Patients on suicidal precautions in a treatment setting should be closely observed by clinical staff. As it stands, suicides of persons in a treatment setting are still reported as sentinel events in the clinical setting. In most clinical settings, suicidal patients are assigned a dedicated “sitter” to watch them; this intervention often decreases the need for restraints in most patients. The use of family members is highly discouraged because family members may connive with patients to make plans for escape, or if they see a patient leaving, they may not try to stop him or her (Kazim, 2017). Mechanical and chemical restraints should be used judiciously in suicidal patients and minimized when possible. However, their use may be essential and potentially lifesaving in violent and uncooperative patients. All restrained patients must be assessed frequently, sometimes hourly. Often, medical staff must document the restrained patient’s neurovascular status. The need for restraints should be reevaluated daily (Kazim, 2017). For patients who are deemed to be below imminent suicide risk (e.g., risk may be high, but intent may be low), but who still have developed suicide plans, the next-most important step in suicide intervention is to take away any possible lethal means accessible to the patient (Stanley, Hom, Sachs-Ericsson, Gallyer, & Joiner, in press). In order to make the patient’s environment safe, clinicians must know which methods for suicide are accessible at home or easily accessed elsewhere. Making the home environment safe includes discarding any unused medications, securing firearms, identifying other potential methods for suicide, and reducing access. Securing any potential firearms in the home is particularly important, given the high frequency of firearm use in death by suicide (Anestis & Anestis, 2017; Houtsma, Butterworth, & Anestis, 2018). Even if no specific plan is identified by patients, a key component of the safety plan involves eliminating or limiting access to any potential lethal means in the environment. Safety planning intervention Originally developed for the U.S. Department of Veterans Affairs, the safety planning intervention (Stanley & Brown, 2008, 2012, 2018) is a brief intervention designed to assist suicidal individuals if a suicidal crisis emerges. It differs dramatically from traditional “no-suicide” contracts in that the safety plan provides information and instruction for suicidal individuals about what to do during a crisis. Conversely, “no-suicide” contracts only state what not to do, and have no evidence supporting their use in reducing someone’s suicide risk (Edwards & Sachmann, 2010; McMyler & Pryjmachuk, 2008). Safety plans should typically be conducted following a comprehensive suicide risk assessment, utilizing data focused on warning signs, triggers, and protective factors. During the intervention it is recommended that the clinician and patient should sit side by side. All responses should be written in the patient’s own words and be clearly legible. In fact, it is often helpful to have the patients fill out a safety plan template in their own writing. The brief instructions of what to do during a crisis can then be adapted to a format that can be carried at all times. The patient may store the written safety plan in a wallet or purse, or keep a photo of the completed safety plan on his or her cellphone. This is particularly helpful for youth, who have their cell phones with them at most times. Outpatient suicide risk interventions Reducing the potential for use of lethal means Stanley and Brown’s brief safety planning intervention, estimated to take 20 to 45 minutes, also provides patients with a prioritized and specific set of coping strategies and sources of support that can be used should suicidal thoughts reemerge. The intent of the safety plan is to help individuals lower their imminent risk for suicidal behavior by consulting a predetermined set of potential coping strategies and a list of individuals or agencies they may
Patients who are eventually discharged from the inpatient setting must have appropriate outpatient follow-up with mental health providers. Follow-up should be scheduled as soon as possible within a few days of discharge. Given that compliance with follow-up appointments may be low, professionals are highly encouraged to use family members to help patients comply. Professionals should also engage family members and friends to help reduce a patient’s access to lethal means of suicide as a strategy to mitigate the prevalence of self-injurious behaviors. This includes removing potential means of suicide from the home such as guns, medications, or other toxic substances. Pay special attention to the patient’s documented suicide plan and implement appropriate interventions. Finally, appropriately document the patient’s progress in the inpatient setting to help guide and inform decisions in the outpatient setting (Kazim, 2017). This may include safely storing and dispensing of medication, implementing firearm safety procedures, or restricting access to knives or other lethal means (Stanley et al., in press). Clinicians can find out which means are available and under consideration by asking patients about the methods they have thought of using for a suicide attempt. Then, with the patient, they can “collaboratively identify ways to secure or limit access to these means” (Stanley & Brown, 2012, p. 260; Stanley et al., 2018). Given the high rate of suicide deaths by firearms in the United States, the clinician should inquire about access to firearms even if the patient does not indicate that this would be a preferred method (Stanley & Brown, 2012). The plan for restricting means, including determining who will store dangerous items, how, when, and for how long items will be stored, should all be noted on the safety plan. Enlisting family members’ support for plan this is a possibility. averted. Table 5 provides an overview of each step for a quick reference. 1. Recognition of warning signs : The first step is to help the patient recognize signs that indicate a suicidal crisis is impending. These warning signs could include “personal situations, thoughts, images, thinking styles, moods, or behaviors” (Stanley & Brown, 2012, p. 258). For example, a patient may identify problematic situations such as arguments with a partner, thoughts such as, “I can’t take it anymore,” images of overdosing, depressed or agitated mood, and/or behaviors like drinking more than usual or refraining from social activities. A good review and history of prior crises can help generate a list of thoughts, feelings, behaviors, or images that may trigger suicidal behaviors. This step could essentially be renamed: “When do I need to pull out my safety plan?” This step also includes discarding any unused medications, securing firearms, and identifying other potential methods for suicide and reducing access. When working with youth, this step can be conducted with both the adolescent and his or her parent(s). 2. Employing internal coping strategies : As noted, “In this step, patients are asked to identify what they can do, without the assistance of another person, should they become suicidal again” (Stanley & Brown, 2012, p. 259). Examples of these strategies include taking a shower, going for a jog or walk, doing a puzzle, partaking in a hobby, playing an instrument, listening to feel-good music or watching a feel- good television program, or playing with a pet. Typically, activities are more helpful if they require attention, are soothing, involve physical activity, foster belongingness, and/or have worked in the past. Clinicians can work with their patient to pick a few activities that seem most helpful and list them in the order the patient would likely try them.
contact (Stanley & Brown, 2012). Five steps of safety planning
There are five basic steps of the intervention, and these steps should be engaged in sequentially until the suicidal crisis is
EliteLearning.com/Psychology
Book Code: PYCA1423
Page 84
Powered by FlippingBook