Active Case
Distress Without Disclosed Danger
Training note: ask about thoughts of suicide directly and plainly, and take the answer as information rather than as clearance. The 988 Suicide & Crisis Lifeline is for mental health struggles, emotional distress, alcohol or drug concerns, or just needing someone to talk to — not only for someone with a plan — and it can be contacted by a person who is worried about someone else. Nobody is ever told to wait until things are worse before contacting 988. Call 911 for immediate physical danger or a medical emergency. A navigator does not diagnose, does not conduct a clinical risk assessment, and does not record risk as ruled out.
Step 1 of 7: Review the case
Read what the case states, what it does not state, and what this practice case is asking you to learn.
Fictional resident
Ms. Priya Raman
38 years old · Adult living with her sister, recently unemployed
ZIP code
78230
Preferred language
English
Coverage
Uninsured since losing her job
What is happening
Ms. Raman was referred by a workforce program. She lost her job three weeks ago. On the phone she says she is worrying constantly, sleeping about four hours a night, and has stopped seeing friends because she does not want to explain herself. She becomes tearful. Asked directly whether she is having thoughts of hurting herself or of suicide, she says no, clearly and without hesitation, and says she wants help sleeping and help finding work. She lost her health coverage with the job.
What you are practicing here
- Decide what has to be asked directly, and how you would record what you are told.
- Work out what support to offer when nothing meets an emergency threshold.
- Decide what happens after this call, and who decides it.
The detailed learning objectives for this case name the intended answers, so they are shown in the debrief after you submit. The safety note on the case page is different: it states the intended emergency response deliberately, because safety information is never withheld to make an exercise harder.
What the resident says matters most
- Sleeping again
- Finding work before her savings run out
- Not being treated as though she is falling apart
Strengths already present
- Took the referral call and spoke openly
- Answered a direct question about suicide directly
- Living with her sister and not alone
- Names clearly what she wants help with
Stated in the case
- Lost her job three weeks ago and lost health coverage with it
- Worrying constantly and sleeping about four hours a night
- Has withdrawn from friends
- Became tearful during the call
- Asked directly, she reports no thoughts of self-harm or suicide
- Living with her sister; asks for help with sleep and with work
Not known — would need asking
- Whether she has any past history she wants to tell you about, if she chooses to
- Whether anything has changed in the last few days
- What she would want to happen if the worry got worse at night
- How she prefers to be contacted, and whether anyone else may be told
Social determinants in this case
Some domains are stated in the case; others are only possible mechanisms to consider and are not established here. The full five-domain framework is mapped on the Methods page.
- Economic Stability stated in this caseJob loss three weeks ago and loss of health coverage with it.
- Health Care Access and Quality stated in this caseUninsured since the job loss, with no current behavioral health contact.
- Social and Community Context stated in this caseWithdrawal from friends, living with her sister.
- Neighborhood and Built Environment possible mechanism, not establishedNot established in this case. Housing stability after a job loss is worth asking about rather than assuming.
Why this is structural: Losing a job in a system where coverage is attached to employment removes income and access to care in the same week, at the point where both are most needed. How quickly an uninsured adult can be seen is a system condition, not a measure of how badly she needs it.