Traditional DBT helps develop emotion regulation and impulse control in people who struggle in these areas, but Radically Open (RO) DBT is an adaptation of DBT targeted towards people struggling in the opposite way: those with an overabundance of self-control and who struggle to express emotion.
I encountered the text version of this crisis response list in the RO-DBT Manual by Thomas Lynch and decided to turn it into this visual reference sheet.
Talking about a mental health crisis is the first step, but the nature of crisis is that many of us “go blank” under pressure. What we’ve learned about mental health crisis response in the past may fly out the window when an actual crisis occurs. This visual alternative to an RO-DBT* crisis checklist is designed to be fun to review and easy-to-remember (when we use more parts of our brains to study- like do when we engage visual information- we are more likely to remember).
DOWNLOAD THIS VISUAL:
If you are a patron, log into your Patreon account to download this visual in a printable form in 4 different color formats (all licensed for professional use). If you aren’t a patron, for a limited time I’ve made the black and white PDF available as a free download for new newsletter subscribers – just click below.
Also available as a professionally printed 18×24: poster:
*One very important note:
This Mental Health Crisis response model was developed specifically for individuals with high self-control and low impulsivity. All items on the list may not be safe or applicable to everyone experiencing a mental health crisis. Always call emergency responders if you are concerned someone is in imminent danger of harming themselves.
This list is an extremely condensed version of the instructions for practitioners for crisis response that are described in the RO-DBT manual. Please refer to the manual for any clarification, this visual is meant to be a sort of artistic “cheat sheet” for refreshing information already learned.
1. Thank you for telling me.
2. Ask: what set this off?
3. Seek what they are trying to communicate.
4. Check-in and invite criticism, “did I miss something?”
5. Validate: “no wonder you feel…”
6. Show concern. Don’t force yourself not to react.
7. Signal openness. Balance concern with signals of openness.
8. Take a break together, go for a walk or make a snack (this can diffuse intensity).
9. Remove access to method or make a plan to remove access to the method and follow up on the plan.
10. Self examine. Be radically open to your own experience of what is happening.
11. Ask what social signal is being sent in the interaction.
12. Show your care with an emotional appeal such as “please stay.”
13. Show trust: “I believe in you and your recovery.”
14. Say “I don’t want you to do this.”
15. Encourage use of self-control.
16. Introduce self-inquiry: invite them to use crisis as discovery about themselves.
17. Remind person of their commitments, agreements, and promises and emphasize their integrity.
18. Get back up. Make sure the person has crisis resources (don’t try to carry the burden alone and push yourself past your own boundaries).
19. Ask them to agree to a safety plan (download a printable safety plan PDF). If appropriate, have them call a friend to be present.
20. Connect and get contact information for person’s other support people.
21. If suicidality cannot be reduced, go with the person to emergency services.
The origin of crisis response guidelines (i.e. Mental Health First Aid) is rooted in western, predominately White, and English-speaking countries. Because of this, it is especially important to keep cultural sensitivity and flexibility in mind when discussing mental health crisis response. As we learn more about crisis response and how best to support people experiencing a mental health crisis, crisis workers need to adapt these strategies based on cultural context, consider cultural differences in emotional language, rethink how health systems function, and grow awareness of how different cultures view suicide. Researchers and first responders are working to address these questions, including different methods of intervention and how risk assessment can be helpfully adapted for non-white, non-English speaking populations, and other marginalized groups. (See this research article by Lu, Li, Oldenburg, Wang, Jorm, He, and Reavley, 2020).