Crisis Support and Safety
This domain tests whether you can recognize and respond to risk without pretending to be a clinician. Items cover suicide risk, safety planning, overdose response, de-escalation, the crisis continuum, and the boundaries of the peer role.
Suicide risk: ask directly
Asking "Are you thinking about suicide?" does not plant the idea; it opens the conversation. If yes, explore ideation, plan, intent, means, prior attempts, and protective factors. Imminent risk means: do not leave the person alone, remove or secure lethal means where safe to do so, and connect immediately to crisis services, emergency services, or a trusted person. Stay engaged and follow through. Document objectively and inform your supervisor.
Safety planning, not no-suicide contracts
Collaborative safety planning (the Stanley–Brown model) covers warning signs, coping strategies, people and places that distract, people to ask for help, professionals and agencies including 988, and making the environment safe. No-suicide contracts are not evidence-based and should not be used.
Overdose and de-escalation
Carry and know how to use naloxone; know your state's Good Samaritan law. For agitation: lower your voice and the stimulation, give space, validate feeling without agreeing with threats, offer choices, avoid arguing or cornering, and know when to call for help. Do not physically intervene.
Worked example
A text at 11 p.m.: "I can't do this anymore." Respond promptly. Ask directly about suicide. If there is a plan and means, stay on the phone, get the address, and contact emergency or mobile crisis; do not drive the person yourself as a solo peer. If risk is not imminent, build a safety plan together, arrange a next-day check-in, and tell your supervisor. Document what was said and done.
Traps that cost marks
Promising to keep suicidal thoughts secret. Avoiding the word "suicide" to reduce discomfort. Using a no-suicide contract. Leaving a high-risk person alone to "cool off." Handling a crisis alone without supervision or emergency backup. Taking a participant to your home. Failing to plan for your own vicarious stress after a crisis.