Intellect’s Care & Escalation Model

Balancing client confidentiality and safety
to ensure optimal mental health care

Nov 2023 | V3.0

Table of Contents 2

Introduction 2

Product & Services Summary 3

Provider Terms & Hiring 4

Intellect’s Escalation Protocol 5

Risk Classification 5

Self-Reported Risk and Outcome Monitoring 7

Confidential Information Disclosure Framework 7

Framework-based Escalation Process 7

Scenario 1: Referral for greater mental health support 8

Scenario 2: Unsuccessful de-escalation of high-risk helpline client 8

Scenario 3: Risk to institutions’ reputation 9

Scenario 4: Physical assault during in-person session 9

Scenario 5: A Firefighter who arrives late to sessions and assessed to be having difficulty maintaining focus and often have reported to doze off during work. 10

Scenario 6: Employee exhibits erratic behaviour and paranoid thoughts about coworkers or people they work with 10

Scenario 7: An army officer expressed intent and plan to harm individuals outside the context of military engagement 10

Escalation Process 11

When to Escalate to the Authorities 15

A session with a Provider 16

24/7 Helpline 16

Liability 16

Case Studies 17

What does Intellect need? 18

Intellect is a Singapore-headquarterd mental health company, with a focus on hyper-localisation and scientifically backed end-to-end care services. Our Providers and clinical staff adhere to strict protocols and procedures, which are outlined in our Care and Escalation Model below.

Intellect’s care aims to provide the full spectrum of mental health support, from our 24/7 helpline addressing immediate and critical needs, to consultations with licensed coaches, counsellors, clinical psychologists and psychiatrists for more specialised mental health requirements. 

Intellect’s Providers are contractored professionals who offer coaching, counselling, and clinical therapy to assigned clients from the Intellect platform. Intellect takes great care to ensure that our Providers are qualified and experienced during the hiring and onboarding process.

With the help of our Providers and partners, we are proud to offer care in the main languages of the following countries. Our Providers can communicate effectively in each country’s primary languages. 

Intellect’s Escalation Protocol

This document outlines Intellect’s escalation protocol for consultations with Providers and the 24/7 helpline. Our top priority is to maintain the clients’ confidentiality, ensure the safety of the clients and safeguard clients’ personal data, health information, and privacy rights. 

However, there will be situations whereby disclosing confidential information about the client is required to ensure the client’s safety. This document aims to provide clear guidelines on assessing risk, escalating cases when necessary, and disclosure of confidential information. This document is reviewed every 4 months to ensure that the protocols are aligned with Intellect values and our client’s interests. The diagram below shows the typical user journey of Intellect users. Please note that escalation to the next level is dependent on the needs of the clients’ care. 

The following process highlights Intellect’s escalation process for consultations over the 24/7 helpline and with Intellect’s Providers. During a session/call, clients are classified into three risk groups based on the guiding descriptions detailed in the table below.  As part of the onboarding process and periodically throughout the contract via multiple channels (check-in calls, engagement with our learning management system, email communication, etc.), Intellect’s Providers are trained to assign a client to Intellect’s different risk groups. 

The flow chart below flashes out Intellect’s approach to managing Cases/ Calls on the “High Risk”  Category

After registering with Intellect, users are invited to complete Intellect’s proprietary ‘Personal Insights’ questionnaire. This questionnaire assesses various aspects of the user’s well-being and organisational outcomes. The PIQ also includes the PHQ-4 screener to pick up possible risks of anxiety and depression, which are common mental health challenges and are often comorbid with various other mental health challenges and suicidal ideation. During the matching stage for Intellect Care session, each user will complete the PHQ-4 screener to assess for severity of anxiety and depression symptoms. A total score of 6-8 indicates moderate symptoms that likely require further intervention, whereas a score of 9-12 indicates severe symptoms of anxiety/depression with potential risk that strongly indicate the need for further clinical evaluation and intervention. The PHQ-4 also helps to identify if the client is more likely to benefit from Intellect Coaching or Intellect Care. At various points of the user journey, the user will be screened for continued risk-tracking.  

Intellect follows a Confidentiality Information Disclosure Framework to ensure that all cases that require escalation are handled in a timely and appropriate fashion. These can be internal or external.

Internal Referral: 

• From one Intellect Provider to another.

External Referral: 

• To facilitate and escalate the client’s care to external services.
• To inform the company or external parties about the client’s case. 

Below, we have outlined scenarios for when we refer or escalate a client to the relevant parties. See the Appendix for an overview of general scenarios in a broader context.

Scenario 1: Referral for greater mental health support

An Intellect Coach who identifies the client’s need for higher level support will submit a referral form to Intellect within 1 business day after obtaining the ROI (Release of Information) from the client. 

Intellect will proceed to match the client to a Clinical Psychologist/Counsellor and share any necessary case information with the new Provider.

Scenario 2: Unsuccessful de-escalation of high-risk helpline client

The Helpline responder is unable to de-escalate a high-risk caller on the phone, and in the event, the helpline responder was not able to reduce the risk of the caller from initially high-risk (imminent plan to act on suicidal thoughts) to moderate risk (committing to abstain from plan), the helpline responder will immediately notify their supervisor (via Google chat or any other applicable communication platform) to consult on the next steps. The Supervisor would call the next-of-kin or the relevant authorities while the responder stays on the call until the case is handed over to the next-of-kin. Meanwhile, the responder will update the supervisor via their communication platform (chat) when the appropriate medical authorities or an ambulance arrives on the scene, or when hospital staff attend to the client. At the end of the call, Intellect’s Case Manager of the company will immediately notify the relevant company via email. 

Scenario 3: Risk to institutions’ reputation 

During a session, the client (e.g. a student) is found to be engaging in activities that may put their institution’s reputation at risk (i.e. using illegal drugs within university compounds). The Provider will explain the need to inform the institution and obtain the ROI (Release of Information) from the student client. 

Intellect will then notify the institution within 1 business day via email.

Scenario 4: Physical assault during in-person session 

The authorities will be called if a client physically attacks the Provider during the session. 

Scenario 5: A Firefighter who arrives late to sessions and is assessed to be having difficulty maintaining focus and often have been reported to doze off during work. 

The HR department/ assigned PIC will be informed of this. Client’s consent may not be needed in such scenarios where physical safety is in question

Scenario 6: Employee exhibits erratic behaviour and paranoid thoughts about coworkers or people they work with

Assigned PIC / HR team to keep a look out for erratic behaviours during workspaces. Additionally, refer the client to a psychiatrist for evaluation. 

Scenario 7: An army officer expressed intent and plan to harm individuals outside the context of military engagement

Intellect will inform the Army PIC and create a safety plan with the client. Based on the assessment, consent may not be needed as the physical safety of others is in question

This flow chart illustrates the process by which referrals are done.

1. Provider identifies that another Provider/service is best suited to client’s coaching/treatment plan based on the following criteria:

1. Presenting issue & severity
2. Risk level 
3. Requested by the user and assessed by Provider
4. The Provider fills in the referral form with necessary details and recommendations.
5. Intellect Coaching to Intellect Coaching (change of Provider)
   
6. Intellect Coaching to Intellect Care or vice versa
   
   
7. Intellect Care Provider to Psychiatrist/ external support
   

    

24/7 Helpline

At the end of every helpline call, Helpline responders will seek the client’s permission to book a session with an Intellect Care Provider for greater and more sustained mental health support. 

When to disclose confidential information to the client’s company

While ensuring the client’s safety and well-being always remains our top priority, there are certain circumstances (e.g., crisis scenarios) where the client’s company must be informed about the risk group their employee belongs to. This helps in two ways: first, it ensures that the employee continues receiving proper care, and second, it safeguards the client and those around them.

Intellect’s decision matrix offers a framework to determine when to inform the company. This matrix is based on evaluating the severity of the client’s challenges or issues and their potential risk of harm to themselves or others.

To establish a communication plan, Intellect, and a designated point of contact within the company will decide:

1. Who to share confidential information with during crisis situations (e.g., HR).
2. Which communication channels to use for sharing this information (e.g., phone number, email, etc.).

During sessions, Providers will continuously assess the client’s safety and any potential risks that could negatively affect those the client interacts with. If the Provider determines that the client is at moderate to significant risk of self-harm, suicide, intentional harm to others, or unintentionally endangering others, Intellect may breach confidentiality to ensure the safety of the client and other relevant individuals. If a Provider identifies a high-risk client who may pose a threat to their own safety or that of others, the Provider must follow these steps:

In this context, the authorities refer to those in the position to enforce laws and regulations, like the police or other emergency services. If de-escalation is unsuccessful, and the Provider assesses that the client is still at risk for harm to him/herself or others, the Provider may escalate the situation to the authorities. In instances where de-escalation efforts are unsuccessful, and the Provider determines an ongoing, active threat to the client (“High-Risk Critical” category), the Provider may escalate the situation to the relevant authorities. The term “authority” in this context refers to entities with the power or right to enforce laws, regulations, or rules, and make decisions or take actions based on that power or right. Such authorities include law enforcement officers, ambulances, emergency responders, and other crisis responders; and these are granted specific powers and responsibilities by society or governing bodies to maintain order, enforce laws, and protect the well-being of individuals and communities. Relevant authorities may be specified in the client’s country. 

A session with a Provider 

In the event of unsuccessful de-escalation, the Provider may have to escalate the client’s case to the relevant authority to maintain safety for both the client and everyone around them. This includes when it involves the risk of suicide or harm to self, risk of harm to others, and risk of harm from others. 

The Provider’s responsibilities include risk evaluation, providing support and undertaking de-escalation efforts, and if it is deemed unsuccessful, the Provider will proceed to further assess the situation. Should there be evidence of imminent danger, the Provider will inform both Intellect and the relevant authorities. In such situations, obtaining client consent for disclosing confidential information isn’t mandatory or necessary as the foremost priority is the client’s safety.

24/7 Helpline 

If a high-risk call is not de-escalated (responder was not able to reduce the imminent plan to act on suicidal thoughts) to committing to abstain from the plan) successfully and the caller is alone with the intention of self-harm/harm to others, the Helpline will obtain location information and contact local authorities as soon as gather sufficient location information.

In cases where Intellect has followed the escalation protocol, and an employee previously assessed as low-risk later becomes high-risk, or in any other event, Intellect or its officers, partners, service providers, therapists, contractors, or subcontractors, will not be liable to a client, whether by indemnity, statute, tort, or any other basis in law or equity, for loss of data, economic loss, punitive or exemplary damages, or any incidental, special, indirect or consequential loss or damage which may be suffered by the client in connection with the mental health assessment, care, treatment, or services, including any death or personal injury resulting from the services provided to the client.

To minimise liability, Intellect and the client should ensure:

1. Clear communication channels are established between Intellect and the company with regular check-ins to jointly support higher-risk employees/patients.
2. The client provides any necessary support or intervention based on Intellect’s recommendations.
3. Intellect provides ongoing training, supervision, and support to the Providers to accurately assess and manage risk.
4. Regular reviews and updates of this escalation protocol SOP.

Case Studies 

The following examples are based on real-life scenarios of how Intellect’s escalation protocol enables us to strike a balance between maintaining the client’s confidentiality and adhering to safety protocols. 

Example 1: Break confidentiality and notify the company; Expressed consent not required

A bus driver on his way to work tells his Provider that he is having active suicidal ideations and worries about acting on it. The Provider assesses that the client demonstrates the risk of potential self-harm and harm to others. As a result, the Provider chooses to break confidentiality with the client’s knowledge by providing the Company with sufficient detail to ensure safety for the client, passengers, and other road users.

Example 2: Successful de-escalation from suicidal ideations; confidentiality not broken

A frontline hospital worker (client) responsible for direct patient care told their Provider that they are having suicidal ideations. On further questioning, the Provider determines that the ideation is not active as the client has no plans to act upon these ideations. The Provider and client will co-create a safety plan, share SOS resources and refrain from escalating as the client poses no risk of self-harm or harm to others. T Should the Provider assess that risk has increased, the Provider may inform the Hospital to mitigate the risk of harm for the client and others in the hospital (patients/ colleagues) with the client’s expressed consent.

Example 3: Unsuccessful de-escalation; authorities notified

A B2B client text messaged their Provider and expressed their thoughts of harming their children because they are “a nuisance”. The client proceeds to detail their specific plan for harming their children. The Provider assesses risk and finds that the client is certain of their plan. All attempts to de-escalate the situation are unsuccessful as the client is certain of their plan. The Provider breaks confidentiality with the client’s knowledge as there is a significant risk of harm to others and informs Intellect of this case. Following this, Intellect will inform the organisation and the relevant authorities on this matter and maintain contact with the client for follow-up care. 

Example 4: A client (B2B) is having a chat session with the Provider. The client expressed their thoughts of harming their kids as they are a nuisance to the client. The client proceeds to tell the Provider about their specific plan on harming the children. The Provider assesses risk, and it is found that the client is assured of the plan. The Provider attempts to de-escalate the situation by giving emotional support and awareness to the client. The de-escalation is unsuccessful as the client is certain of their plan. The Provider tells the client that confidentiality must be broken as there is a potential of harm to others. The Provider informs Intellect of this case. Intellect will inform the Organization and the relevant authorities on this matter. Intellect will also get in touch with the client for follow-up care. 

Example 5: A counsellor receives emails from an army officer deployed overseas, revealing intentions to harm individuals outside the scope of military engagement. The counsellor identifies this as an immediate risk of harm and a potential violation of military conduct. Counselling efforts to change the officer’s intent are unsuccessful. With the officer’s awareness, the counsellor breaches confidentiality, notifying the PIC from the Military. The counsellor refers the officer to military mental health services, informs the commanding officers, and arranges for remote counselling focusing on anger management and stress. They explore options for reassignment or leave based on mental health assessments, ensuring continuous follow-up care.

Example 6: In sessions with a school teacher, a counsellor observes alarming signs of emotional distress, including statements about self-harm made in front of students. The counsellor assesses a high risk of self-harm and negative impact on the students. Despite counselling efforts, the teacher’s state remains concerning. The counsellor, acknowledging the seriousness of the situation and with the teacher’s knowledge, informs the relevant PIC. An immediate mental health intervention is planned, along with a potential leave of absence for the teacher. The counsellor focuses on therapy for stress management and plans collaboratively with the school for a supportive work re-entry, continuing to provide counselling and follow-up care.

To ensure that your employees/ colleagues are well covered by Intellect

1. Ensure your employees have registered on the appropriate Intellect platform and have done the following
   1. input personal information
   2. input emergency contact information
   3. agree to the informed consent policy (which includes a release of information consent) 
2. Ensure that Intellect has an updated list of Contact persons 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.
   1. Required information of Primary and at least 1 other Secondary Person in charge
      1. Name & Role
      2. Company/ Agency
      3. Department
      4. Phone number ( ideally able to receive WhatsApp calls and messages on top of normal phone calls) 
      5. email addresses
3. The primary mode of communication for non-urgent scenarios will be email. For Urgent situations, the primary mode of communication will be via phone call. 
4. In the event Emergency services are engaged (case by case) Intellect may inform the PICs via email since risk is already managed by the emergency services ( Ambulance, Police etc)

Appendix