Step two identifies internal coping strategies that may have been effective previously in reducing thoughts of depression, loneliness, or suicide. This is the first of the brief lifesaving steps an individual can take when in crisis. As with all of the steps in the safety planning intervention, it is important to help elucidate as many options as possible. Further, clinicians should help patients consider what barriers may exist that would interfere with attempting any of the items on the safety plan or reduce the likelihood of its success. Options should be varied enough that at least one option is available in any situation. For example, going for a walk may be effective during the day or on the weekend, but it may not be the safest approach if a crisis emerges at 2:00 a.m. Realistic alternatives should be available for all situations. 3. Utilizing social contacts as a means of distraction from suicidal thoughts : The next step involves patients identifying people or places where socialization is likely to happen. The idea is that if internal strategies were not successful at alleviating the suicidal crisis, the patient should next try distraction from the suicidal thoughts through socializing. Stanley and Brown (2012) list examples of social contacts such as spiritual centers, coffee shops, Alcoholics Anonymous meetings, and workout classes. Step three is built upon the finding that most suicidal crises are short-lived; identifying distractions can be helpful in getting a suicidal individual through a crisis (Stanley & Brown, 2012). Further, an underlying theme in the National Strategy for Suicide Prevention (U.S. Department of Health & Human Services, 2012) is that connection with others is perhaps the greatest protective factor. Strategies for this step can include entering distracting situations or engaging with individuals with whom the patient can spend time, even if the topic of the suicidal crisis is not a part of the conversation. The goal is simply to put the suicidal individual in the presence of others, with
the hope that a sense of connection will trigger lifesaving cognitions. 4. Contacting family members or friends who may help to resolve the crisis : If the previous three steps have been unsuccessful in reducing the crisis, then patients should reach out to others and let them know that they are in a crisis and need help and support. If possible, the patient should share the safety plan with the individuals named in this step. Step four takes step three further by including people the patient could talk to when feeling down, depressed, or suicidal. There should be as many people as possible on the patient’s list. One concern is that if a patient consistently approaches the same friend when feeling suicidal, that friend may eventually become overwhelmed and start to withdraw. This withdrawal may lead patients to a greater sense of isolation and hopelessness, two feelings suicidal individuals should avoid during a crisis. Additionally, individuals listed in Step 4 should be upbeat and able to help foster a sense of hope. Individuals who are being added to the list should be made aware of their role in the patient’s safety plan, and if they feel unable to be of help during a time of crisis, the patient should seek alternatives. 5. Contacting mental health professionals or agencies : In this step, the clinician and patient work together to create and prioritize a list of professionals or other services that could be helpful to the patient when he or she is in distress. This list could include the patient’s current treatment provider (if he or she has one), contact information for local 24-hour emergency treatment facilities in the area, and local or national services, such as the National Suicide Prevention Lifeline (1-800-273-TALK [8255]) and the Crisis Text Line (741- 741), professional agencies and resources that are available to the suicidal youth at any hour of the day. This section may also include local emergency departments, or 911.
Table 5: Safety Planning Intervention Steps Safety Planning Step Detailed Considerations Step 1: Warning signs that a crisis may develop.
• What are the thoughts, feelings, images, behaviors, and/or situations that precede suicidal thoughts or behavior? • When do I need to access my safety plan? • Making the environment safe: which methods for suicide are accessible at home? • How might these methods be best stored or removed (e.g., throw away old medications or remove firearms from the home)? • What can I do to take my mind off my problems without having to contact others? (e.g., relaxation, listening to music, and going for a walk) • Who can I hang out with when I am feeling down, depressed, or suicidal? ◦ Write down names and phone numbers for all possible contacts. • Where can I go to hang out that will prevent me from being alone when I am feeling down, depressed, or suicidal? ◦ Write down names of places. • Write down names and phone numbers for people who the patient can contact when feeling down, depressed, or suicidal. ◦ This should include upbeat and positive individuals who can provide a sense of hopefulness. ◦ For youth, this list should not only include the names of peers, but also adulty contacts such as parents, extended family, teachers, and faith or community leaders.
Step 2: Internal coping strategies. Step 3: People and social situations that provide distraction. Step 4: People who can be accessed in a time of crisis. Step 5: Professionals or agencies that can be contacted during a crisis.
Write down the names and phone numbers for all contacts. ◦ Therapist/Clinician (including any pager numbers or after-hours numbers). ◦ Local crisis centers/urgent care centers. ◦ National Suicide Prevention Lifeline (1-800-273-TALK/1-800-273-8255). ◦ Local emergency department (including address). ◦ 911.
Note . Adapted from Safety Plan Treatment Manual to Reduce Suicide Risk: Veteran Version, by B. Stanley and G. K. Brown, 2008, New York, NY: New York Suicide Prevention Center, Department of Psychiatry: Columbia University & New York State Psychiatric Institute; and “Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk,” by B. Stanley and G. K. Brown, 2012, Cognitive and Behavioral Practice, 19(2), pp. 256- 264.
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Book Code: PYCA1423
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