August 10, 2022
Components
- Suicide Prevention, Intervention and Postvention
Resource Types
- Intervention
What is the practice?
Safety Planning Intervention is a brief intervention intended to provide people who are experiencing suicidal ideation with a set of concrete strategies to use in order to decrease the risk of suicidal behavior. The safety plan includes coping strategies that may be used and individuals or agencies that can be contacted during a crisis. The Safety Planning Intervention is a collaborative effort between a trained adult, an individual (student), and a guardian or parent. It takes about 30 minutes to complete. The basic steps of a safety plan include (a) recognizing the warning signs of an impending suicidal crisis; (b) using your personal coping strategies; (c) engaging in social settings or contacting others in order to distract from suicidal thoughts; (d) contacting family members or trusted adults who may help to resolve the crisis; (e) contacting mental health professionals or crisis responders; and (f) reducing the availability of means to complete suicide.
Who is the practice for?
Safety planning is conducted with people who have a history of suicidal behavior, recent history of suicidal ideation, or who have been determined to be at risk of suicide. The intervention has been used with diverse groups, with specific steps in the plan personalized to the individual’s unique experience. In schools, safety planning should be adapted to the age of the student, such as the use of the Gizmo story for elementary students.
What outcomes does the practice produce?
- Fewer suicide attempts
- More rapid decline in suicidal ideation
- Fewer inpatient hospital days; reduced risk of hospitalization
- Greater reduction in negative mood states and increase in positive mood
What is the evidence?
Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., et al. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900. https://doi:10.1001/jamapsychiatry.2018.1776
This cohort comparison study of Safety Planning plus follow-up calls versus usual care for individuals in emergency departments within the Veterans Administration due to suicide concern found (a) 45% fewer suicidal behaviors in the intervention condition in the 6 month period and (b) more than 2 times greater likelihood of attendance in outpatient treatment for those receiving safety planning.
Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., et al. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in US Army soldiers: a randomized clinical trial. Journal of affective disorders, 212, 64-72. 10.1016/j.jad.2017.01.028
Bryan, C. J., Mintz, J., Clemans, T. A., Burch, T. S., Leeson, B., Williams, S., & Rudd, M. D. (2018). Effect of crisis response planning on patient mood and clinician decision making: A clinical trial with suicidal US soldiers. Psychiatric Services, 69(1), 108-111. https://doi.org/10.1176/appi.ps.201700157
In this randomized, controlled trial of crisis response planning (similar to Safety Planning), crisis planning was compared to safety contracts within active duty military personnel. The study found (a) 75% greater reduction in suicide attempts for the intervention group compared to safety contracts; (b) a more rapid decline in suicidal ideation for those receiving crisis planning intervention; (c) fewer inpatient hospitalization days for those in the intervention group, and (d) a greater reduction in negative mood states and greater increase in positive mood for the intervention group.
Ferguson, M., Rhodes, K., Loughhead, M., McIntyre, H., & Procter, N. (2021). The effectiveness of the safety planning intervention for adults experiencing suicide-related distress: A systematic review. Archives of suicide research, 1-24. https://doi.org/10.1080/13811118.2021.1915217
This review examined 26 studies of safety planning intervention with adults. The review concluded that SPI is associated with improvements in suicidal ideation and behavior, decreases in depression and hopelessness, as well as reductions in hospitalizations and improvements in treatment attendance.
How is the practice implemented?
Typical training includes: (a) reading the safety planning manual (Stanley, B. & Brown, G., 2008) and reviewing the safety planning form; (b) attending a training in which the intervention, its rationale and evidence base are described; and (c) conducting role-plays or observation with feedback.
Who can implement the practice?
Providers with a wide range of professional backgrounds (e.g., nurses, psychologists, counselors, primary care providers, social workers) can be trained to implement Safety Planning.
What are the costs and commitments associated with becoming trained in this practice?
Costs include staff time for participation in training; program materials are available free of charge, with permission from the authors.
What resources are useful for understanding or implementing the practice?
- Visit the Safety Planning website at: https://suicidesafetyplan.com/
- Safety Planning in the VA (Stanley & Brown VA Safety Planning Manual, 2008)
- View Safety Plan template here
- Safety Planning webinars: (NASHPD August 2019) https://www.nasmhpd.org/content/ta-coalition-webinar-safety-planning-intervention-reduce-suicide-risk
- Joint Commission Safety Planning Video Examples (click below to see videos):
Rating: Promising
Secondary components: Grief and Trauma-Informed Practices
