Pastoral AI Crisis & Referral Protocol

These resources provide the strongest foundation for an integrated protocol addressing AI companions, chatbot mental-health advice, apparent delusional or spiritually charged beliefs, griefbots, suicidal disclosures, safeguarding, documentation, referral, and clergy boundaries.

The clinical and legal resources below are primarily U.S.-focused. International versions of the toolkit will need country-specific crisis numbers, mental-health referral systems, safeguarding laws, and confidentiality rules.

Foundational AI and mental-health sources

1. American Psychological Association health advisory

APA — Health Advisory on the Use of Generative AI Chatbots and Wellness Applications for Mental Health

This should be the principal clinical foundation for the entire protocol. It addresses limited evidence, inaccurate or harmful responses, privacy, emotional dependency, crisis handling, anthropomorphism, vulnerable populations, and the danger of presenting general-purpose chatbots as therapists. (American Psychological Association)

2. APA public-facing evaluation guide

APA — Navigating AI Chatbots and Wellness Apps for Mental Health

This translates the advisory into accessible questions pastors can use with congregants: what the tool claims to do, who designed it, what evidence supports it, what happens to personal information, whether a qualified professional is involved, and how the system responds to crisis. (American Psychological Association)

3. WHO guidance on responsible AI for mental health

WHO — Toward Responsible AI for Mental Health and Well-Being

WHO emphasizes evidence, mental-health expertise, lived-experience participation, cultural context, consumer empowerment, crisis-referral frameworks, and accountability. This is particularly useful for the toolkit’s global and public-health framing. (World Health Organization)

4. WHO guidance on generative AI in healthcare

WHO — Ethics and Governance Guidance for Large Multi-Modal Models

This addresses patient safety, inaccurate medical information, privacy, bias, automation bias, governance, and the responsibility of organizations using generative AI in health-related contexts. (World Health Organization)

5. APA guidance concerning adolescents

APA — Health Advisory on Artificial Intelligence and Adolescent Well-Being

This is essential when the person involved is a child or teenager. It addresses developmental vulnerability, emotional attachment, manipulation, harmful content, privacy, and the need for age-appropriate safeguards and adult involvement. (American Psychological Association)

1. Pastoral listening

Best sources

988 Lifeline — Help Someone Else

This provides accessible guidance for responding when another person is distressed or considering suicide. It encourages direct, nonjudgmental engagement and contacting 988 for help with someone who is struggling. (988 Lifeline)

NIMH — Five Action Steps for Helping Someone Having Thoughts of Suicide

The five steps are an excellent pastoral framework:

Ask.
Be there.
Help keep the person safe.
Help the person connect.
Follow up.

NIMH specifically supports asking directly about suicide, reducing access to lethal means, connecting the person with professional and relational support, and maintaining contact afterward. (National Institute of Mental Health)

Association of Professional Chaplains — Professional Ethics

This establishes professional expectations concerning dignity, ethical conduct, accountability, competence, boundaries, and confidentiality in spiritual care. (Association of Professional Chaplains)

Common Code of Ethics for Chaplains and Pastoral Counselors

The code is especially useful for confidentiality, appropriate professional relationships, respect for the person’s values, protection from exploitation, and responsible communication with relatives or other caregivers. (Association of Professional Chaplains)

2. Spiritual and theological discernment

Best Christian sources

Vatican — Antiqua et Nova: The Relationship Between Artificial Intelligence and Human Intelligence

This is one of the most substantial official Christian treatments of AI. It distinguishes computational performance from embodied, relational, moral, spiritual, and human intelligence. It supports the principle that an AI system should not be treated as a human person, moral conscience, spiritual director, or source of divine revelation. (Vatican)

ELCA Journal of Lutheran Ethics — Preparing for a Future of AI-Driven Pastoral Care

This directly considers proposals to replace human chaplains with AI avatars and examines what AI lacks in presence, relationship, moral understanding, spiritual care, and accompaniment. (learn.elca.org)

ELCA — Congregational Discussion: Artificial Intelligence, Spirituality, and the Church

This is especially useful for group formation. It asks why people turn to AI for spiritual care, whom people should trust with spiritual questions, and what human communities owe those experiencing moral injury or mental distress. (learn.elca.org)

World Council of Churches — Human Dignity and Artificial Intelligence

This provides an ecumenical theological anthropology grounded in the biblical understanding of humanity and the revelation of authentic humanity in Jesus Christ. (World Council of Churches)

3. Mental-health referral

General referral sources

SAMHSA — FindTreatment.gov

This is the principal U.S. government treatment locator for mental-health and substance-use services. It is confidential and can be searched by location and type of care. (FindTreatment.gov)

SAMHSA — Find Help and Support

This consolidates 988, FindTreatment.gov, the SAMHSA National Helpline, veterans’ services, and other behavioral-health resources. (SAMHSA)

SAMHSA — National Helpline

The helpline provides free, confidential treatment information and referral for mental-health and substance-use concerns. (SAMHSA)

Possible psychosis or serious mental illness

NIMH — Understanding Psychosis

This is the strongest public clinical resource for recognizing possible impairment in reality testing. Warning signs include unusual or overly intense ideas, paranoia, trouble thinking clearly, social withdrawal, impaired communication, sleep disruption, declining self-care, and difficulty distinguishing reality from fantasy. NIMH emphasizes that early treatment matters. (National Institute of Mental Health)

SAMHSA — Early Serious Mental Illness Treatment Locator

This helps families locate programs for recent-onset serious mental illness, including early psychosis services. (SAMHSA)

SAMHSA — Early Recognition and Effective Treatment of Serious Mental Illness

This supports early recognition, prompt referral, family engagement, and timely treatment rather than waiting for symptoms to become severe. (SAMHSA Library)

Recommended referral threshold

Referral should be strongly encouraged when AI use is associated with:

Significant sleep disruption
Social withdrawal or replacement of human relationships
Inability to work, study, worship, or care for oneself
Severe anxiety, depression, paranoia, agitation, or confusion
Compulsive or escalating use
Belief that the AI has coercive authority
Medication changes based on chatbot advice
Self-harm, suicide, violence, abuse, or exploitation concerns

Clergy should describe observable concerns rather than diagnose the person.

4. Emergency escalation

Immediate crisis resources

988 Suicide & Crisis Lifeline

In the United States and its territories, a person can call or text 988 or use online chat for confidential crisis support. A pastor may also contact 988 for guidance concerning another person. (988 Lifeline)

988 — Help Someone Else

This is the best resource for clergy supporting someone else during a crisis. (988 Lifeline)

NIMH — Warning Signs of Suicide

This identifies warning signs such as talking about wanting to die, unbearable guilt or shame, being a burden, hopelessness, making plans, withdrawing, giving away important belongings, severe mood changes, or taking dangerous risks. (National Institute of Mental Health)

NIMH — Five Action Steps

This should become the protocol’s emergency response core. (National Institute of Mental Health)

Emergency rule

Call 911 or local emergency services when there is imminent danger, a suicide attempt in progress, a specific plan with immediate access to lethal means, severe medical danger, violent behavior, or an inability to maintain immediate safety. NIMH directs people to 911 in life-threatening situations and to 988 for suicide or mental-health crises. (National Institute of Mental Health)

The protocol should direct the pastor, when reasonably safe, to:

Remain with or connected to the person.
Ask directly about suicide and immediate danger.
Involve 988 or emergency services.
Reduce access to lethal means without placing the pastor or others at risk.
Bring in a trusted family member or responsible adult when appropriate.
Avoid leaving the person alone during an imminent crisis.
Avoid promising absolute confidentiality.

5. Safeguarding notification

Children and mandatory reporting

Child Welfare Information Gateway — Clergy as Mandatory Reporters

This is the best national starting point for determining clergy reporting obligations. Requirements and clergy-penitent privilege exceptions differ significantly among states, so the toolkit should not make one universal legal claim. (Child Welfare Information Gateway)

Child Welfare Information Gateway — Mandated Reporting

This provides access to state reporting laws and related child-protection resources. (Child Welfare Information Gateway)

Online sexual exploitation, sextortion, or synthetic sexual images

NCMEC — CyberTipline and Exploitation Resources

The CyberTipline accepts reports of suspected online child sexual exploitation and routes information to the appropriate law-enforcement agency. (NCMEC)

NCMEC — Sextortion Resources

This is particularly relevant when a child or teenager reports threats involving real or AI-generated intimate images. (NCMEC)

NCMEC — Take It Down

This helps young people limit the online spread of nude, partially nude, or sexually explicit images without requiring them to upload the image itself. (Take It Down)

Vulnerable adults and older adults

Administration for Community Living — Suspected Abuse, Neglect, or Exploitation

This directs users to Adult Protective Services in the state where the older adult or vulnerable adult resides and recommends 911 when danger is immediate. (ACL Administration for Community Living)

Recommended church rule

When the disclosure concerns a minor, vulnerable adult, sexual exploitation, abuse, financial coercion, or immediate danger, the pastor should consult the applicable reporting law and denominational safeguarding procedure immediately. Internal church reporting must never substitute for a legally required report to civil authorities.

6. Documentation

Best professional spiritual-care source

Association of Professional Chaplains — The Impact of Professional Spiritual Care

This describes documentation of spiritual care, development of a care plan, collaboration within scope of practice, ethical conduct, and confidentiality. It states that documentation should contain information relevant to the care recipient’s well-being and contribute to coordinated care. (Association of Professional Chaplains)

Common Code of Ethics

This should govern confidentiality, respectful communication, professional conduct, and use of pastoral information. (Association of Professional Chaplains)

Privacy and HIPAA

HHS — Who Is Covered by HIPAA?

HIPAA applies to defined covered entities and business associates; it does not automatically cover every church or clergy relationship. A congregation should determine its actual legal status rather than claiming to be either “HIPAA compliant” or “not subject to privacy requirements” without analysis. (HHS.gov)

HHS — HIPAA Privacy Rule

This provides a useful privacy benchmark for protecting sensitive health-related information even where HIPAA does not formally apply. (HHS.gov)

What the pastoral record should contain

Document only what is necessary:

Date, time, location, and people present
The person’s own significant words, especially statements about harm or suicide
Observable behaviors and circumstances
AI platform or technology involved
Questions asked concerning immediate safety
Referral recommendations
Crisis or safeguarding consultations
Consent to contact family, clinicians, or others
Disclosures made and the legal or safety reason
Follow-up plan and responsible person

Avoid speculative diagnoses, pejorative theological labels, unnecessary intimate details, and unverified conclusions. Pastoral notes should not be entered into a consumer AI system or general-purpose chatbot.

7. Follow-up care

Best source

NIMH — Five Action Steps

NIMH explicitly includes follow-up as a core suicide-prevention action and notes that supportive ongoing contact can make a meaningful difference after a crisis or discharge from care. (National Institute of Mental Health)

SAMHSA — Find Help and Support

Use this to connect the person with continuing treatment, recovery support, family resources, and appropriate helplines. (SAMHSA)

Association of Professional Chaplains — Spiritual Care Standards

This supports a continuing plan of spiritual care developed collaboratively and within the chaplain or pastor’s scope. (Association of Professional Chaplains)

Follow-up should address

Whether the referral was successfully reached
Current safety and access to crisis resources
Changes in sleep, isolation, functioning, or AI use
Restoration of human relationships and community
Appropriate spiritual practices
Family or caregiver support
Boundaries around the chatbot or digital replica
A plan for relapse or renewed crisis
The pastor’s consultation and supervision needs

Pastoral follow-up complements rather than replaces clinical treatment.

8. Limits of clergy competence and confidentiality

Professional competence

Association of Professional Chaplains — Professional Ethics

The APC framework emphasizes competence, accountability, dignity, ethical practice, and professional boundaries. (Association of Professional Chaplains)

Association of Professional Chaplains — Standards

These standards reinforce that professional spiritual care is governed by defined ethical and competency expectations. (Association of Professional Chaplains)

Confidentiality and its limits

Common Code of Ethics

This supports confidentiality while recognizing that pastoral care operates within legal, professional, and organizational responsibilities. (Association of Professional Chaplains)

Child Welfare Information Gateway — Clergy Reporting Laws

This demonstrates why clergy cannot assume that every pastoral communication is legally privileged or exempt from reporting. The rules vary by state, the role in which the clergy member receives the information, and the nature of the communication. (Child Welfare Information Gateway)

Recommended boundary statement

The protocol should say:

Pastors provide spiritual care, relational presence, theological reflection, prayer, community support, and appropriate referral. Unless separately licensed and acting within that professional role, they do not diagnose mental illness, provide psychotherapy, prescribe treatment, independently determine that a chatbot caused a psychiatric condition, or promise confidentiality beyond the limits of law and church safeguarding policy.

At the beginning of a sensitive conversation, the pastor should explain that privacy will be respected, but information may have to be shared when someone faces immediate danger or when reporting is required by law or safeguarding policy.

Specialized sources for the scenarios named

Emotional dependency on an AI companion

These collectively address anthropomorphism, overreliance, emotional vulnerability, evidence, safety, and accountability. (American Psychological Association)

Harmful mental-health guidance

WHO urges caution concerning untested generative systems used for health information because of risks involving inaccuracies, bias, privacy, and misplaced trust. (American Psychological Association)

Belief that a chatbot is conscious or divinely inspired

Together, these allow the pastor to distinguish theological inquiry from emotional dependency, spiritual-authority claims, and possible difficulty distinguishing reality from fantasy. (National Institute of Mental Health)

Grief through a digital replica

NIH/PubMed Central — The Ethics of “Deathbots”

This peer-reviewed ethical analysis considers how digital simulations of the deceased may affect bereavement, autonomy, dignity, and the grief process. (PMC)

Philosophy & Technology — Griefbots, Deadbots and Postmortem Avatars

This peer-reviewed paper identifies risks involving consent, commercialization, manipulation, psychological distress, children’s exposure, and the need for transparent ways to end interaction with a postmortem avatar. (Springer Nature Link)

These are ethics sources rather than clinical treatment guidelines. The toolkit should therefore avoid claiming that griefbots are either inherently therapeutic or inherently harmful; their clinical effects remain insufficiently established.

Recommended decision-tree sequence

The integrated protocol can follow this order:

Is anyone in immediate danger?
Contact 911 or 988 and remain engaged.
Is a child, vulnerable adult, abuse victim, or exploited person involved?
Follow mandatory-reporting and safeguarding procedures.
Is reality testing, functioning, or personal safety significantly impaired?
Arrange urgent clinical assessment or early-serious-mental-illness referral.
Is there no immediate crisis, but meaningful emotional, relational, or spiritual harm?
Provide pastoral listening, assess functioning and dependency, establish boundaries, and recommend appropriate clinical support.
Is the issue primarily theological or spiritual?
Offer Christian discernment without treating the AI as a person, spiritual authority, or source of revelation.
Document the encounter appropriately.
Follow up and confirm connection to care.
Seek supervision or consultation when the pastor’s competence, legal obligations, or confidentiality limits are uncertain.