This article provides an overview of referring a patient during a crisis situation including Rula’s procedure, best clinical practices, when to refer a patient to emergency services, as well as how to document and bill for these situations.
| Where can I refer Kaiser patients who are in crisis? Kaiser Permanente patients who are experiencing a behavioral health emergency or mental health crisis should contact the Kaiser Permanente Behavioral Health Care Helpline (BHCL) at 800-900-3277. This number should be given to Kaiser patients along with 988 (the national crisis and suicide hotline). Both are available at no charge and open 24/7. |
How Rula Responds to Patient Crisis
Rula does not provide 24-hour emergency response services. If a person contacts the Support or Scheduling Team during an emergency, a team member will:
- Engage with and encourage the patient to seek help immediately.
- Provide them with hotline information (e.g. 911/988).
- Notify the patient’s Rula provider(s) of the situation; direct back the patient to their provider for assessing the patient's level of risk and following best practices.
Best Clinical Practices for Providers
As a provider who is assessing and managing a patient in crisis, you’re encouraged to adhere to best practices and take the following action(s) as needed:
- All patients should be provided with emergency crisis resources from their treating provider during the first appointment and if/as requested throughout treatment. These resources may be used in the event of a behavioral health or psychiatric emergency. Providers should document the resources provided to the patient.
- Assess the patient’s level of risk
- Contact 911 or the Suicide & Crisis Lifeline: 988. Additional hotline resources are available at SpeakingOfSuicide.com/resources
| Resource! Check out the Rula Provider H.E.L.P. Guide, which is designed to help providers support patients experiencing a crisis. |
Some states may have specific requirements for how providers and/or prescribers should handle a crisis, so make sure you check your local guidelines.
When to Refer to Crisis/First Responders
It’s important to recognize, assess, and have resources available for the two types of crises a patient may encounter:
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Emergent Medical Crisis: Individual is experiencing medically related injury (e.g. heart attack, severe wounds)
- Action → Contact 911/First responders
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Emergent Mental Health Crisis: Behavioral health-related crisis can be identified whenever an individual places themself or others at immediate risk/self-harm; behavior/episode of behavior becomes severe and/or can’t be easily de-escalated (i.e. active suicidal or homicidal ideations with intent, acute psychosis, alcohol & drug withdrawal delirium)
- Action → Assess for level of risk (if possible) → Contact 911/First responders and/or 988
Rula’s Clinical Quality staff recognizes there are situations in which patients who are identified as high risk might be best served in an in-person or higher level of care environment if their needs are not being met effectively through individual counseling or routine outpatient psychiatry services. Please reference the help center article Determining Appropriateness for Telehealth before considering transferring a patient outside of Rula due to high-risk needs.
| NOTE: Any individual experiencing a life-threatening medical emergency should always be directed to 911 and/or 988 for a behavioral health crisis and an emergency room/crisis center, regardless of whether it's a telehealth or in-person setting. |
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