Steps to Containing a Mental Health Crisis Printable- RO-DBT model

Traditional DBT helps develop emotion regulation and impulse control for people who struggle in these areas. 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.

In accordance with this website’s terms of use, this data is presented as an educational resource and artistic creation. The resources posted on Instagram and my website are not therapy and do not construe a therapeutic relationship.  

How to Respond to Crisis: RO-DBT Crisis Response

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).

Dowload this Illustration:

NOTE: Price paid is compensation for art/ illustration services only. For clinical resources see the RO-DBT Manual.

*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. Call local emergency services 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 the 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 the use of self-control.
16. Introduce self-inquiry: invite them to use crisis as discovery about themselves.
17. Remind the 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.

IMPORTANT: If you are in crisis or need help creating a crisis plan urgently, reach out to a mental healthcare provider, contact the crisis text line by texting “home” to 741741, or call the National Suicide Prevention Lifeline by dialing 988. The educational resources included on this site are not therapy and do not replace mental health treatment or crisis services.
 
RO-DBT Crisis Response - Steps to Containing a Mental Health Crisis

Cultural Considerations

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 responses. 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 intervention methods 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).

Image Description for Screen Readers:

The illustration is a checklist on how to respond to a crisis, based on the RO-DBT Manual by T. Lynch and adapted to an art layout by Lindsay Braman.

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 the 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 the use of self-control.
16. Introduce self-inquiry: invite them to use crisis as discovery about themselves.
17. Remind the 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.

One Comment

  1. Thank you for this! RO-DBT has been life-changing for me as someone who experiences an over-controlled coping style.

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