values and attachments that inspire them to manage their current pain. ● Inspiring delay : Generally, the impulse to engage in suicidal behaviors is fleeting. By having the patient
delay action on the impulse, it could save their life. This includes having the patient reflect on things they may miss if they die, year by year.
Table 5. Psychotherapeutic Interventions for Addressing Suicidality Intervention Overview Cognitive-behavioral therapy (CBT) for suicide prevention (CT-SP)
Identifies a person’s biopsychosocial vulnerabilities that interact with suicidal thoughts and behaviors to produce a “suicide mode” (Center for Deployment Psychology, n.d.) Encourages the belief in one’s own ability to succeed, the ability to emotionally self- regulate, and interpersonal effectiveness (Prada et al., 2018); emphasizes the idea that patients must build a life worth living, even if they have problems in their life and wish to die (Sudak & Rajalakshmi, 2018) Six-session protocol that lowers distress and hopelessness, improves hope, and improves clinical retention to care (CAMS-Care, 2022); therapist and client work to keep patient stable and identify “drivers” that compel patient to suicide (CAMS- Care, 2022)
Dialectical behavior therapy (DBT)
Collaborative Assessment and Management of Suicidality (CAMS)
Problem-solving therapy Teaches and empowers patients to solve their here-and-now problems that are contributing to depression and helps increase self-efficacy (AIMS Center, 2021) Attachment-based family therapy Family therapy model aimed to repair attachment relationships or establish a secure base for adolescent development (Drexel University Center for Family Intervention Science, 2022) Other therapies Nonpharmacological interventions for the treatment of
Preliminary evidence has suggested that high doses of repetitive transcranial magnetic stimulation might rapidly decrease suicidal ideation and suicidal behaviors. This intervention is potentially useful in emergency or crisis scenarios to expeditiously address a patient’s ideations and intent (Columbia Lighthouse Project, 2016).
suicide include electroconvulsive therapy (ECT). For severely suicidal patients, ECT provides a quick response that may be lifesaving in the short term (American Foundation for Suicide Prevention [AFSP], n.d.). The ECT treatment can be administered in an inpatient or outpatient setting but requires anesthesia and the delivery of an electric current to the brain (AFSP, n.d.). Crisis hotlines There is substantial information that crisis telephone helplines, or crisis hotlines, reduce distress and suicidal behaviors in many callers (Washington State Department of Health [WA DOH], 2016). Crisis lines, which are available 24 hours a day, provide immediate access to crisis intervention, particularly for those who are unwilling or unable to have a face-to-face interaction with a mental health care provider Safety planning intervention A safety planning intervention (SPI) is a brief 30- to 45-minute clinical intervention when an individual is identified as being at risk for suicide. (Stanley & Brown, 2018). This intervention proposes that if individuals are provided tools that enable them to resist or decrease suicidal urges for brief periods, the risk for suicide is likely to decrease (Stanley & Brown, 2018). The target population for an SPI evaluation is those at increased risk for suicide who do not need immediate rescue (Stanley & Brown, 2018). Patients at this level of risk may have (Stanley & Brown, 2018): ● History of suicidal behavior (e.g., plans/preparations for suicide, suicide attempts, aborted attempts). ● Recent history of SI. ● Otherwise determined to be at risk for suicide. The safety plan includes a collaboratively identified coping strategy and a list of individuals or agencies that may be contacted during a crisis (Stanley & Brown, 2018). It prioritizes relying on internal, individual resources and
SAFETY PLANNING STRATEGIES
(WA DOH, 2016). In 2020, the Federal Communications Commission (FCC) adopted rules to designate a 988 dialing code that operates through the existing National Suicide Prevention Lifeline (NSPL). Finally launched in July 2022, dialing or texting 988 will now route the individual directly to the NSPL call center (FCC, 2022). expands to include the participation of external resources (e.g., supportive others) (Stanley & Brown, 2018). A 2018 study found that SPI with follow-up resulted in 45% fewer suicidal behaviors over a period of six months (Stanley & Brown, 2018). The basic steps of SPI involve more tasks than simply completing a safety plan form (see Table 6; Stanley & Brown, 2018). These include: ● Identify and assess suicide risk. ● Obtain the patient’s subjective crisis narrative. ● Provide psychoeducation around suicide and introduce safety planning. ● Identify warning signs that may indicate the beginning or escalation of a crisis and explain how to follow the steps that allow the individual to cope with the crisis before acting on suicidal thoughts. ● Complete the safety plan (see Figure 1 for the safety planning document). ● Implement the safety plan. ● Follow up with the patient to continuously assess their risk for suicide.
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