Crisis Line · Sections 6, 7, 8 — Master Notes + Flow
Sections 6, 7, 8 — Study Notes

Master Reference Notes

Mental Health · Victimology · Addiction & Homelessness. Everything you need to know for practice calls. Click any section to expand.

🧠 Section 6 — Mental Health Overview Foundation
The Continuum

Mental health and mental illness are two ends of a spectrum — no one sits at either extreme. Everyone fluctuates. Never label or diagnose a caller.

📋 If a caller names a disorder you don't recognize — say you're not an expert and let them explain it. They become the expert. Relieves pressure off you.
✋ Never suggest or confirm a diagnosis. Never imply a caller's self-reported diagnosis seems wrong. That is not your role.
DSM-5 — What it is

The Diagnostic and Statistical Manual of Mental Disorders v5 — the classification system used by clinicians. You reference it as background; you don't use it to diagnose on calls.

⚡ Anxiety & Panic Disorders S6 · Common on lines

GAD (Generalized Anxiety)

Excessive, uncontrollable worry about many things for 6+ months. Restlessness, fatigue, poor concentration, muscle tension, sleep issues.

Panic Attack

Abrupt surge of intense fear, peaks in minutes. Heart racing, sweating, chest pain, shortness of breath, fear of dying or losing control.

Panic Disorder

Panic attacks + 1 month+ of persistent worry about more attacks OR significant behaviour changes (like avoiding situations).

Key Distinction

Having a panic attack ≠ having Panic Disorder. Anyone can have a panic attack without any mental disorder.

⚠️ If chest pain and they're unsure if it's a panic attack — suggest hospital. Could be a heart attack. Don't assume.
How to help — panic attack in progress

Let's breathe together — in for three… pause… out for three.

This is going to pass. It's passed before.

On the call

Stay calm — your tone regulates theirs. Let them talk first. Ask their name and use it to anchor them to the present moment.

🔁 OCD — Obsessive Compulsive Disorder S6
What it is

Obsessions — intrusive, unwanted thoughts/urges/images that cause anxiety. The person feels no control over them.

Compulsions — repetitive behaviours (hand washing, checking, counting) performed to neutralize the obsession. Gets complicated quickly — specific sequences, specific numbers.

✋ Never say "you're being silly" or "don't worry about it." That invalidates them. Their reality is their reality.
💡 OCD ≠ OCPD. OCD is extreme anxiety + intrusive thoughts. OCPD is about orderliness/perfectionism. Common mix-up.
On the call

Validate without judgment. Let them describe obsessions and compulsions fully. Meet them where they are — non-judgment is everything here.

🌧️ Depressive Disorders — MDD & PDD S6 · Assess suicide risk

MDD (Major Depressive Disorder)

2+ weeks of depressed mood OR loss of interest, plus 4+ more symptoms: weight changes, sleep issues, fatigue, worthlessness, poor concentration, recurrent thoughts of death or suicidal ideation.

PDD (Persistent Depressive Disorder)

Less intense than MDD but more chronic — 2+ years of depressed mood most days. Low energy, low self-esteem, hopelessness, poor concentration.

🚨 Recurrent thoughts of death are a diagnostic criterion for MDD. Always assess for suicide on depression calls.
↕️ Bipolar Disorders S6 · Always assess suicide

Manic Episode

Extremely elevated/irritable mood + high goal-directed activity for 7+ days. Grandiosity, decreased sleep, racing thoughts, risky behaviour. May involve psychosis.

Hypomanic Episode

Same as mania but less severe, 4+ days. No psychosis, no hospitalization needed. Noticeable but not as impairing.

Bipolar I

At least one full manic episode. May also swing to depression or hypomania.

Bipolar II

At least one hypomanic + one major depressive episode. Never a full manic episode.

💊 If they mention medication — encourage them to keep taking it. Stopping abruptly has serious negative effects.
🚨 Always assess for suicide risk. Treat like any other service user in crisis — don't get distracted by the mood swings.
🩺 Eating Disorders — Anorexia & Bulimia S6

Anorexia Nervosa

Very low body weight, restricted intake, intense fear of weight gain, distorted body image. Two types: restricting, and binge/purge. ~5% mortality within 4 years.

Bulimia Nervosa

Recurrent binge eating + purging (vomiting, laxatives, exercise). Person is typically average weight — purging to prevent gain, not to lose more.

💡 Key distinction: Anorexia = low BMI + distorted body image. Bulimia = average weight + loss of control over eating then purging.
✋ Don't try to convince them to stop. The disordered eating can function like an addiction. Focus on what's driving it — the fear, the feelings underneath.
On the call

Accept their reality. Talk about their fears, what's behind the behaviour. If they want help, offer urgent care or doctor resources.

🌀 Schizophrenia & Psychosis S6 · Assess suicide + homicide
What it is

Distorted reality — delusions, hallucinations, disorganized speech, chaotic behaviour, negative symptoms (apathy, flat affect). 2+ symptoms for 6+ months with significant functioning decline.

✋ Never diagnose. Never argue with their reality. If not yet diagnosed and showing symptoms — encourage them to see a doctor or go to hospital.
On the call
  • Stay calm — they may be terrified by what they're experiencing
  • Reduce distractions — TV, radio, mirrors
  • Use their name repeatedly to ground them
  • Always assess for suicide AND homicide risk
🌊 Borderline Personality Disorder (BPD) S6 · High call frequency
What it is

Pervasive instability in relationships, self-image, and emotions. Fear of abandonment, intense interpersonal swings, identity disturbance, impulsivity, recurrent suicidal behaviour, chronic emptiness, anger dysregulation.

✋ Never suggest to someone that you think they might have BPD — extremely high stigma, can cause harm.
⚠️ These callers can be manipulative — stay in control of the call, be firm with boundaries. Their behaviour isn't personal and isn't deliberate.
⚖️ Medical Assistance in Dying (MAiD) S6 · Handle with care
What it is

A physician/NP-assisted intentional end of life using drugs, by request. Legal in Canada since 2016 for adults 18+ with a grievous and irremediable medical condition. Not currently available for sole mental health conditions (may change March 2027).

✋ Do not introduce the topic of MAiD to callers. Do not give resources on MAiD on the 988 line. Direct to their family doctor or Government of Canada website if they ask.
🎯 Your role: build connection, assess immediate safety, help them reconnect with hope and what they can do today. MAiD may be a choice — but it's not the only choice. That's the space you create.
If a caller brings up MAiD

It sounds like this has been weighing on your mind — what had you thinking about this today?

How have you been coping with all of this so far?

What do you need tonight?

→ Still always ask: "Are you thinking about suicide?" MAiD and suicide are different — but imminent risk still requires the same intervention.
🧠 No supportive or unsupportive comments about MAiD. Listen without judgment. Your own feelings about MAiD are valid — debrief with a supervisor afterward if needed.
📜 Mental Health Act — BC S6 · Know your role
Voluntary vs Involuntary Admission

Voluntary — person requests their own admission (16+). Can leave any time.

Involuntary — against their will. Requires a physician to certify: severe mental disorder, needs care, unable to admit voluntarily. First cert = 48 hours. Second cert = up to 1 month.

Our role

Support and inform — we can explain rights to callers who want voluntary admission, and inform families about involuntary admission. Police can apprehend someone who is endangering themselves or others.

⚡ Confidentiality exception: We can break confidentiality only if someone is about to harm themselves or others imminently, or if there is child abuse/neglect. In those cases, police can be enlisted.
💜 Section 7 — Trauma & PTSD Victimology
What trauma is

An event (or series) experienced as physically or emotionally harmful, with lasting effects on wellbeing. Trauma is a public health crisis — 80–90% of people seeking public mental health services have experienced personal violence or trauma.

PTSD — 4 criteria clusters
  • Intrusion symptoms — flashbacks, nightmares, intrusive memories
  • Avoidance — of reminders, people, places related to the event
  • Negative cognitions/mood — self-blame, distrust, detachment
  • Altered arousal — hypervigilance, irritability, sleep disturbance, self-destructive behaviour
✋ Do not explore or re-live the trauma event. You are not a trauma therapist. Re-living can re-traumatize. Stay focused on the present.
🎯 Trauma-Informed Care: shift from "What's wrong with you?" → "What happened to you?" Give them pace, choice, and control. Restore safety, power, and self-worth.
Keep them present-focused

What brought this up for you today?

What do you do to get through the difficult moments?

What would help you feel safer right now?

🚨 Intimate Partner Violence (IPV) S7 · Safety first
4 Types
  • Physical — hitting, choking, restraining, use of weapons
  • Sexual — any non-consensual sexual act or contact
  • Threats — communicating intent to cause harm
  • Psychological/Emotional — humiliating, isolating, controlling finances, stalking
⚡ Leaving is not always the safest option. Research shows women are at greatest danger after filing for a restraining order. Respect their decision — do not push them to leave.
Immediate safety check
  • Are they in a safe place right now?
  • Is there imminent risk of harm? Have they already been harmed?
  • Do they need medical attention?
  • Are there children in the home? (duty to report may apply)
⚠️ If children are at risk — alert your supervisor before contacting police or MCFD. Do not act alone on this.
On the call

Withhold judgment completely. Empower their choices — they are likely already experiencing powerlessness. You can help them safety plan (emergency bag, safe contacts) and provide shelter resources.

🛡️ Child Abuse — Policy & Procedure S7 · Legal duty to report
⚖️ Legal obligation under BC's Family and Child Services Act. Any person with reasonable grounds must report. CLRs have a legal responsibility to report suspected child abuse.
What to do on the call
  • Build empathy, trust, and rapport first (Crisis Intervention Model)
  • Determine if abuse is ongoing, current, or past
  • Gather as much identifying info as possible — names, ages, address, school, phone
  • Encourage caller to contact MCFD themselves if appropriate
  • After the call — debrief with supervisor and have them make the report
📋 CLRs do not report directly. You pass info to your supervisor or Staff on Call — they do the reporting. After-hours MCFD: 1-800-663-9122. Children's helpline: 310-1234.
💡 If the caller is the abuser — stay non-judgmental. They are in crisis too. Focus on the service user and their feelings, assess immediate safety of children, explore healthier options.
💗 Sexual Assault S7 · Trauma-informed
Key facts

Sexual assault = sexual contact without explicit consent. Rape = specifically penetration without consent (a form of sexual assault). Highly underreported due to fear and risk of re-traumatization.

💡 Their story may be disjointed and not linear. That's how trauma is stored — in pieces. Do not expect a coherent timeline. Meet them where they are.
On the call
  • No one responds the same way — laughing, crying, yelling are all valid
  • Ask about feelings around the event — not the event itself
  • Thoroughly assess suicide cues
  • End with a short-term stabilization plan for tonight and the next few days
  • If just assaulted — ask about medical attention and encourage (not force) hospital/doctor
⚠️ Caller Wants to Harm Someone — Violence Assessment S7 · Call 911 if imminent
🚨 If harm is in progress or has already occurred today — call 911 immediately after the interaction (or during, if imminent).
Violence/Harm Assessment — 7 factors (score 1–4 each)
  • History of violence — none → previous homicide attempts
  • Plan — none → specific current plan
  • Availability of means — none → lethal weapon + knows how to use it
  • Support available — many supports → none accessible
  • Current homicidal threats — none → immediate risk to someone
  • Alcohol/drug use — none → current use + homicidal threat
  • Relationship with victim — none → previous assaults + dehumanization
Scoring
  • 1–7: Low — general skills
  • 8–14: Low/Moderate — general skills + safety plan if escalates
  • 15–21: Moderate/High — check in with On-Call. Consider duty to warn.
  • 22–28: High — gather info, contact On-Call Support immediately
🔗 Section 8 — Addiction / Substance Use Disorders Look behind the surface

Abuse

Recurrent use causing failure at work/school/home, use in hazardous situations, related legal problems, or continued use despite interpersonal problems.

Dependence

3+ in 12 months: tolerance, withdrawal, increased consumption, failed quit attempts, significant time lost, reduced activity, continued use despite harm.

🔍 Look behind the addiction. What caused these feelings? What are they trying to drown? PTSD and substance use disorders are frequently seen together.
On the call

Don't get caught in the addiction story on the surface. Go deeper — emotions, history, drivers. Give lots of empathy and validation. If they want help, offer appropriate resources.

🏙️ Homelessness & Elder/Vulnerable Adult Abuse S8
Homelessness — key realities
  • Only 20% of homeless people are visibly on the streets — 80% are couch-surfing, moving between friends/relatives
  • Most are working low-wage jobs — unable to afford housing
  • Causes: mental health, addiction, lack of supports, abuse, funding cuts
→ Homelessness calls are rare. When they happen — food banks, food boxes, and local income support resources are key. Respond with respect, no judgment.
Elder / Vulnerable Adult Abuse

Elders and vulnerable adults (people with disabilities, new immigrants, etc.) can be treated similarly to children when they are unable to stop their own abuse. If in immediate danger — call 911. To report: contact local Adult Protection Line, BC Senior's Abuse and Information Line (SAIL), or Seniors Resource Centres.

📋 Module 4 — Mental Health System & Resource Referral (BC) What we're learning this week
The big picture

The BC mental health system is complicated and most people don't know how to navigate it. Our job is not to be experts — it's to connect people to the right level of help. There are three sectors: public (free, government-funded), private (fee-for-service), and non-profit (free or low-cost, like Chimo).

Three levels of care
  • Primary — first point of contact. Family doctors, walk-in clinics, urgent care centres, emergency departments. Usually self-referred.
  • Secondary — specialists who require a referral. Psychiatrists, mental health centres/teams.
  • Tertiary — highly specialized, referral required. Red Fish Healing Centre, BC Children's Hospital, ACT Teams. Usually longer-term.
Public system — key providers (free with BC CareCard)
  • Nurses (811) — good first step to decide if/when to see a doctor
  • Family doctor / GP — diagnosis, medication, referrals to psychiatrist. Find via walk-in or BC College of Physicians and Surgeons
  • Psychiatrist — requires GP referral. Can prescribe and monitor medication. Not the same as a psychologist.
  • UPCC (Urgent and Primary Care Centre) — same-day, walk-in, no appointment. For urgent non-life-threatening concerns.
  • Mental health teams/centres — multidisciplinary teams, crisis intervention, counselling, outreach. Most can be self-referred.
  • Children/youth under 19 — services through MCFD, not Ministry of Health. Includes Short Term Assessment Response Teams, Child and Adolescent Response Teams, Suicide Prevention and Counselling.
Private system — fee-for-service (not free unless EAP/extended benefits)
  • Psychologists — PhD level, can assess and provide therapy. Registered with BCPA. Cannot prescribe.
  • Counsellors / Clinical Counsellors — varying training. Registered with BCACC. Short or long-term therapy. Cannot prescribe.
  • Some offer sliding scale fees based on income
How we find resources — approved sources only
  • iCarol resource directory — primary tool, search here first
  • BC211 (dial 2-1-1) — if you can't find anything useful elsewhere, give caller the number 211
  • HealthLink BC — healthlinkbc.ca/services-and-resources/find-services
  • Fraser Health / VCH websites — for health authority-specific services
  • Kids Help Phone database — for youth calls
  • 988 Resource Map — crisis-specific
Special cases — direct links only, not searchable
  • Subsidized psychiatric medications — gov.bc.ca forms (refer back to prescriber first)
  • Reduced-cost counselling Metro Vancouver — Willow Tree counselling PDF
  • Affordable Therapy Network — sliding scale therapists across Canada
  • MediMap (medimap.ca) — find local doctors
⚠️ Referrals are limited to sources found within the approved databases or the direct links listed above. Do not refer to resources outside of these unless listed.
💡 The more calls you take and referrals you make, the more familiar the system becomes. You are not expected to know everything — that's what the databases are for.
Sections 6, 7, 8 — Branching Call Flow

Call Flow Script

Follow the main spine top to bottom. When a caller discloses something from this week's topics, the branch for that topic activates — telling you exactly what to ask, what to do, and what actions or resources apply. The spine continues after every branch.

📌 How to use this: Every call follows the numbered spine (01 → 11). Branches are triggered by what the caller discloses — you may hit one branch, multiple, or none. After any branch, return to the spine and keep going.
01🧩 Open — Greeting + Build Safety Outcome 1
Answer the call — always first

Hi, BC Crisis Line — how are you doing tonight?

💡 This is your anchor. Calm, warm, and simple. Let them respond and lead from there — don't jump ahead.
Once they start talking — affirm and open it up

I'm really glad you called tonight.

What's been going on for you?

→ If emotional or struggling to start: "Take your time — I'm right here with you." Get their name early and use it throughout.
02🧠 Hear the Story — Listen First, Don't Fix Outcome 1
Open questions — use freely, don't rush

Can you tell me more about that?

What's been making this so hard lately?

When did things start feeling this way?

What does a day look like for you right now?

What happened today that brought you to this point?

How long have things been feeling this way?

What's been the hardest part of all of this?

Validation — use throughout, not just once

That sounds really overwhelming.

I can hear how heavy that is for you.

Anyone in your position would be struggling with this.

That makes a lot of sense given everything you're dealing with.

It sounds like you've been carrying this for a long time.

That's a lot to be going through — especially on your own.

I'm really glad you reached out tonight.

Reflecting — mirror back what you hear

So what I'm hearing is… [repeat their key words back].

It sounds like [feeling] has been really present for you lately.

You've been feeling [word they used] — and that's been building up for a while now.

If I'm understanding right, [summarize situation] — is that right?

✋ Do not fix, advise, or problem-solve yet. Listen until you understand what this call is really about.
⬇️ As the story comes out — note what topics come up. Each one below has its own branch. You may hit several.
Topic Branches — activate when caller discloses
↳🧠 Branch — Caller Discloses Mental Health Condition S6
⚡ Triggered when caller mentions a diagnosis, disorder, or symptoms — depression, anxiety, bipolar, OCD, schizophrenia, BPD, eating disorder, etc.
Ask — understand their experience of it

How long have you been dealing with this?

How has it been affecting you lately?

Are you currently getting any support for this — a doctor, therapist, medication?

Condition-specific scripts
⚡ Anxiety / GAD
Validate and open

That kind of worry can feel completely overwhelming — like your brain won't stop.

What's been on your mind the most today?

  • Let them talk it out — expressing the worry starts to deflate it
  • Don't try to rationalize or solve the worry — just listen and reflect
🚨 Panic Attack — In Progress
Ground them first

I'm right here with you. This is going to pass — it has before.

Can you breathe with me? In slowly for three… pause… and out slowly for three.

You're safe right now. Just stay with me.

Once they're calmer — check in

Has this happened before?

How are you feeling now?

⚠️ If they have chest pain and aren't sure it's a panic attack — suggest hospital. Could be a heart attack.
🌧️ Depression / MDD / PDD
Validate

Depression can make everything feel heavier and harder than it already is.

How long have you been feeling this way?

Is there anything that's helped — even a little — in the past?

🚨 Recurrent thoughts of death are a symptom of MDD. Always move to the 4 suicide questions.
↕️ Bipolar I / II
Ask about medication first

Are you still taking your medication?

If they've stopped

I hear you — I'd really encourage you to reach back out to your doctor about that. Stopping suddenly can make things a lot harder on your body and your mood.

Regardless — ground in self-care

Have you been able to eat today? Sleep?

What does the rest of tonight look like for you?

🚨 Always assess for suicide. Treat like any other crisis caller.
🔁 OCD
Validate — never dismiss

That sounds really exhausting — feeling like your mind won't let go of something no matter what you do.

Can you tell me more about what's been happening?

✋ Never say "just don't think about it" or "that doesn't make sense." Let them describe it fully without judgment.
🌀 Schizophrenia / Psychosis Signs
Anchor them — use their name often

[Name], I'm here with you. Can you tell me where you are right now?

I hear that things feel very real and very scary right now.

If undiagnosed and showing symptoms

What you're describing sounds really distressing. Have you been able to talk to a doctor about what you've been experiencing?

✋ Never argue with their reality. Don't say "that's not real." Ask them to reduce distractions — TV, radio off. Always assess suicide and homicide risk.
🩺 Eating Disorder
Go to the feeling underneath

It sounds like there's a lot going on underneath all of this.

What do you think is driving this for you?

What are you feeling when it gets really bad?

✋ Do not try to convince them to stop the behaviour. Accept their reality. If they want help — offer doctor or urgent care.
🌊 BPD Signs
Stay steady — boundaries and empathy together

I hear you — that sounds incredibly painful.

I want to help you through tonight. Can we focus on what's going on for you right now?

✋ Never name or suggest BPD. Stay firm with boundaries — don't get pulled into escalating. Their behaviour is not personal. Don't take hostility personally.
✋ Never diagnose. Never suggest a diagnosis. Never imply their stated diagnosis seems wrong. If unfamiliar — let them explain it. They become the expert.
Resource offer — if they seem open to support

There are some supports that might be able to help with this — would it be okay if I shared a number with you?

📋 If yes → BC Mental Health Crisis Line: 310-6789. Or their family doctor / walk-in as a first step. One number only.
→ Every mental health condition in S6 carries elevated suicide risk. Continue spine to Step 04 — always complete the 4 questions.
↳⚖️ Branch — Caller Brings Up MAiD S6 · Handle carefully
✋ Do not introduce this topic. Only engage if they bring it up. Do not give MAiD resources on 988. No supportive or unsupportive comments about MAiD itself.
Listen and redirect to today — open questions

It sounds like this has been weighing on your mind — what had you thinking about this today?

How have you been coping with all of this so far?

What do you need tonight?

How long have you been feeling this way?

What's been the hardest part of what you're going through?

Is there anyone in your life you've been able to talk to about this?

Validation — without commenting on MAiD itself

It sounds like you're carrying something really painful right now.

Whatever you're feeling — I want you to know that I'm here to listen, without judgment.

It takes a lot to reach out and talk about something this personal.

Reflecting

So what I'm hearing is that you've been thinking about this for a while — and tonight things came to a head.

It sounds like what's really at the centre of this is [pain / exhaustion / loss of hope] — is that right?

If they ask how to access MAiD
  • Tell them you're not a specialist for MAiD
  • Your priority is finding out how they're doing today and building connection
  • Direct them to their family doctor or the Government of Canada website for accurate information
📋 If they ask for MAiD resources → do not provide them on 988. Direct to family doctor or Canada.ca only.
→ Still complete all 4 suicide risk questions. MAiD and suicide are different — but imminent risk requires the same intervention regardless.
↳💜 Branch — Caller Discloses Trauma or PTSD S7
⚡ Triggered when caller references a traumatic past event, PTSD, flashbacks, nightmares, or says something like "something happened to me."
Stay present-focused — open questions

What brought this up for you today?

How is this affecting you right now — tonight?

What do you usually do to get through the hard moments?

When things get really difficult, what has helped — even a little?

What does it feel like when it comes up for you?

How long have you been carrying this?

Is there anyone in your life who knows what you've been through?

Validation — go here often

What you went through was really serious — and it makes complete sense that it still affects you.

The fact that you're still here, still trying — that takes real strength.

You don't have to be over it. You don't have to be okay with what happened.

There's no right or wrong way to feel about something like this.

Reflecting

So it sounds like this has been with you for a while — not just tonight.

What I'm hearing is that [what they shared] has been making it hard to feel safe / settled / like yourself.

It sounds like tonight something brought it all back to the surface.

✋ Do not ask them to re-tell or re-live the traumatic event. You are not a trauma therapist. Reliving it can re-traumatize and escalate. Stay anchored in the present.
Trauma-Informed approach — always
  • Give them pace and control — let them lead the conversation
  • Ask "what happened to you" not "what's wrong with you"
  • Validate emotional responses — there's no wrong way to feel about trauma
  • Focus on support network and what they can do right now to care for themselves
Resource offer — if they seem open

There are some supports that might be able to help with this — would it be okay if I shared a number with you?

📋 If yes → Victim Services in their area (if connected to a crime or assault), or their doctor / a trauma-informed counsellor. One number only.
→ Continue spine. Trauma significantly elevates suicide risk — complete all 4 questions.
↳🚨 Branch — Caller Discloses Violence or Unsafe Situation S7 · Assess safety now
⚡ Triggered when caller discloses abuse, violence, or an unsafe situation — partner violence, family violence, elder abuse, or any form of physical threat. Assess their immediate safety first.
Immediate safety check

Are you in a safe place right now?

Has anyone hurt you today — do you need medical attention?

Is there anyone else with you right now?

Open questions — understand their situation fully

Can you tell me more about what's been happening?

How long has this been going on?

What does it look like when things get really bad?

Has this happened before — or has it been getting worse?

What's been stopping you from being able to get out or get help?

Is there anyone in your life who knows what's been going on?

What does tonight feel like compared to other times?

Validation — they need to hear this

What's been happening to you is not okay — and it's not your fault.

It takes a lot of courage to talk about this.

You deserve to feel safe. What you're going through isn't something you should have to handle alone.

I hear how hard this has been — and how much you've been managing on your own.

Whatever choices you've made — you've been doing your best in a really difficult situation.

Reflecting

So what I'm hearing is that this has been going on for a while and you're feeling [trapped / scared / exhausted / alone].

It sounds like tonight things reached a point where you couldn't hold it in anymore.

You've been carrying this mostly by yourself — and that's an enormous amount of weight.

Key principles — IPV, family violence, or any abuse situation
  • Withhold all judgment. Do not tell them what to do.
  • They likely already feel powerless — empower their choices, don't override them
  • Do not pressure them to leave the situation — leaving is not always the safest option. Research shows risk is highest after a restraining order is filed.
  • You can help them plan (emergency bag, safe contacts, exit plan) but only if they want to
  • Provide shelter or support resources if they ask or are ready
⚠️ Check whether children are present or at risk in the home. If yes — this may trigger a mandatory report. Alert supervisor before contacting police or MCFD. Do not act alone.
Resource offer — if they seem open

There are some supports that might be able to help — would it be okay if I shared a number with you?

📋 If yes → VictimLinkBC: 1-800-563-0808 (24/7, multilingual, anonymous). Or BC Society of Transition Houses: 1-800-661-1040. One number only.
At Step 07b stabilization — what to cover for this caller
  • Immediate safety: Are they safe where they are right now? Do they need to leave — and if so, where can they go tonight?
  • Emergency plan: Is there a bag they can grab, a safe contact they can call, a place they can go if things escalate?
  • Tonight only: You're not solving the whole situation — just getting them safe for tonight
→ Continue spine. Violence situations carry elevated suicide risk — complete all 4 questions.
↳🛡️ Branch — Child Abuse Disclosed or Suspected S7 · Legal duty to report
📋 Order matters: Emotional support first → suicide assessment (Step 04) → stabilize if needed → then share the mandate. Exception: if a child is in immediate danger right now — alert supervisor immediately before anything else.
Step 1 — Emotional support first
🎯 Before anything else — give them space to be heard. Do not jump to the mandate or information-gathering until they feel supported. Connection first, always.
Empathy, validation and open questions — before anything else

That sounds really difficult — I'm glad you reached out.

It takes a lot to talk about something like this.

I want to make sure I understand what's been going on for you.

Can you tell me a little more about what's been happening?

How long has this been going on?

What's been the hardest part of this for you?

How are you feeling right now — tonight?

Is there anyone else who knows about this, or have you been dealing with it alone?

Validation

You did the right thing by reaching out.

What you're describing sounds incredibly hard — and you shouldn't have to carry this alone.

Whatever you're feeling right now makes sense.

Reflecting

So what I'm hearing is that [summarize what they shared] — and this has been going on for [timeframe].

It sounds like you've been worried about [the children / what to do / who to tell] and weren't sure where to turn.

Step 2 — When you have enough to trigger the mandate
⚡ You don't need certainty — you need reasonable grounds to believe a child may be at risk. That bar is lower than proof. If you're hearing enough to suspect it, that's enough.
You have enough when you know any combination of the following
  • A child has been physically harmed, or there are signs of it (injuries, unexplained marks)
  • A child is being neglected — food, clothing, supervision, medical care
  • A child has been or may be sexually abused
  • A child is being emotionally abused — chronic belittling, terrorizing, isolation
  • The caller describes a specific incident, even if framed as "I'm not sure if it's a big deal"
  • An adult discloses their own past abuse and the person who harmed them still has access to children
  • Abuse is ongoing or currently happening
✋ You do not have to be 100% sure. Suspicion with reasonable grounds = duty to report. When in doubt — share with your supervisor and let them make the call.
Step 3 — Gather identifying info naturally while in rapport
Work these in organically — not as an interrogation

How old are the kids?

What's going on at home right now?

Where are you all staying?

What you're trying to gather
  • Names and ages of children involved
  • Parent or guardian names
  • Address or general location
  • School, phone number, sports teams — anything that could help a social worker locate the child
  • Whether the abuse is ongoing, current, or past
Step 4 — Share the mandate once you have enough
💡 Be honest and calm about it. Don't hide it or spring it at the end. Frame it as something you do because you care about the child's safety — not as a threat or consequence.
Say — mandate disclosure

I want to be open with you about something. Because of what you've shared with me, I have a responsibility to make sure the children involved are safe. That means I'll need to pass this information along to my supervisor, and from there it may be reported to the Ministry of Children and Family Development.

If they push back or get upset

I understand this might feel scary, and I want you to know this isn't about getting anyone in trouble. It's about making sure the kids are safe. I'm still here with you.

Encourage them to report themselves if appropriate

If you feel comfortable, you can also call MCFD directly — you don't have to give your name. Would you like that number?

Caller type variations
If caller is a concerned third party (friend, neighbour, family member)
  • Same approach — empathy first, gather info, then share the mandate
  • Encourage them to report directly if they're willing. Offer the MCFD number.
If caller is the adult who was abused (disclosing their own past)
  • Empathy and validation — it took courage to share this
  • If the person who harmed them is still alive and has access to children → duty to report still applies
  • Share mandate gently: "Because of what you've shared, and the possibility that others could be at risk, I do need to pass this along."
If caller is the abuser
  • Stay non-judgmental — they are in crisis too and reaching out is significant
  • Focus on their feelings and what's going on for them
  • Assess immediate safety of the children
  • Explore healthier options without lecturing
  • Mandate still applies — share it clearly and calmly
Step 5 — Offer a resource
→ Use the resource offer script on spine Step 09b. For child abuse specifically — see the numbers below.
Key numbers
  • MCFD (After-hours): 1-800-663-9122
  • Children's Helpline (24hr): 310-1234 — give this if the caller is a child
  • Reports can be made anonymously
📋 After the call: Debrief with supervisor immediately. They make the report — not you. Pass them everything you gathered.
↳💗 Branch — Caller Discloses Sexual Assault S7 · Trauma-informed
💡 Their story may be non-linear or fragmented. That is how trauma is stored in memory. Do not expect a coherent timeline — meet them where they are.
Ask about feelings, not the event

How are you feeling right now?

What do you need most in this moment?

Is there anything that would help you feel even a little bit safer right now?

How long ago did this happen?

Is there anyone you trust that you can be with tonight?

Validation — say this clearly and early

What happened to you was not okay — and it is not your fault. None of it.

However you're feeling right now — that's okay. There's no right way to feel about this.

It took a lot to reach out tonight. I'm really glad you did.

You don't have to have everything figured out right now. You just have to get through tonight.

Reflecting

It sounds like right now you're feeling [their words — numb / scared / in shock / angry].

What I'm hearing is that you're not sure what to do next — and that makes complete sense.

You reached out tonight, which tells me part of you is looking for some support.

Key actions
  • No one responds the same way — laughing, crying, silence, anger are all valid responses
  • If it just happened — ask if they need medical attention and encourage (not force) hospital or doctor. It is their choice unless the injury is life-threatening.
  • Thoroughly assess suicide risk — sexual assault significantly elevates it
  • End with a short-term stabilization plan: what will help them get through tonight and the next few days
✋ Do not ask them to walk through what happened. Ask about how they're feeling and what they need now.
Resource offer — if they seem open

There are some supports that might be able to help — would it be okay if I shared a number with you?

📋 If yes → VictimLinkBC: 1-800-563-0808 (24/7, multilingual). Or local sexual assault centre / SANE nurse — check your resource sheet. One number only.
→ Sexual assault significantly elevates suicide risk — complete all 4 questions on the spine.
↳⚠️ Branch — Caller Expresses Intent to Harm Another Person S7 · 911 if imminent
🚨 If harm is currently in progress or has happened today — contact 911 immediately after the interaction. Do not wait.
Assess — Violence/Harm Assessment (7 factors, score 1–4 each)

Is there a current plan to harm someone?

Do you have access to what you'd need to do that?

Is there a specific person you have in mind?

Have you ever hurt someone before?

Scoring guide
  • 1–7 — Low: general skills, continue call normally
  • 8–14 — Low/Moderate: general skills + safety plan if feelings escalate
  • 15–21 — Moderate/High: check in with On-Call Supervisor. Duty to warn may apply.
  • 22–28 — High: gather as much identifying information as possible + contact On-Call Support now
→ Still listen for strengths and reasons not to act. Find buffers — same ambivalence work as a suicide call. Safety plan around the violence: remove means, identify supports, alternatives to acting on it.
↳🔗 Branch — Caller Discloses Substance Use or Addiction S8
🔍 Don't get caught in the addiction story on the surface. Go deeper — what's underneath it? PTSD and substance use disorders frequently co-occur.
Go beneath the surface — open questions

How long has this been going on for you?

What do you think is driving it for you?

What were things like before this started?

What does it feel like right before you use?

What are you looking for when you reach for it — what does it give you?

Has there been a time when things were different — when you felt more in control?

What's been the hardest part of all this for you?

Is there anyone in your life who knows what you've been going through?

Validation — they may not have heard this in a while

It takes a lot to talk about this — I'm glad you did.

Addiction isn't a character flaw. You've been trying to cope with something really painful.

You're dealing with a lot — and reaching out tonight says something about you.

What you're going through is hard, and you don't have to figure it all out tonight.

Reflecting

So it sounds like [substance] has been a way of dealing with [feeling / situation] — is that right?

What I'm hearing is that underneath this there's a lot of [pain / loneliness / stress] that's been building.

It sounds like you've been trying to manage something really heavy without much support.

If caller is currently intoxicated or altered
  • Speak slowly and clearly — one question at a time
  • They may not be able to collaborate on a safety plan — watch for this at Step 08
  • Get location earlier than usual in case safety escalates and they become incoherent
  • Keep them talking and present
Immediate safety — check this first if they're currently using
  • Are they alone right now?
  • Do they have a naloxone kit nearby if using opioids?
  • Is there someone with them or nearby who knows what they're doing?
  • If alone and using — encourage them to call the BC Alcohol and Drug Information line or use a supervised consumption site if available in their area
Harm reduction — at Step 07b stabilization
  • Not about stopping right now — about getting through tonight more safely
  • Can they use less, or use somewhere safer?
  • Is there anyone they can check in with tonight?
  • What would help them feel less alone or overwhelmed right now?
Resource offer — if they seem open or ask for help

There are some supports that might be able to help with this — would it be okay if I shared a number with you?

📋 If yes → BC Alcohol and Drug Information and Referral: 1-800-663-1441. Or local detox / treatment — check your resource sheet. One number only.
→ Give lots of empathy and validation — they likely haven't heard much of that. Addiction calls carry elevated suicide risk. Complete all 4 questions.
↳🏙️ Branch — Caller Is Homeless or Has No Stable Housing S8
💡 Homelessness is rarely chosen. Most people experiencing it are working low-wage jobs or couch-surfing — not visibly on the streets. Respond with full respect and no assumptions.
Understand their situation — open questions

Where are you staying right now?

Do you have somewhere safe to go tonight?

What's been the hardest part of this for you?

How long have things been this way?

What brought you to this point — was there something that changed recently?

Is there anyone in your life you've been able to lean on at all?

What does a typical day look like for you right now?

Validation — meet them with dignity

This situation sounds incredibly hard — and it sounds like you've been managing a lot on your own.

You reached out tonight, which takes courage when things are this difficult.

What you're going through is real and it matters — and you deserve support.

You're not invisible. I hear you.

Reflecting

So what I'm hearing is that right now the most immediate thing is [their words — a safe place / food / not being alone].

It sounds like things have been unstable for a while and tonight it got to be too much.

You've been dealing with this largely alone — that takes a toll.

🎯 The stabilization plan at Step 07b must reflect their actual resources. "Call a friend" or "go home" may not be options. Ask what they actually have access to and build around that.
Resource offer — if they seem open

There are some supports that might be able to help — would it be okay if I shared a number with you?

📋 If yes → dial 2-1-1 (BC211 — connects to local shelters, food banks, income assistance). Get their location first so the resource is relevant. One number only.
→ Continue spine. Complete all 4 suicide questions — homelessness significantly elevates risk.
💡😶 If You Go Blank — Recovery Strategies Any point in the call
📌 You don't have to fill silence immediately. A few seconds is fine. But if you need a moment to think — use one of these. They all keep the conversation moving without making it obvious you've gone blank.
Reflect back what they said
Repeat or paraphrase their last point

So what I'm hearing is… [repeat their words back].

It sounds like [summarize the feeling or situation] — is that right?

💡 This buys you time, makes them feel heard, and often prompts them to say more. You don't need to add anything — just reflect and let them continue.
Summarize what you've heard so far
Mini recap

So you've been dealing with [topic], and on top of that [second thing], and tonight things got to the point where you called — did I get that right?

💡 Summarizing shows you've been listening, gives them a chance to correct or add to it, and resets the conversation so you can pick a natural next thread.
Acknowledge the weight of it
Empathy filler — never sounds forced

That's a lot to be carrying.

I just want to take a moment with that — that sounds really hard.

Ask them to say more
Open it back up

Can you tell me a bit more about that?

What did that feel like for you?

How long has this been building up?

💡 These work anywhere in the call. If you have no idea what to say next — "can you tell me more about that" almost never fails.
Name the emotion you're hearing
Label what you're picking up

It sounds like you're feeling really [exhausted / scared / alone / overwhelmed] right now.

→ Even if you name the wrong emotion — they'll correct you and keep talking. Either way you're moving forward.
Buy yourself a literal second
Natural pause phrases

I hear you…

Thank you for sharing that with me.

I want to make sure I understand…

✅ These give you 2–3 seconds while sounding completely natural. Say one, take a breath, and pick your next move.
Return to Main Spine
03🔀 Transition to Risk Assessment Bridge
Say

I really appreciate you sharing that with me — I do need to ask you something important, and I want to be direct with you…

💡 Closes the listening phase without cutting them off. Gives them a beat before a direct question. Works on every call type.
04🚨 4 Suicide Risk Assessment Questions Outcome 2 — Every call
Q1 — Ideation

I want to ask you directly — are you thinking about suicide?

Q2 — Action taken today

Have you done anything to hurt yourself today?

Q3 — Plan

Have you thought about how you might do it?

Q4 — Means / Access

Do you have access to that right now?

→ If YES to ideation: "Thank you for telling me. That took courage."
💡 Higher risk = ideation + plan + access + action taken. All four present = escalate sooner. Ask on every call where any risk signal was present — that means virtually every call touching S6, 7, or 8.
05🔍 Go Deeper — What's Driving This Outcome 1
Open questions — follow the feeling

What's been making things feel this unbearable?

What feels like it's been pushing you to this point?

When you think about what's hurting the most right now — what comes up?

What does it feel like when it gets really bad?

Has there been a moment lately where things felt even a little bit okay?

What do you wish people understood about what you're going through?

If you could change one thing about your situation right now — what would it be?

Validation — go deeper here too

It makes complete sense that you feel this way given everything you've described.

You've been dealing with so much — it's no wonder this feels like too much right now.

What you're feeling is real, and it matters.

A lot of people would have broken down a long time ago — you've been holding on.

Reflecting — name what you're hearing

So underneath all of this, it sounds like there's a lot of [loneliness / pain / exhaustion / fear].

What I'm hearing is that [situation] has been making you feel like [feeling] — is that close?

It sounds like this has been building for a while — not just tonight.

📌 Stay present-focused. What brought this up today — not a full history. You're listening for the emotional core underneath the presenting issue.
06🔄 Find Ambivalence — The Life Side Outcome 1
Reflect both sides — the core phrase

Part of you wants this pain to stop… but part of you called tonight. Can you tell me about that part?

Open questions — find what's keeping them here

What's been keeping you going so far?

Is there anyone — or anything — that matters to you right now?

Has there ever been a time when things felt different — even a little better?

What would need to change for tonight to feel even slightly more bearable?

When you imagine things being different — what does that look like?

Is there anything you'd miss — even one thing?

Validation — honour both sides

It makes sense that you want the pain to stop — what you're going through is really hard.

And the fact that you called — that means something. That part of you matters.

You don't have to have it all figured out right now. You just have to get through tonight.

Reflecting — name the life side when you hear it

So [person / reason they named] is something that still matters to you.

Even in the middle of all of this — [thing they said] is still there for you.

That sounds like it's been a real anchor for you — even when things feel hopeless.

⚓ Whatever they name — hold onto it. Bring it back during the safety plan. It's the most powerful thing you have.
07a🛡️ Safety Plan — Suicide Risk Present Outcomes 3, 4, 5
📌 Only build this if suicide risk was identified in Step 04. This is the formal safety plan — means reduction, coping, support, backup. If there is no suicide risk, skip to 07b.
Open it

Would you be open to us finding a way to help you get through tonight safely?

Reduce means

Is there anything nearby you could use to hurt yourself that we could move — even just to another room?

Coping — what they actually have

What helps even a little when things feel like this?

Support person

Is there anyone you trust that you could reach out to?

Backup — if things worsen

If things get harder before morning, what could you do instead of acting on those thoughts?

📌 Build around what they actually have. Thin support network, unstable housing, impaired — account for it. A plan they can't follow isn't a safety plan.
07b🌱 Stabilization Plan — No Suicide Risk, Caller Still in Distress All other calls
📌 Use this when there is no suicide risk but the caller is still struggling. Less structured than the safety plan — the goal is simply: what gets them through tonight. Keep it short and realistic.
Open it — same for any topic

Before we hang up, I want to make sure you have a sense of what tonight looks like for you.

What do you think you need most right now to get through the rest of tonight?

By topic — what to focus on
Mental health / anxiety / panic (S6)
  • What has helped them manage this before?
  • Do they have a doctor, therapist, or medication they can lean on?
  • If not: "Would it be okay if I shared a number that might be able to help?"
Trauma / PTSD (S7)
  • What helps them feel safer when this comes up?
  • Is there someone they feel safe being with tonight?
  • What have they done in the past to get through the hard moments?
Violence / IPV / unsafe situation (S7)
  • Are they safe where they are right now?
  • Do they have somewhere safe they can go tonight if needed?
  • Is there someone they can call if the situation changes?
  • Do they want to think through an emergency plan — bag, contacts, exit?
Child abuse — caller is the one at risk or concerned (S7)
  • Are they and the children physically safe right now?
  • What support do they have around them tonight?
Sexual assault (S7)
  • What would help them feel safer or more grounded right now?
  • Is there someone they trust they can be with tonight?
  • If recent — have they thought about whether they want to see a doctor?
Addiction (S8)
  • What can they do if the urge gets stronger tonight?
  • Is there someone they can call who understands what they're going through?
  • What has helped them hold on before?
Homelessness / housing instability (S8)
  • Do they have somewhere to sleep tonight?
  • Do they know about local shelters or 211?
  • What is the most immediate thing they need right now?
→ Keep it realistic and brief. You're not solving everything — you're just making sure they have something concrete to hold onto for tonight.
08👁️ Recognize Unwilling or Unable to Commit — Suicide Calls Only Outcome 4
📌 This step only applies when suicide risk is present (07a). If you're on 07b stabilization, skip this and go straight to 09.
Flat refusals "I don't care anymore" No response to direct questions Action already taken Currently intoxicated Disoriented / psychosis Escalating desperation
→ Inability to commit is not always a choice — impairment, acute crisis, and psychosis all prevent it. Recognize it, acknowledge without judgment, shift to 911 protocol.
09📋 Summarize the Safety Plan Before Ending Outcome 5 — Always
Before you hang up — every call

Before we hang up, I want to go over what we talked about together.

Reflect it back in their words

You mentioned [their coping step] when things feel overwhelming.

You said you'd reach out to [their support person or resource].

You're going to [means reduction step they agreed to].

And if things get harder, you'll [their backup plan].

✅ Confirm: "Does that sound right to you?" Let them correct or add to it. It becomes theirs when they affirm it.
09b📖 Offer a Resource — If Relevant All branches · Module 4
📌 How to find a resource: Use iCarol resource directory or BC211 first for most referrals. A small number of specific resources are not searchable and require direct links — those are listed below. Do not refer to resources outside of the approved databases unless listed here.
How to offer — always ask first, one at a time
Standard offer

There are some supports that might be able to help with this — would it be okay if I shared a number with you?

If hesitant or says they've tried before

I understand — I just want to make sure you have it in case it feels right at some point.

→ Ask before giving. One number, not a list. Only offer if they seem open — pushing resources at someone who isn't ready can feel like you're trying to end the call.
Primary databases — search these first
  • iCarol resource directory — primary tool, search here first
  • BC211 — dial 2-1-1 or search online. Give caller the number 211 if you can't find anything relevant elsewhere
  • HealthLink BC directory — healthlinkbc.ca/services-and-resources/find-services
  • Kids Help Phone database — resourcesaroundme-prod.kidshelpphone.ca (for youth calls)
  • Fraser Health — fraserhealth.ca
  • Vancouver Coastal Health — vch.ca/en
  • 988 Resource Map — for crisis-specific resources
Direct links — not searchable, use these specifically
  • Subsidized psychiatric medications — gov.bc.ca/gov/content/health/healthforms (best to refer back to prescriber first)
  • Reduced-cost counselling Metro Vancouver — willowtreecounselling.ca (PDF list)
  • Affordable Therapy Network — affordabletherapynetwork.com/Vancouver (sliding scale therapists)
  • BC College of Physicians and Surgeons — to find a GP accepting patients
  • BC Psychological Association (BCPA) — to find a psychologist
  • BC Association of Clinical Counsellors (BCACC) — to find a private counsellor
  • MediMap — medimap.ca — to find a local doctor or health practitioner
  • BC Mental Health & Substance Use Services — lists BC programs and services
  • HeretoHelp — heretohelp.bc.ca — mental health and substance use info and support
By topic — what to look for
Mental health — general (S6)
  • First step: family doctor, walk-in clinic, or Urgent and Primary Care Centre (UPCC) — same-day, no appointment needed
  • HealthLink BC nurse line: 811 — good first step if unsure about seeing a doctor
  • Mental health team or centre in their health authority — can self-refer by calling local centre
  • If already in system — encourage them to contact their existing GP, psychiatrist, or mental health team
  • Psychiatrist requires GP referral — cannot self-refer
  • For medication cost concerns → subsidized psychiatric medication form (direct link above)
Counselling / therapy — private or reduced cost (S6)
  • Affordable Therapy Network — sliding scale rates (direct link)
  • Willow Tree reduced-cost counselling list — Metro Vancouver (direct link)
  • Non-profits: Options Community Services, Diversecity, Fraserside, Touchstone Family Association, Chimo
  • Employee Assistance Program (EAP) if they have one through work
MAiD (S6)
  • Direct to family doctor or Canada.ca only — do not provide MAiD resources on 988
Trauma / PTSD / sexual assault (S7)
  • Search iCarol or HealthLink BC for local trauma-informed counselling
  • VictimLinkBC: 1-800-563-0808 (24/7, multilingual, anonymous) — for anyone affected by crime or violence
  • If recent assault — hospital or doctor (their choice, never forced)
Violence / IPV (S7)
  • Search iCarol for local transition houses and shelters
  • BC Society of Transition Houses: 1-800-661-1040
  • VictimLinkBC: 1-800-563-0808
Child abuse (S7)
  • MCFD After-Hours: 1-800-663-9122
  • Children's Helpline 24hr (if caller is a child): 310-1234
  • Reports can be made anonymously
Addiction / substance use (S8)
  • Search iCarol or BC211 for local detox and treatment
  • BC Alcohol and Drug Information and Referral Service: 1-800-663-1441
  • HeretoHelp — heretohelp.bc.ca for substance use info
Homelessness / housing / food (S8)
  • BC211: dial 2-1-1 — best first option for local shelters, food banks, income assistance
  • Search iCarol for local shelter and transitional housing
Elder / vulnerable adult abuse (S8)
  • BC Seniors Abuse and Information Line (SAIL): 1-866-437-1940
  • Search iCarol for local Adult Protection services
  • If immediate danger — 911
Youth / children specifically
  • Kids Help Phone database — resourcesaroundme-prod.kidshelpphone.ca
  • MCFD provides children and youth mental health services for under 19
  • Children's Helpline: 310-1234
10✅ Check Shift + Leave the Door Open Outcome 1
Check where they're at now

How are you feeling now compared to when you first called?

Do you feel like you can get through tonight?

Leave door open

If those thoughts come back — or get stronger — will you call us again?

11👋 Close with Warmth Outcome 1
Say

I'm really glad you called tonight.

You don't have to go through this alone.

Take care of yourself.

⚠️🔍 911 Pre-Call — Branch-Specific Check-In Questions Before you call
📌 Before or while initiating 911, try to gather as much of this as possible. It makes your brief to emergency services faster and more useful. Use what applies to the call you're on.
All calls — always try to get these
  • Full address or location
  • Are they alone?
  • Current state — calm, escalating, altered, unresponsive
  • Any immediate physical danger right now?
Suicide risk present
  • What is the plan and method?
  • Do they have access to it right now?
  • Have they already taken any action — pills taken, weapon out, etc.?
  • Any history of previous attempts?
Addiction / intoxication
  • What did they take — substance and amount if known
  • How long ago was the last drink or use?
  • Are they mixing substances?
  • Any known medical conditions or allergies?
  • Are they conscious and responsive?
  • Any naloxone on hand?
Violence / IPV / unsafe situation
  • Is the person who harmed them still present?
  • Has physical harm already occurred — injuries, weapons used?
  • Are there children in the home?
  • Does the caller have a way to get out safely or do they need police presence first?
Mental health / psychosis
  • Known diagnosis if disclosed
  • Are they on medication — have they taken it?
  • Are they oriented — do they know where they are, what day it is?
  • Any history of hospitalization for mental health?
  • Are they a danger to themselves or others right now?
Sexual assault — if recent
  • Are they physically injured and in need of immediate medical care?
  • Is the person who assaulted them still nearby?
  • Are they in a safe location right now?
Homelessness / exposure
  • Are they outside in dangerous weather or conditions?
  • Any medical concerns — hypothermia, injury, illness?
  • Exact location or nearest landmark
🚑
When Safety Planning Fails — 911 Three-Way Protocol
Triggered at Step 08 when caller is unwilling or unable to commit — for any reason, any scenario. One last try → introduce 911 → ask consent → get location → three-way → stay on line.
A🤝 One Last Collaboration Attempt Try first
Ask

Would you be willing to reach out to someone you trust to stay with you right now?

Is there anything we can do to make where you are safer right now?

→Still no engagement — move to B.
B🚑 Introduce 911 — Explain, Don't Threaten Outcome 6
Say

Because I'm really concerned about your safety, I think the best way I can support you right now is to bring in emergency services.

C📞 Ask Consent — Then Act Outcome 6
Ask

Would you be open to us calling 911 together so we can make sure you stay safe?

✅ YES

"Okay, thank you. I'm going to stay with you the whole time."

⚠️ Hesitant

"I know that might feel uncomfortable or scary… but my priority right now is making sure you're safe."

❌ NO

"I understand you don't want that, and I hear you… but I'm really concerned about your safety, and I may need to call for help to make sure you're okay."

📋 Follow your organization's policy if consent is refused. Never surprise-call without warning if at all avoidable.
D📍 Get Location — Before the Call if Possible Do not skip
Ask

Where are you right now? What's the address?

→ If resistant: "I just want to make sure help can reach you if needed." If caller is intoxicated or becoming incoherent — get this as early as possible.
E–H📡 Three-Way Call — Brief 911, Stay with Caller Outcome 6
Brief 911 — fast and factual

Caller is suicidal. [Plan and means if known]. Located at [address]. Current state: [calm / escalating / intoxicated / altered].

Return to caller immediately

I'm right here with you.

Help is on the way.

Can you tell me what you can see around you right now?

✋ Do not argue. Do not raise your voice. Do not apologize for the decision.
When help arrives

You've done something really strong by staying through this.

They're there to help you.

📋 After the call: document everything and debrief with your supervisor. Follow your post-call protocol.
Sections 6, 7, 8 — At a Glance

Quick Reference

Key rules, phrase starters, and call-type reminders for practice scenarios.

Always assess suicide risk for these call types
Depression / MDD / PDD Bipolar I & II PTSD / Trauma IPV / Domestic Violence Sexual Assault Addiction / Substance Use Schizophrenia / Psychosis Eating Disorders MAiD (still ask)

⚡ Panic Attack — On the Call

  • Stay calm — your voice regulates them
  • Ask their name, use it
  • Breathing: in 3, pause, out 3
  • Remind them: "This will pass — it has before"
  • Chest pain + unsure = suggest hospital

💜 Trauma / PTSD — On the Call

  • Stay present-focused — not the event itself
  • "What brought this up today?"
  • "What do you do to get through hard moments?"
  • Give them pace and control
  • Do not explore or relive the trauma

🚨 IPV — On the Call

  • Assess immediate safety first
  • Check for children in home
  • Do NOT push them to leave
  • Empower their choices
  • Alert supervisor before contacting police/MCFD

🔗 Addiction — On the Call

  • Don't stay on the surface story
  • Go deeper — what's underneath it?
  • Lots of empathy and validation
  • Strong link to PTSD — check history
  • Offer resources if they want help

⚖️ MAiD — On the Call

  • Do not introduce the topic
  • Listen without judgment — no supportive OR unsupportive comments
  • Focus on today: "What do you need tonight?"
  • Still ask the suicide question
  • Direct to family doctor or gov.ca — not 988 resources

🛡️ Child Abuse — On the Call

  • Legal duty to report — but CLRs don't report directly
  • Build rapport first, gather info
  • Debrief supervisor → they make the report
  • After-hours MCFD: 1-800-663-9122
  • Children's line: 310-1234

⚠️ Caller Wants to Harm Someone

  • Harm in progress → call 911 immediately
  • Use Violence/Harm Assessment (7 factors, score 1–4)
  • 15–21: consult On-Call. 22–28: gather info + On-Call now
  • Still listen for strengths and buffers
  • Safety plan around the violence if possible

🧠 Key "Never Do" List

  • Never diagnose or suggest a diagnosis
  • Never dismiss OCD thoughts as silly
  • Never tell someone to stop the eating disorder behaviour
  • Never argue with psychotic reality
  • Never name BPD to a caller
  • Never push an IPV victim to leave
  • Never give MAiD resources on 988
4 Suicide Risk Assessment Questions — Every Call
Q1 — Are you thinking about suicide?
Q2 — Have you done anything to hurt yourself today?
Q3 — Have you thought about how you might do it?
Q4 — Do you have access to that right now?
Module 4 — Resource Referral

Resource Referral Guide

How to find and offer resources on the line. Always search iCarol or BC211 first unless the resource is listed as a direct link below. One resource at a time — ask before giving.

📌
How to offer a resource — every time:
"There are some supports that might be able to help — would it be okay if I shared a number with you?"
If yes → give ONE relevant resource. Not a list. Ask before giving.
🔍 Where to Search First — Always Use these before anything else
✋ Referrals are limited to resources found in the following databases — unless a direct link is listed below as an exception. Don't go outside these sources.
Frequently used — check these first
  • HealthLink BC Directory — healthlinkbc.ca/services-and-resources/find-services
  • Mental Health Frequent Referrals — see QRG section: Mental Health Calls
  • Fraser Health — fraserhealth.ca
  • Vancouver Coastal Health — vch.ca/en
  • Kids Help Phone Database — resourcesaroundme-prod.kidshelpphone.ca
  • 988 Resource Map — available in your tools
  • BC211 Directory — dial 211 or search online. If you can't find anything relevant elsewhere, give the caller the number 2-1-1 directly.
Less frequently used
  • VICL Database — vicrisis.ca/community-resource-database
  • Surrey Libraries Services — surreylibraries.ca/research/5634.aspx
  • West Kootenay Boundary — kb.fetchbc.ca
  • Crisis Centres Worldwide — thelifelinecanada.ca/incrisisneedhelp
  • US National Suicide Prevention Lifeline — 1-800-273-8255
🔗 Direct Links — Use These Only, Not Searchable in iCarol Go straight to the link
  • Subsidized Psychiatric Medications — gov.bc.ca/gov/content/health/healthforms
    For callers who cannot afford meds. Best to refer back to prescriber first. Forms available online and at mental health centres.
  • Reduced-Cost Counselling (Metro Vancouver) — willowtreecounselling.ca
    Direct to the PDF list of reduced-cost counselling options.
  • Affordable Therapy Network — affordabletherapynetwork.com/Vancouver
    Low-cost and sliding scale therapists across Canada.
  • BC College of Physicians and Surgeons — to find a GP accepting patients
  • BC Psychological Association (BCPA) — to find a psychologist
  • BC Association of Clinical Counsellors (BCACC) — to find a private counsellor
  • MediMap — medimap.ca — to find a local doctor or health practitioner
  • BC Mental Health & Substance Use Services — lists BC mental health programs
  • HeretoHelp — heretohelp.bc.ca — mental health and substance use info and support
🏥 Levels of Care — Know Where to Point Someone M4 S1

Primary Care

Self-referred. Family doctor, GP, pediatrician, walk-in clinic, urgent care, hospital ER. First point of contact for most people.

Secondary Care

Referral required. Psychiatrist, mental health centre or team. Specialist level.

Tertiary Care

Referral required. Red Fish Healing Centre, BC Children's Hospital, ACT Team. Highly specialized, often long-term.

Public vs Private vs Non-Profit

Public = free via MSP. Private = fee for service. Non-profit = free or low cost. Chimo = non-profit.

🗂️ Resource by Situation — What to Reach For Call types
Mental health — general
  • First step → family doctor / walk-in / UPCC (same-day urgent, no appointment)
  • Nurse advice line → call 811
  • BC Mental Health Crisis Line → 310-6789 (no area code needed)
  • Mental health centre → self-refer by calling local centre in their health authority region
  • Psychiatrist → needs GP referral first
  • Can't afford meds → subsidized psychiatric medications link (see above)
  • Can't afford counselling → Willow Tree list or Affordable Therapy Network (see above)
Child / youth mental health (under 19)
  • MCFD provides services — Short Term Assessment Response Team, Child and Adolescent Response Team, Suicide Prevention Education and Counselling
  • Kids Help Phone Database → resourcesaroundme-prod.kidshelpphone.ca
  • Children's Helpline (24hr) → 310-1234
  • After-hours MCFD → 1-800-663-9122
Crisis / suicide risk
  • 988 Suicide Crisis Helpline → 9-8-8
  • 988 Resource Map → available in your tools
  • BC Mental Health Crisis Line → 310-6789
  • Hospital ER / psychiatric unit → for psychiatric emergencies, psychosis, severe suicidal ideation
Violence / IPV / safety
  • VictimLinkBC → 1-800-563-0808 (24/7, multilingual, anonymous)
  • BC Society of Transition Houses → 1-800-661-1040
  • Local shelter or transition house → search HealthLink BC or BC211
Sexual assault
  • VictimLinkBC → 1-800-563-0808
  • Local sexual assault centre or SANE nurse → search HealthLink BC or Fraser Health
  • If recent and needs medical care → hospital ER (their choice, never forced)
Child abuse — reporting
  • After-hours MCFD → 1-800-663-9122
  • Children's Helpline (if caller is a child) → 310-1234
  • Reports can be made anonymously
  • CLRs do not report directly — pass to supervisor after the call
Addiction / substance use
  • BC Alcohol and Drug Information and Referral → 1-800-663-1441
  • Local detox / treatment → search HealthLink BC or BC211
  • HeretoHelp → heretohelp.bc.ca
  • BC Mental Health & Substance Use Services → search online
Homelessness / housing / food
  • BC211 → dial 2-1-1 — local shelters, food banks, income assistance, social services
  • If caller can't find anything via other sources → give them 211 directly
Elder / vulnerable adult abuse
  • BC Seniors Abuse and Information Line (SAIL) → 1-866-437-1940
  • If immediate danger → 911
  • Adult Protection Line → search by caller's area
Finding a doctor / counsellor / psychologist
  • Find a GP → BC College of Physicians and Surgeons, or MediMap (medimap.ca)
  • Find a psychologist → BC Psychological Association (BCPA)
  • Find a counsellor → BC Association of Clinical Counsellors (BCACC)
  • Low-cost options → Willow Tree list or Affordable Therapy Network
🤝 Non-Profit Mental Health Organizations in BC Access directly — no referral needed
💡 These can usually be accessed by contacting them directly. There may be waitlists and geographic limitations.
Crisis Intervention and Suicide Prevention Centre of BC Vancouver Island Crisis Society Chimo Community Services Options Community Services Diversecity Community Services Fraserside Community Services Society Touchstone Family Association