Emergency Contact Procedures for Private Practice

Handling client or patient emergencies can be stressful for therapists, psychiatrists, and other mental health clinicians in private practice. In these circumstances, the provider must determine how to best care for their client or patient, while also considering medico-legal factors that may arise in an emergency situation.  

Developing  private practice emergency contact procedures in alignment with medical and legal guidelines can help alleviate some of the stress when handling emergency situations that may arise.

First, let’s define the different types of emergencies mental health clinicians may encounter in private practice:

• A genuine life or death emergency: For example, a patient who is having a serious physical reaction to a medication, is in danger of being physically harmed, or who is planning self-harm or suicide.
  
• An urgent matter: For example, a patient has run out of medication, or they are experiencing discontinuation symptoms or side effects. While there is no imminent danger to life, they may be experiencing significant discomfort.
  
• A matter of high anxiety: This includes issues that provoke high-affect and are too intense for clients to manage without professional intervention. For instance, the patient may require professional attention in that moment to lessen the intensity of their symptoms or reactions.

As a solo private practitioner, being on-call for emergencies can be challenging because you’re always responsible for handling them. This is one reason some clinicians choose to join or create a group practice or hire an employee, so that the responsibilities of emergency contact policies can be shared via an on-call pool of providers.

Regardless of practice size, three of the most commonly used emergency contact procedures in private practice are: 

• Instructing patients to call 911
• Using an answering service
• Providing your home phone number and/or cell phone number to patients 

We’ll look at the pros and cons of each of these emergency policies below.

Instructing patients to call 911 

Pros:

• Meets minimum standards without additional work for the practitioner or practice.
  
• Establishes work-life boundaries that patients/clients have to respect.
  
• Makes private practice sustainable, since practitioners don’t have to be “on-call” at all times.

Cons:

• Patients may not feel cared for in their time of need.
  
• If a patient calls their provider to report feeling suicidal, they may not be able to call 911 when redirected to do so.

Using a remote answering service

Pros:

• Patients can feel reassured knowing they can leave a voicemail and get a call back after hours, in case of an emergency.
  
• These are widely used in the medical field, so patients are usually familiar and comfortable with leaving their provider a message
  
• If you have an operator, they can be trained to screen for emergencies, based on a script of questions the patient answers or an algorithm. Then, the operator can determine whether to contact you immediately or not.
  

• Establishes a healthy boundary between a provider’s work and personal life, without seeming impersonal.
  
• Gives the provider confidence that trained staff or supportive technology will assess the urgency of a message, and contact the private practitioner immediately, if necessary. 

Cons:

• Can be expensive for providers if hiring an employee or using a service.
  
• Patients may still be frustrated that they can’t directly connect with you on the phone.

Giving personal phone numbers to patients

Pros:

• Patients may feel very cared for and reassured that they can reach you directly anytime. This may, in and of itself, be calming and reduce the need to actually contact you.
  

• Clinicians can maintain complete control over their practice at all times.
  
• Providers can market their practice more as a “concierge” service.

Cons:

• Providers may not feel that they can take time off or go on vacation. For example, what happens when you go out of town, or out of the country? What happens if you’re in a dead cell phone area? 
• Some patients may abuse this access, and it blurs boundaries between the provider’s professional and personal life.
  
• Not ideal for building a sustainable clinical practice (i.e., it’s difficult for providers to make themselves available 24/7 to clients over a 30-year career, especially as your practice grows).

Developing the right emergency contact plan for your practice

Choosing and developing  the right emergency contact plan involves providing quality patient care that works for your lifestyle and your practice’s capacity, while also providing your clients the support they require in emergency circumstances that may arise. 

The more a private practice emergency contact plan fulfills all three, the more comfortable you’ll feel in dealing with these often uncomfortable, though hopefully rare, situations.

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