In virtually every mental health clinician's career, a situation arises that requires immediate response: A client or patient presents who is suicidal, potentially violent, and/or at risk of being victimized. In such a situation—considered a behavioral emergency—the clinician may have little or no time to consult resources before responding.

In this book, Phillip M. Kleespies and his colleagues provide clinicians with critical, evidence-based approaches for the evaluation and management of behavioral emergencies.

This book makes clear the distinction between a behavioral crisis, which is a serious disruption of functioning that does not necessarily imply danger, and a behavioral emergency. Guidance on behavioral emergencies is drawn from both clinical experience and empirical evidence, and the book's structure functions as a curriculum for educating both new and seasoned clinicians. Unique to this book are chapters on violence and suicide risk among adolescents, as well as individuals who are chronically ill. Contributors also discuss the legal and psychological risks associated with treating behavioral emergencies.

Comprehensive in scope, this book provides a solid knowledge base that will be an invaluable resource for all clinicians.

Table of Contents




—Phillip M. Kleespies

I. Foundations

  1. Emergency Intervention and Crisis Intervention
    —Jay Callahan
  2. Evaluating Behavioral Emergencies: The Clinical Interview
    —Phillip M. Kleespies and Janet S. Richmond

II. Evaluation and Management of Suicide Risk

  1. Assessing Suicide Risk in the Adult Patient
    —Glenn R. Sullivan and Bruce Bongar
  2. Children and Adolescents at Risk of Suicide
    —Alec L. Miller and Jill M. Emanuele
  3. Suicide Risk in People With Medical and Terminal Illness
    —Phillip M. Kleespies, Sigmund Hough, and Angela M. Romeo

III. Evaluation and Management of Risk For Violence

  1. Assessment and Management of Acute Risk of Violence in Adult Patients
    —Dale E. McNiel
  2. Children and Adolescents at Risk of Violence
    —Randy Borum

IV. Evaluation and Management of Interpersonal Victimization

  1. Evaluation and Acute Intervention With Victims of Violence
    —Michael R. McCart, Monica Fitzgerald, Ron E. Acierno, Heidi S. Resnick, and Dean G. Kilpatrick
  2. Risk for Intimate Partner Violence: Factors Associated With Perpetration and Victimization
    —David S. Riggs, Marie B. Caulfield, and Kathryn Fair

V. Emergency-Related Crises and Conditions

  1. Self-Injury: Treatment of a Complex Adaptation
    —Pamela Deiter-Sands and Laurie Anne Pearlman
  2. Contemporary Issues in the Evaluation and Management of Alcohol- and Drug-Related Crises
    —Glenn R. Trezza and Harriet Scheft
  3. Suicide Risk in Personality Disorders: An Argument for a Public Health Perspective
    —Paul Duberstein and Tracey Witte

VI. Medical Conditions Presenting as Behavioral Emergencies

  1. Common Neurological Disorders Associated With Psychological/Behavioral Problems
    —Roberta F. White, Maxine Krengel, and Terri Ann Thompson
  2. Psychological and Behavioral Symptoms in Endocrine Disorders
    —Karina Tsatourian and Jacqueline Samson

VII. Follow-Up Treatment of Patients at Risk of Recurrent Emergencies

  1. The Psychological and Behavioral Treatment of Suicidal Behavior: A Critique of What We Know (and Don't Know)
    —M. David Rudd, Thomas Joiner, David Trotter. Ben Williams, and Liliana Cordero
  2. Reducing the Risk of Violence among Persons With Serious Mental Illness: A Critical Analysis of Treatment Approaches
    —Kevin S. Douglas, Tonia L. Nicholls, and Johann Brink
  3. Psychological/Behavioral Treatment With Victims of Interpersonal Violence
    —Monica M. Fitzgerald, Michael R. McCart, Ron Acierno, and Dean G. Kilpatrick

VIII. Legal and Psychological Risks in Treating People With Behavioral Emergencies

  1. Legal and Ethical Risk Management With Behavioral Emergencies
    —Wendy Packman, Houri Andalibian, Kerry Eudy, Brooke Howard, and Bruce Bongar
  2. The Stress and Emotional Impact of Clinical Work With the Patient at Risk
    —Phillip M. Kleespies and Allison N. Ponce

Author Index

Subject Index

About the Editor

Editor Bio

Phillip M. Kleespies, PhD, was awarded his doctoral degree in clinical psychology from Clark University in 1971. He is an assistant clinical professor of psychiatry at Boston University School of Medicine.

As a clinical psychologist in the Department of Veterans Affairs (DVA) Boston Healthcare System, he has over 35 years of experience working in emergency department, urgent care clinic, and inpatient psychiatric settings with patients who are at risk of such behavioral emergencies as suicidal behavior, violence, and victimization. During those years, he has been an active supervisor and teacher to psychology interns and postdoctoral fellows with an interest in evaluating and managing patients at risk to self or others.

His research interests have included the development of a database for the study of self-injurious and suicidal behavior in veterans and the impact of patient suicide and suicidal behavior on the treating clinician.

In 2006, Dr. Kleespies was awarded a DVA Kizer Award Recognition grant for his work on developing a monitoring system for patient self-injurious behavior in DVA Boston.

He has authored or coauthored many publications and has made numerous presentations on behavioral emergencies and related topics. He is the editor of the book Emergencies in Mental Health Practice: Evaluation and Management (1998) and the author of the book Life and Death Decisions: Psychological and Ethical Considerations in End-of-Life Care (American Psychological Association [APA], 2004). He is a member of the VA Boston Ethics Case Consultation Team and the VA Boston Palliative Care Consult Team.

Dr. Kleespies is a diplomate in clinical psychology of the American Board of Professional Psychology and a fellow of APA. He was the founding president of Clinical Emergencies and Crises, Section VII of APA Division 12 (Society of Clinical Psychology), and he remains involved with the section as chair of its advisory board. He resides in Cambridge, Massachusetts.

Companion Products
  • Decision Making in Behavioral Emergencies

    This book is about developing the skills and attitudes needed to practice competently when assessing and working with patients who are at risk for suicide, violence, or victimization.