SAN DIEGO—A safety plan is a powerful resource which mental health clinicians can develop with their patients to help prevent suicidal behaviors, a speaker at the Psych Congress 2019 Suicide Prevention 360 Pre-Conference said.
The plan is part of a clinical intervention which gives patients a written, predetermined set of strategies to use when they are in crisis, said Kelly L. Green, PhD, senior research investigator, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. It is designed to get patients through times of acute risk and get their minds off suicide before they make an attempt.
As with other emotional experiences, being at acute risk of suicide is not static and fluctuates over time, Dr. Green explained.
“Time is our friend. What we’re trying to do is give our suicidal patients an intervention they can use to procrastinate suicide and to let time do its natural work,” she said.
She likened safety planning to the “stop, drop, and roll” drill that teaches schoolchildren what to do if they ever catch on fire.
“It’s not very often that someone is going to be on the verge of a suicide attempt, but we want them to know what to do when they are and we want them to over-practice it so that it becomes really automatic,” she said.
Dr. Green outlined the steps in a specific planning tool, the Safety Planning Intervention (SPI) published in Cognitive and Behavioral Practice in 2012. The effectiveness of the intervention was studied in people at moderate risk of suicide who presented to a Veterans Affairs emergency department. The patients who received the intervention, as well as follow-up calls until they engaged in 2 sessions of care, were 45% less likely to have suicidal behaviors in the following 6 months.
The 6 parts of the SPI, outlined in a form to be filled out by the patient and clinician, are:
1. Identify warning signs.
2. Identify internal coping strategies.
3. Identify social contacts and social settings that can provide distraction from the crisis.
4. Identify family members or friends the patient can go to for help.
5. List professionals or agencies they can contact.
6. List ways to make the person’s environment safer.
Making a person’s environment safer could include changes such as getting rid of or removing access to excess medication, disassembling, unloading or locking away firearms, keeping copies of the safety plan visible, and getting rid of things that could be used to hang themselves.
“It’s all about creating that hesitation and that time and distance,” Dr. Green said.
Clinicians should assess patients’ use of the plan once it is completed and revise it over time if necessary. The quality of safety plans has been shown to influence their effectiveness, Dr. Green said.
Safety plans are different from “no-suicide contracts,” in which patients promise not to kill themselves before the next time they see their clinician. Dr. Green said those documents do not work and are not really contracts.
Patients see the contract as something to protect the clinician or their institution, and not the patient, she said. They also can give clinicians a false sense of security and might be done by clinicians because they are scared or anxious, Dr. Green said.
“It really asks the person to stay alive without helping them know how to do that,” she said. “We want to use safety planning as a way to help them know how to do that rather than just have them promise that they will stay alive.”
The daylong preconference, one of two Psych Congress 2019 preconference tracks, was presented in partnership with the American Foundation for Suicide Prevention as part of the Suicide Prevention 360 Initiative.
For more information, visit:
• Lethal Means Safety & Suicide Prevention - Options
• Safety Planning Intervention
• CALM: Counseling on Access to Lethal Means
“An Overview of the Safety Planning Intervention.” Presented at the Psych Congress 2019 Suicide Prevention 360 Pre-Conference: San Diego, CA; October 2, 2019.