Table 6. Safety Planning Intervention Steps Step Goals
Communication
6. Making the
• Explain that having access to lethal means places the individual at greater risk for suicide and does not allow enough time to use the coping strategies or sources of support listed on the safety plan. • For each method that is identified, determine the individual’s access to the lethal means and collaborate to find voluntary options that reduce access to the lethal method and make the environment safer.
• Express concern about the patient’s safety and explain that making the environment safer will help to lower risk of acting on suicidal feelings. For some individuals who attempt suicide, the interval between thinking about and acting on suicidal urges is usually a matter of minutes. • For each lethal method, ask, “What can we do to make the environment safer?” • Ask, “How likely are you to do this? What might get in the way? How can we address the obstacles?” • If doubt is expressed about limiting access, ask, “What are the pros of having access to this method and what are the cons? Is there an alternative way of limiting access so that it is safer?”
environment safe and reducing the availability of means to complete suicide:
Note : Adapted from Stanley, & Brown (2018). Stanley, B., & Brown, G. K. (2018). The safety planning intervention to reduce suicide risk for people with SMI [PowerPoint slides]. Substance Abuse and Mental Health Services Administration. https://www.nasmhpd.org/sites/default/ files/SAMHSA%20SPI%20SMI%20PPT%20final_2.pdf
An example form used for a safety planning intervention follows (Stanley & Brown, 2021). This plan should be developed collaboratively with the individual. Whenever possible, the patient should complete the form themselves, and the health care professional should provide clarification and ensure that the plan is achievable. Once the safety plan is completed, review the entire plan with the patient (Stanley & Brown, 2018). Inform the patient that it is not necessary to follow all the steps before reaching out for help. The clinician should provide a copy to the patient and discuss a specific location the patient will keep it. It should be a location that makes sense for the individual patient (e.g., bedside table, bathroom mirror, wallet). At follow-up visits, periodically review the safety plan.
Figure 1: Stanley–Brown Safety Plan
Note: From Stanley & Brown (2021). Stanley-Brown safety plan [Graphic]. Stanley–Brown Safety Planning Intervention. https:// bgg.11b.myftpupload.com/wp-content/uploads/2021/08/ Stanley-Brown-Safety-Plan-8-6-21.pdf Medications: ● Never keep lethal doses of any medication on hand. ● Consider keeping medications locked in a safe place. ● Properly dispose of medications that are no longer needed. Firearms: ● Keep firearms locked and unloaded in a safe and ammunition stored in a separate location. ● Ask a friend or family member to store a firearm for a while. ● Unloaded firearms can also be secured with a gun- locking device, making them unusable.
Strategies to reduce access to lethal means The conceptual model of reducing access includes means restriction, which results in the individual either substituting or delaying the attempt. This substitution or delay results in fewer fatal attempts, and often the suicidal crisis even passes, ultimately resulting in a drop in the overall suicide rate (WA DOH, 2016). Health care providers should educate patients on how to make their family members and homes safer by reducing access to medications and firearms (Harvard School of Public Health, 2021; National Action Alliance for Suicide Prevention, Lethal Means Stakeholder Group, 2020):
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