The holiday season brings a unique set of challenges and shifts in routine that directly impact patient care. While it’s common to hear the "holiday tale" about a spike in behavioral health crises during November and December, national data tell a different story. For behavioral health counselors, understanding the true risk period is essential for proactive planning.
Contrary to popular belief, national data, including reports from the US CDC and multinational studies, consistently show that November and December have the lowest daily suicide rates of the year.
This pattern is believed to reflect the protective effects of social connection and family gatherings. Increased feelings of belonging and reduced isolation are powerful mitigators of suicide risk, aligning with concepts like Thomas Joiner’s Interpersonal Theory of Suicide.
The Real Risk: Post-Holiday Spike
The critical takeaway is that risk doesn’t peak during the holidays; it moves right after them. Suicide rates and behavioral health utilization consistently climb in the first weeks of January, around the New Year. Behavioral health clinicians must intensify their vigilance during this immediate post-holiday period.
Why does risk shift? The holidays are, at their core, a major transition period.
Clinicians can think of the holidays as a planned discharge from routine care. Clinicians often take time off, patient schedules shift due to travel and family commitments, and access to care often narrows. We know from inpatient psychiatry that transitions are a major risk amplifier—suicide risk is drastically higher in the first week after psychiatric hospitalization.
The holiday period functions similarly. Unless this transition is managed intentionally, risk can rise, not because of the season itself, but because established therapeutic systems and routines go off-rhythm.
Protecting the integrity of the therapeutic relationship and maintaining continuity is paramount during this time.
The message should be clear: intentional planning to maintain continuity and alliance is a direct patient safety measure.
To apply this evidence operationally, clinicians can look to use the pre-holiday weeks (ideally before Thanksgiving) to plan for the upcoming disruption:
Intentionality should guide the final pre-holiday visits. Clinicians can start the conversation with a simple, direct prompt: "Before we end today, let’s talk a little bit about what might change for you over the holidays."
This is a prime opportunity to integrate behavioral activation (BA), focusing on small, manageable steps. Specifically, clinicians can focus on more manageable goals, and consider what routines or activities might change and what little steps can be taken to maintain function or mood.
Clinicians can also help patients partialize big, ambitious New Year’s resolutions (e.g., "I'm going to lose 20 pounds") into small, achievable goals that can be built upon across the year. Success, even small success, is a powerful motivator—it’s the caboose that pushes the train. Prioritizing a resolution they can realistically work on between now and the New Year gives them a success story they can carry into January.
Finally, clinicians must remember that they are also impacted by these transitions. Data show that high clinician stress during the holidays is common, and burnout leads to lower patient safety and care quality.
Their reliability is a key piece of their patients' protective factors. As clinicians plan care coverage and boundaries for their patients, they must plan their own rest, self-care, and time off as well. This intentional planning is an essential component of maintaining clinical reliability.