Intellect’s Care & Escalation Model

Balancing client confidentiality and safety
to ensure optimal mental health care

May 2023 | V2.0

Intellect is one of the world’s fastest growing mental health & wellbeing benefits providers, with a focus on hyper-localisation and scientifically-backed end-to-end services. Our providers and clinical staff adhere to strict protocols and procedures, which are outlined in our Care & Escalation Model below.

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

Intellect’s providers are freelance contractors 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 have the ability to communicate effectively in each country’s primary languages. 

 Intellect’s Escalation Protocol

The following outlines Intellect’s escalation protocol for consultations with providers and the 24/7 helpline. This document aims to provide clear guidelines on assessing risk and escalating cases when necessary. It will be reviewed every 4 months to ensure that the protocols are aligned with Intellect values and our clients’ interests.

Our top priority is to honour our clients’ confidentiality agreement with us, and safeguard clients’ personal data, health information and privacy rights. However, should our clients’ safety be compromised, it will necessitate disclosing confidential information with the client’s consent. 

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 providers are trained  to assign a client to Intellect’s different risk groups. 

Users are invited to complete Intellect’s proprietary Personal Insights questionnaire (PIQ), which assesses various domains of well-being and organisational outcomes. The PIQ includes the PHQ-4 screener for anxiety and depression, which are common mental health challenges and often comorbid with various other mental health problems and suicidal ideation. 

Each user begins the matching  process by completing  the PHQ-4 screener to assess the severity of their anxiety and depressive symptoms, which allows Intellect to determine whether coaching, counselling, or psychotherapy would best suit the client’s needs, and if further evaluation and intervention are needed. The user will continue to be assessed at various points of their journey with us, and treatment will be adjusted as required.  

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 and notifies their supervisor. The responder stays on the call until the case is handed over to the next-of-kin, when an ambulance arrives on the scene, or when hospital staff attend to the client. At the end of the call, Intellect will immediately notify the 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. 

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
2. The provider fills in the referral form with necessary details and recommendations.

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 remains our top priority at all times, 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. In the event that 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.

Session with a provider 

In the event of unsuccessful de-escalation during a session, the provider may need to escalate the client’s case to the authorities to ensure the safety of both the client and those around them if the client demonstrates a high risk of suicide, self-harm, or significant harm to or from others.

The provider will assess the client’s risk, offer support, and attempt to de-escalate the situation. If unsuccessful and the potential for active harm is evident, the provider will inform Intellect and the relevant authorities.

In such a situation, obtaining consent from the client is not necessary, as safety is paramount.

24/7 Helpline 

If a high-risk call is not successfully de-escalated and the caller is alone with the intention of self-harm or harm to others, the Helpline will obtain the caller’s location and contact the local authorities.

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 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 client’s expressed consent.

Example 3: Unsuccessful de-escalation; authorities notified

A B2B client text messaged their provider and expresses their thoughts to harm their children because they are “a nuisance”. The client proceeds to detail their specific plan on 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 which, Intellect will inform the organisation and the relevant authorities on this matter and maintain contact with the client for follow-up care. 

Appendix