Intellect’s Escalation Protocol
[For General Public / Intellect’s Website]
This document outlines the procedures to be followed when a client presents with high-risk to self or others. It defines how such cases should be escalated, by involving additional support or emergency services, and details the follow-up actions required. The goal is to ensure timely intervention, effective communication, and accurate documentation for clients’ safety and accountability.
The diagram below shows the typical user journey of Intellect users. Throughout the user journey with Intellect, Risk Assessment will be conducted by Intellect at various points to ensure that the user is receiving the appropriate support for their risk level and the topic of interest.
Risk Assessment & Classification
Intellect employs a comprehensive and dynamic approach to clinical risk identification and assessment, integrated throughout the client’s care journey. This involves the use of objective (e.g., PHQ-4 scores, etc.) and subjective (e.g., clients’ subjective reporting, Providers’ clinical observations in sessions, etc.) measures, as well as integrating the client’s unique contextual factors (e.g., medical/ psychiatric history, cultural background, etc.) for a comprehensive risk formulation that would be continuously updated.
Intellect broadly categorises risk into the following levels:
| Risk Level | Risk Description |
| Low | – No suicidal ideation or thoughts of harming self or others. If the client has suicidal ideation, or thoughts of harming self or others, there is NO intent to act on these thoughts. – Fleeting thoughts of not wanting to live or to harm others or self, but these are transitory. – Able to exert some control over them (e.g. might verbally dismiss some of these thoughts during the call). |
| Medium | – May have suicidal ideation, and/or thoughts to harm self or others are present, with some/ low intention to act on these thoughts – No specific plan, or the plan to end their life, harm themselves, or others is not accessible |
| High | Non-Critical – Suicidal ideation/thoughts to harm others, intention, and plan are present, and means are available/accessible. – Not in the act when they make the call * Efforts will be made to triage and develop safety plans for the client, potentially including calling their emergency contact, if provided, to ensure that support networks are established and aware of risk. May require breaking confidentiality to the relevant care teams, e.g., Wellbeing teams/ Psychological teams. Critical – Actively suicidal or homicidal, e.g., they are walking to/already on the ledge of the building when they call the Intellect Helpline, or walking to/already in the same space with the individual they want to harm * Emergency services (ambulance/ police) and/or emergency contacts will be contacted immediately to ensure safety. |
Escalation Process
During the Escalation Process, the main stakeholders are:
- Intellect Provider – Clinical Psychologist/ Counsellor/ ICF Coach
- Intellect’s Team – Intellect’s Team that assesses, manages High-Risk cases and provides crisis support
- Client’s Emergency Contact – This person is nominated by the Client to be contacted when the client is undergoing a crisis
- Emergency Services – The police/ ambulance, or any other relevant authorities.
- Company Point Of Contact (POC)
When a High-Risk Critical case occurs, the Providers and/or the Intellect’s team would take the necessary actions to ensure the client’s safety, including contacting the client’s emergency contact and/or the emergency services. The escalation protocol might be activated for certain Medium-Risk cases as well, on a case-by-case basis.
By and large, Intellect will take action to ensure that the client’s information remains as private and confidential as possible. The grounds for breaking confidentiality include any of the following:
- Immediate harm to self and/or others
- Abuse involving minors and/or children
- Court subpoena for client information and session records
If confidentiality needs to be broken, Intellect will ensure that the client is notified, and whenever possible, with the client’s consent. Intellect will, to the best of their abilities, provide only the necessary information needed to ensure the safety of the client and/or others.
Under certain circumstances, the client’s Company POC would be informed of the client’s risk status and be provided with workplace recommendations for the following purposes:
- To ensure the client receives necessary care; and
- To maintain the safety of the client, the people around the client, and/or the general public
As a general rule of thumb, Intellect will only inform the Company POC for High-Risk cases occurring in the Company premises, if there are intention to harm the Company and/or the Company’s employees, and/or the client’s occupation allows the client access to devices that might pose harm for the client and/or the general public.
Escalation Actions
Intellect and the Company are required to decide on specific Company POCs (i.e., the Psychology/ Wellness/ Security teams, HR or Company Mental Health First Aider). The Company POCs need to be contactable 24/7 in the case of a crisis. A designated communication channel (e.g., via email, call, or designated platforms such as Google Chat, MS Teams, etc.) shall be established for crisis communications. Intellect will email the relevant Company POC with a brief incident summary and recommendations for continuity of care.
| Step 1: Initial Assessment & De-escalation | – During the session1 or Helpline call, the Providers or Intellect team will continuously assess the client’s safety and any potential risks that could affect the client or those with whom the client interacts. – If the Provider or Intellect’s team identifies or assesses that there is risk of harm to self, harm to others around the client or risk of harm to organisation/ society/ country, the Provider should document the observed behaviour and concerns with as much detail as possible, including the date, time, specific behaviours observed. – The Provider or Intellect’s team will proceed to de-escalate the situation as per the De-escalation Protocol, such as creating a collaborative safety plan with the client 1Intellect’s Providers are required to conduct a risk assessment during the initial intake session. If there were signs of suicidal ideation, regardless of the client’s risk level, the Provider should continuously monitor and assess for signs of escalation throughout the course of intervention, and ensure safety by de-escalating as necessary according to the risk status. |
| Step 2: Crisis Response according to Escalation Protocol | – If de-escalation is unsuccessful, the Provider or Intellect’s team should then activate Intellect’s Escalation Protocol, which includes contacting emergency services and/or the client’s emergency contact, and/or informing the on-site Company POC (only if required, see Step 3). The necessary steps are available on the Provider dashboard and handbook. – Confidentiality will only be broken if the Intellect Provider and/or Intellect team ascertains that there is a significant or imminent risk of harm to self, harm to others around the client or risk of harm to the organisation/ society/ country. Whether confidentiality needs to be broken will be determined on a case-by-case basis. These scenarios are in line with Intellect’s stringent escalation protocol to ensure client safety while upholding the utmost standards of confidentiality and care. – If it is deemed that confidentiality needs to be broken, the Intellect team and the Provider will ensure that only necessary information will be relayed to the relevant parties, whilst ensuring the client’s personal and other sensitive information (e.g., sexuality, religious beliefs, etc.) will be protected and remain confidential. – Example scenario: A Muslim client is in high-risk critical distress due to conflicts with their same-sex partner, and the Intellect team is required to break confidentiality to either the emergency services or the client’s emergency contact to ensure the safety of the client. – What could be shared: “Client is currently at home and self-harming, and we require emergency services or the emergency contact to intervene.” – What NOT to say: “Client, who is a Muslim, is experiencing high distress due to conflicts with their same-sex partner.” |
| Step 3: (If required) Notification of Company POC during Crisis | The relevant Company POCs will be contacted during the crisis under the following circumstances: – The client is currently within the Company’s premises, and the client’s safety or the safety of people around the client is at immediate risk, and additional physical support from the Company’s POC is crucial to ensure safety. – After being contacted, the relevant Company POC may internally manage the situation, prioritising the safety of the client and who they may interact with within the Company. Tiers of Emergency Contacts within the relevant Company POC for Scenarios of Imminent Risk/Crisis within Company Premises – At least 2 Company POC will have to be identified (Primary & Secondary Company POC). – The Intellect team will inform the Company’s designated 1st POC via an agreed-upon channel. If the 1st POC does not respond, the team will contact the Company’s designated 2nd POC. – If neither responds and the crisis warrants immediate intervention, the Intellect team will contact the emergency services. |
| Step 4: High-Risk Reporting and Case Management | – The Intellect Provider is required to submit a High-Risk report to Intellect’s team for all High-Risk Critical and Non-Critical cases. – Within the High-Risk report, the Provider would provide detailed accounts of the actions taken during the crisis response, including whether emergency services and/or emergency contact have been contacted. – Intellect’s team will provide post-crisis case management support, including performing wellbeing check-in calls with the client, scheduling supervision for the Provider to discuss follow-up steps, monitoring the client’s status with the Provider, and performing mandatory reporting duties (if necessary). |
| Step 5: (If required) Notification of Company POC Post-Crisis and Recommendations for Intervention | Intellect’s team will inform the Company POC post-crisis if: – The case has been managed, but further steps are necessary for the client’s wellbeing, including recommendations for additional support in the workplace, with the client having provided consent for the relevant Company’s POC to be informed. The purpose of contacting the relevant Company’s POC post-crisis is to provide recommendations to ensure the client’s well-being and safety. Consent from the client may be overridden in the following cases (but the client will still be notified): – There is still a significant risk of self-harm or harm to others, and continuous monitoring is required; or – If it’s not realistic, e.g. client has not been contactable for 48 hours and Intellect has assessed the client to be high risk previously; or – If the client is assessed to be unable to make sound decisions – Actions need to be taken to control access to instruments of harm (under the law or duty to warn) Relevant Company’s POC will be notified via the designated channel based on an agreed-upon timeframe (e.g., X amount of time post-crisis). – Intellect’s team will then provide recommendations for the Company as well as a suggested support plan, where appropriate. Adopting the support plan by Intellect is at the sole discretion of the Company. |
What does Intellect need from our Company clients?
To ensure that your employees/ colleagues are well covered by Intellect:
- Ensure your employees have registered on the appropriate Intellect platform and have done the following:
- Input personal information
- Input emergency contact information
- Agree to the informed consent policy (which includes a release of information consent)
- Ensure that Intellect has an updated list of Company Point of Contact (POC) from each of your agencies, locations and subsidiaries. These can be HR, supervisors, safety officers or Mental Health First Aid Officers (MHFAO). Anyone who has access to employee information to provide quick identification and coordination in case of emergencies or high-risk situations.
- Required information of Primary and at least 1 other Secondary Company Point of Contact
- Name & Role
- Company/ Agency
- Department
- Phone number (Ideally able to receive WhatsApp calls and messages on top of normal phone calls)
- Email address
- Required information of Primary and at least 1 other Secondary Company Point of Contact
Client to fill in for each city/ entity served:
| Company / Subsidiary / Agency | Location | 1st Company Point of Contact | 2nd Company Point of Contact |
| – Name: – Role: – Department: – Mobile:Email: | – Name: – Role: – Department: – Mobile: – Email: | ||
| – Name: – Role: – Department: – Mobile: – Email: | – Name: – Role: – Department: – Mobile: – Email: |
Liability
In cases where Intellect has adhered to this escalation protocol, should a client initially assessed as low-risk subsequently be identified as high-risk, or in any other unforeseen circumstance, Intellect and its affiliated entities—including its officers, partners, service providers, therapists, contractors, or sub-contractors and any representaive (employee, part-timer, contractor or freelancer) acting for and on behalf of Intellect—will not be held liable. This exemption from liability applies regardless of the type of legal claim and covers any potential damages. Such damages include, but are not limited to, loss of data, economic loss, punitive or exemplary damages, or any incidental, special, indirect, or consequential loss or damage. This includes death or personal injury that may arise from the mental health assessment, care, treatment, or services provided to the client.
To minimise liability, Intellect and/or the client’s Company should ensure that:
- Clear communication channels are established between Intellect and the Company, and have frequent check-ins to support higher-risk employees/patients.
- The Company provides any necessary support or intervention based on Intellect’s recommendations.
- Intellect provides ongoing training, supervision and support to the Providers to accurately assess and manage risk.
- Regular reviews and updates of this Escalation Protocol.
For precise record-keeping, effective crisis intervention, and compliance with mandatory reporting, all clients accessing Intellect’s services must provide their legal name. In the case where a client used an alias instead of their legal name, Intellect can only provide any other information available on hand to support local emergency services in locating the client. Intellect is not liable for delays in prompt action or difficulties locating clients during crises (e.g., suicidal ideation, self-harm, harm to others) if a client has not provided their legal name. The critical implications of this and the necessity of accurate personal information are clearly outlined in the Informed Consent Form, which clients acknowledge and sign before commencing sessions.
Case Example
Scenario: Mark, a 34-year-old sales consultant, reports escalating substance abuse (alcohol and prescription pain medication) leading to growing dependence and going to work intoxicated. During a session with the Provider, Mark expresses his dissatisfaction about work and shares his detailed plan to physically assault his manager in the office after the session, where Mark is located as well. The Provider notices that Mark appears to be intoxicated during the session.
Escalation Process:
Step 1 – Initial Assessment and De-escalation: The Provider conducts an initial risk assessment to determine Mark’s risk status, which appears to be in High-Risk Critical. The Provider proceeds to attempt de-escalation with Mark.
Step 2 – Crisis Response according to Escalation Protocol: If Mark still intends to act as he planned, the Provider will activate the Escalation Protocol, which could involve actions such as contacting Mark’s emergency contact and/or emergency services.
Step 3 – (If required) Notification of Company POC during Crisis: As Mark is also in the office, and intends to harm his manager who is also in the same office, Intellect and the Provider need to exercise their duty to warn and ensure safety of others by informing the Company POC to intervene or escort the manager to safety.
Step 4 – High-Risk Reporting and Case Management: After the crisis has been managed, the Provider will submit the High-Risk report to Intellect’s team for further action.
Step 5 – (If required) Notification of Company POC Post-Crisis and Recommendations for Intervention: As this situation involves the Company and other employees (the manager), Intellect will share a brief incident report and recommendations for the Company to further support the client (e.g., provide extended leave for treatment, adjustment of workload, change of managers, etc.). It is up to the Company’s discretion to implement Intellect’s recommendations.
Special Considerations Case – Country laws criminalising suicide or LGBTQIA+ expression
Scenario: Muhammad is a 26-year-old man who is experiencing relationship conflicts with his same-sex partner. He is currently based in a Middle Eastern country that has strict laws regarding suicide and same-sex relationships. The initial risk assessment conducted for Muhammad during the intake session showed that he was in the low-risk category. However, during the third counselling session, Muhammad shared that he had a huge argument with his partner the day before, and expressed strong desires to end his life, but has no immediate plans.
Escalation Process:
Step 1 – Initial Assessment and De-escalation: The Provider conducts an initial risk assessment to determine Muhammad’s risk status, which appears to be in Medium-Risk. The Provider proceeds to create a safety plan with Muhammad and explore options to minimise risk.
Step 2 – Crisis Response according to Escalation Protocol: No immediate crisis response required as Muhammad is not in High-Risk. However, efforts will be made to identify safe places where Muhammad could reach out to during distress, such as a local health agency (e.g., Red Crescent, local clinic), and informing Muhammad’s emergency contacts or next-of-kin to provide additional social support and closer monitoring.
Step 3 – (If required) Notification of Company POC during Crisis: As this incident did not occur within Muhammad’s Company’s premises, nor does it involve Muhammad’s Company, the Company will not be informed about Muhammad’s case.
Step 4 – High-Risk Reporting and Case Management: No High-Risk report required at this moment as Muhammad’s status remained as Medium-Risk. The Provider could enlist support from Intellect’s team to conduct wellbeing check-in call with Muhammad to ensure Muhammad’s risk level remains stable in between sessions. In the case where Muhammad’s risk level shifts to High-Risk, then the Provider is required to submit a High-Risk report to Intellect’s team for further case management and support.
Step 5 – (If required) Notification of Company POC Post-Crisis and Recommendations for Intervention: As the situation did not involve Muhammad’s Company, Intellect will not provide any report or recommendations for Muhammad’s Company.
Appendix
Incident Summary
Template to be used by the Intellect team to notify Company POC / Relevant teams of the escalation & follow-up steps, where appropriate and necessary.
