When distress suggests risk, crisis or safeguarding concern

Most distress can be managed with calm communication and normal practice procedures. Some situations need urgent escalation, especially where a person mentions self-harm or suicide, severe deterioration, safety concerns at home, or an inability to cope.

Do not let a label such as "angry patient" obscure possible danger. Someone who sounds angry may also be suicidal, confused, breathless, at risk from another person, or unable to follow the usual care route safely.

Escalate when the words suggest immediate risk

• Self-harm or suicide: "I cannot do this anymore", "I might hurt myself", "I do not want to be here".
• Harm from others: "I cannot go home", "they will hurt me", "my partner checks everything".
• Threat to others: "I am going to make them pay", "someone will get hurt".
• Serious deterioration: confusion, severe weakness, breathlessness, collapse or not making sense.
• Safeguarding clues: the person cannot speak freely, is being controlled, or children or adults at risk may be affected.

Do not contain serious risk alone

Reception and care navigation staff should not carry out formal risk assessments or decide a person is safe. If the wording suggests urgent danger or crisis, follow the local urgent, safeguarding or emergency route.

If local procedure requires keeping the person on the line, do so when it is safe and possible. If the person disconnects, follow the failed-contact or emergency escalation process rather than only recording that the call ended.

Record risk wording exactly

Record the person's words verbatim where possible. "Patient said 'I might hurt myself if nobody helps'" gives far more information than "patient upset". Exact wording helps the receiving clinician or safeguarding lead judge the urgency.

Urgent Mental Health Help

Do not try to contain serious risk alone; use the urgent, safeguarding or emergency route.