By Rebecca Stone, LMHC-QS of Stone Counseling & Consulting Services, LLC

Special Note from the Author

The information in this post is comes directly from a lesson in my e-course How to Start a Solo Private Practice. While it is a lesson in my much larger e-course, I believe safety should not be behind a paywall or email signup—so this guidance is free for all mental health professionals.

Dedication

This post is dedicated to all mental health professionals who have been lost to violence in the line of service. May their work and commitment never be forgotten.

I also dedicate this to every clinician, staff member, and practitioner who engages with this guidance—may it help protect you, your colleagues, and your clients, and give you the tools to continue your essential work safely.

Supporting Safety in Mental Health Practice: Key Actions and Recommendations

Violence in mental health settings, while not extremely common, is a serious concern that practitioners must prepare for. Mental health providers may experience risks ranging from harassment, stalking, threats, verbal abuse, and physical assaults—particularly in outpatient or solo practice environments with limited supports and minimal security. While no safety plan can guarantee complete protection from harm, thoughtful vigilance and proactive precautions can significantly reduce risk.

Safety planning is not one-size-fits-all. Risks and protective strategies vary based on practice setting, client population, physical environment, and service delivery model. Experts emphasize the importance of individualized safety planning, intentional office or home-office design, ongoing training, and situational awareness to mitigate potential threats.

As an overall suggestion, consider having law enforcement conduct a safety assessment of your building, office, or home office. Many law enforcement agencies offer this as a prevention service, providing walk-through evaluations, safety recommendations, and assistance with creating emergency plans tailored to your specific setting.

Below are some suggestions for supporting safety:

1. Develop a Workplace Violence Prevention Plan

• Conduct safety risk assessments regularly to identify potential safety risks and mitigation strategies.

• Create a written prevention and response plan.

• Collaborate with security, law enforcement, and legal advisors when necessary.

• Prohibit weapons on-premises by posting a conspicuous sign and including this information in informed consent. Consult legal guidance for your state or locality regarding permissibility under local and state laws.

2. Office Layout and Physical Safety

• Do not share keys, codes, or other entry or access information with others.

• Walk the building to identify any unlocked, hidden, or secondary entry and exit points, and note areas that could pose increased risk of unauthorized access.

• Maintain well-lit entrances and exits.

• Restrict access to the office with locked doors, buzz-in systems, and video surveillance when appropriate.

• Discourage building or office patrons from holding doors open or allowing others to “tailgate” into secured areas. Controlled access relies on doors closing and locking properly; signage and staff reminders can reinforce this practice.

• Ensure at least two locked doors between the provider and public access areas whenever possible (e.g., exterior door + suite door, or suite door + office door).

• Use doors with secure locking systems and easy-exit features. Exterior doors should auto-lock upon closing, while doors must always allow free exit from the inside without requiring keys, codes, or manual unlocking (e.g., panic hardware or fail-safe exit mechanisms).

• Confirm that door locks, panic bars, and auto-lock features comply with local fire and building codes and are tested regularly.

• Escort clients to and from the office as appropriate, ensuring access doors close and lock behind you and restricting access to private areas.

• Arrange office furniture so the provider does not have their back to the door and is seated closest to the exit, with a clear path for escape.

• Avoid working alone when possible; use an office “buddy system” so no one works or walks to their vehicle alone.

• When leaving your office—for example, to use the restroom or visit the breakroom—take your keys and phone with you, and lock the door. This helps prevent unauthorized or surprise entry into your office while you're away and keeps you personally safe.

3. Screening and Managing Clients

• Screen new clients for potential violence risk using phone consultations, clinical interviews, and psychological testing when appropriate.

• Maintain documentation of concerning behaviors, threats, or boundary violations in clinical records.

• Communicate safety concerns to other HIPAA-compliant staff members when working with individuals who raise safety concerns. Discuss safety plans such as session interruptions or support check-ins, and ensure staff are aware when sessions begin and end.

• Notify HIPAA-compliant staff and/or building security (providing names or photos only, without identifying individuals as clients) of persons prohibited from scheduling appointments or being on the premises.

• Terminate treatment when clients become violent or threatening, in accordance with ethical and legal guidelines.

• File police reports and/or seek restraining or protective orders when appropriate. Involve law enforcement for safety patrols when needed.

4. Personal and Online Boundaries

• Restrict what the public can see on personal social media profiles and how those profiles can be found. Avoid sharing personal information related to location, family, routines, or habits.

• Avoid social media interactions with clients and do not initiate or accept friend requests from people you do not know.

• Use a professional address or postal box address (not a home address) for licensure and professional correspondence, as license databases are often public record.

• Regularly search for yourself online and request removal of personal information, such as home addresses, from online databases and directories.

• When applicable, request that home property records be made private or restricted. Many jurisdictions allow opt-outs, redactions, or confidentiality programs through county assessor or recorder offices.

• Remain vigilant regarding stalking, harassment, and boundary crossings.

5. Situational Awareness and Escape Planning

• Observe changes in clients’ behavior, demeanor, clothing, or belongings that may indicate escalation, aggression, or weapon access.

• Remove or secure objects that could be used as weapons; store sharp or heavy items out of reach.

• Use clinical judgment to de-escalate or excuse yourself from sessions that are escalating.

• Allow colleagues to interrupt sessions when safety concerns arise.

6. Emergency Procedures

• Designate a safe room for emergencies when feasible.

• Practice evacuation and emergency response drills.

• Install or use wearable panic buttons or alarms and clearly communicate safety protocols.

• Configure cell phone or smart watch emergency SOS features and know how to activate them quickly.

• Know when to call 911—HIPAA permits disclosures when there is an imminent threat to safety.

7. Education, Training, and Self-Defense

• Obtain training in recognizing warning signs of aggression and verbal de-escalation techniques.

• Consider self-defense training and scenario-based safety drills.

• Provide additional education and supervision for early-career clinicians and students, who are statistically at higher risk for workplace violence.

8. Administrative and Front Desk (or Virtual Assistant) Safety (If Applicable)

• Train administrative and front desk staff to recognize escalation and use verbal de-escalation strategies.

• Establish clear protocols for managing hostile calls, walk-ins, or individuals refusing to comply with office policies.

• Develop scripts and procedures for ending unsafe interactions and summoning assistance.

• Design reception areas with clear sightlines, safe exit access, and physical separation when appropriate.

• Encourage prompt reporting and documentation of concerning interactions.

9. After-Hours, Opening, Closing, and Transition Safety

• Establish safety procedures for opening and closing the office, including scanning surroundings before entry or exit.

• Avoid being alone in the building after hours when possible; coordinate arrival and departure times.

• Limit after-hours appointments or implement additional safeguards when they are necessary.

• Ensure parking areas, walkways, and entry points are well-lit.

• Be mindful of predictable routines and vary schedules or routes when feasible.

10. Telehealth and Hybrid Practice Safety Considerations

• Verify clients’ physical location and emergency contact information at the start of telehealth sessions.

• Establish protocols for responding to threats or severe dysregulation during virtual sessions, including session termination and emergency contact procedures.

• Protect therapist privacy when working remotely by using secure platforms, private workspaces, and professional contact information only.

• Clearly outline telehealth safety expectations and emergency procedures in informed consent documents.

11. Post-Incident Response, Documentation, and Recovery

• Document safety incidents promptly, objectively, and thoroughly.

• Complete internal incident reports and notify supervisors or administrators as required.

• Consult legal counsel, professional liability insurers, or risk management resources when appropriate.

• Conduct debriefings to identify lessons learned and improve safety planning.

• Address the emotional impact of incidents by seeking supervision, peer support, or mental health care.

12. Ethical and Clinical Decision-Making Related to Safety

• Recognize that provider safety is an ethical consideration alongside client welfare.

• Consult supervisors, ethics committees, or licensing boards when navigating complex safety decisions.

• Document the clinical and ethical rationale for safety-related boundary changes, treatment modifications, or termination.

• When safety concerns arise, prioritize actions that reduce risk while remaining consistent with ethical standards and legal obligations.

Special Guidance for Therapists Providing In-Home Services or Practicing From Their Personal Residence

Therapists Offering In-Home Services (Client Homes)

• Conduct pre-visit risk screening, including household composition, pets, substance use, aggression history, and weapons.

• Clearly communicate in-home session boundaries and the right to terminate or leave sessions if safety concerns arise.

• Share visit schedules with a trusted HIPAA-compliant colleague and use check-in/check-out procedures.

• Park in well-lit areas and remain aware of exits.

• Carry a charged phone, enable location sharing, and consider a wearable panic device.

• Trust your instincts and leave immediately if safety concerns escalate.

• Consider limiting in-home services to daylight hours and avoiding first sessions in-home when possible.

Therapists Practicing From Their Personal Residence

• Maintain physical separation between therapy spaces and personal living areas.

• Use multiple locked barriers between clients and private spaces.

• Utilize separate entrances for clients when feasible.

• Install auto-locking doors that allow free exit without unlocking from the inside.

• Avoid sharing personal details related to living arrangements or routines.

• Do not allow clients to arrive early or remain after sessions.

• Use noise machines, exterior lighting, and entryway cameras (not therapy rooms) when appropriate.

• Proactively pursue property record suppression and professional mailing addresses.

• Reassess regularly whether home-based practice remains clinically, ethically, and personally appropriate.

Wrap Up

Safety for therapists is paramount. While no safety plan can guarantee complete protection from harm, intentional vigilance, preparation, and layered precautions can significantly reduce risk. By remaining alert, responding to warning signs, and committing to ongoing safety practices, mental health professionals can foster safer environments for themselves, their colleagues, and their clients.

Safety planning is not one-size-fits-all and should be tailored to each practice setting—particularly for clinicians offering in-home services or practicing from their personal residence, where risks and mitigation strategies differ from traditional office environments.

Key takeaways:

• Be proactive: Safety begins with preparation and prevention.

• Design your space wisely: Office layout can serve as a frontline defense.

• Don’t ignore red flags: Document and respond promptly to concerning behaviors.

• Train regularly: Ongoing, practical training for all staff is essential.

• Protect boundaries: Strong online and in-person boundaries reduce risk.

Mental health professionals are not immune to workplace violence. By integrating these strategies, clinicians can meaningfully enhance safety for themselves, their staff, and the clients they serve.

Disclaimer

This lesson is intended for educational and informational purposes only and does not constitute legal, medical, clinical, or security advice. The safety considerations outlined are general in nature and may not be comprehensive nor appropriate for every setting or jurisdiction.

There are no guarantees of safety, and implementation of any recommendation does not eliminate risk. Clinicians are encouraged to use professional judgment and consult relevant licensing boards, professional organizations, legal counsel, and local authorities when developing or modifying safety plans.

Each practitioner is responsible for determining which strategies are appropriate for their specific setting, population, and scope of practice.

About Rebecca Stone, LMHC-QS

Rebecca Stone, LMHC-QS, is a Licensed Mental Health Counselor, Qualified Supervisor, and owner of Stone Counseling & Consulting Services, LLC, a private practice based in Florida. With over a decade of experience in clinical therapy and a strong background in business and office management, Rebecca blends compassionate care with operational expertise. She is passionate about supporting individuals on their mental health journey—and empowering fellow professionals through supervision, consultation, training and education, and practical tools to grow thriving practices.