phone?” We’re asking, “Did they feel cared for? Are they safer now? Did they get what they needed to heal?”
Safety Planning Needs Follow-Up, Too
A safety plan isn’t just a form. It’s a lifeline—but only if it lives. Too often, it’s handed off at discharge and never seen again. Real impact happens when we revisit that plan together. What’s working? What’s not? Have your supports changed? Are your reasons for living still front and center?
In fact, research shows the only time safety planning really works is when it’s coupled with follow-up. As the late Dr. Barbara Stanley once shared with me—follow-up is the lifeblood of any effective safety plan.
A Call to All of Us
Whether you’re a clinician, a crisis counselor, or a peer advocate, this is the moment to act. As Dr. Richard McKeon of SAMHSA said, follow-up is a key lever in preventing suicide. And it’s one we can all pull.
Start small. Send a text. Make the call. Review the plan. Let someone know you care enough to check in. Peer advocate Tom Kelly put it best: follow-up reminded him that he is a person, not a lost cause.
That’s the power of follow-up.
Let’s stop treating it like an option. Let’s make it a standard.
Let’s make it a promise.
John Draper, Ph.D., is President of Research, Development, and Government Solutions at Behavioral Health Link