Therapeutic Modalities

Risk Assessment / Safety Planning

What is Risk Assessment / Safety Planning

The collaborative development of a safety plan is a brief psychosocial intervention for suicidal patients. The intent of a safety plan is to help patients to lower their imminent risk of suicidal behavior. It provides patients with a specific and prioritized set of coping strategies which can be used in the event of a suicidal crisis, or should suicidal thoughts emerge. Clinicians unfamiliar with safety planning should note that it differs from a ‘no-suicide contract’ – empirical evidence that no-suicide contracts prevent suicidal behavior is poor, whereas there is emerging evidence that developing a safety plan is an evidence-based intervention for reducing suicide risk.

What is a safety plan?

A Safety Plan is a prioritized written list of coping strategies and sources of support patients can use who have been deemed to be at high risk for suicide. Patients can use these strategies before or during a suicidal crisis. The plan is brief, is in the patient’s own words, and is easy to read.

Who should have a safety plan?

Any patient who has a suicidal crisis should have a comprehensive suicide risk assessment. Clinicians should then collaborate with the patient on developing a safety plan.

How should a safety plan be done?

Safety Planning is a clinical process. Listening to, empathizing with, and engaging the patient in the process can promote the development of the Safety Plan and the likelihood of its use.
Implementing the safety plan. There are 6 steps involved in the development of a safety plan.

Step 1: Warning Signs

  • Ask: “How will you know when the safety plan should be used?”
  • Ask: “What do you experience when you start to think about suicide or feel extremely depressed?”
  • List warning signs (thoughts, images, thinking processes, mood, and/ or behaviors) using the patient’s own words.

Step 2: Internal Coping Strategies

  • Ask: “What can you do, on your own, if you become suicidal again, to help yourself not to act on your thoughts or urges?”
  • Assess likelihood of use: Ask: “How likely do you think you would be able to do this step during a time of crisis?”
  • If doubt about use is expressed, ask: “What might stand in the way of you thinking of these activities or doing them if you think of them?”
  • Use a collaborative, problem solving approach to address potential roadblocks and ID alternative coping strategies.

Step 3: Social Contacts Who May Distract from the Crisis

  • Instruct patients to use Step 3 if Step 2 does not resolve the crisis or lower risk.
  • Ask: “Who or what social settings help you take your mind off your problems at least for a little while?” “Who helps you feel better when you socialize with them?”
  • Ask for safe places they can go to be around people (i.e. coffee shop).
  • Ask patient to list several people and social settings in case the first option is unavailable.
  • Remember, in this step, the goal is distraction from suicidal thoughts and feelings.
  • Assess likelihood that patient will engage in this step; ID potential obstacles, and problem solve, as appropriate.

Step 4: Family Members or Friends Who May Offer Help

  • Instruct patients to use Step 4 if Step 3 does not resolve crisis or lower risk.
  • Ask: “Among your family or friends, who do you think you could contact for help during a crisis?” or “Who is supportive of you and who do you feel that you can talk with when you’re under stress?”
  • Ask patients to list several people, in case one contact is unreachable. Prioritize the list. In this step, unlike the previous step, patients reveal they are in crisis to others.
  • Assess likelihood patient will engage in this step; ID potential obstacles, and problem solve.
  • Role play and rehearsal can be very useful in this step.

Step 5: Professionals and Agencies to Contact for Help

  • Instruct the patients to use Step 5 if Step 4 does not resolve the crisis or lower risk.
  • Ask: “Who are the mental health professionals that we should identify to be on your safety plan?” and “Are there other health care providers?”
  • List names, numbers and/or locations of clinicians, local urgent care services.
  • Assess likelihood patient will engage in this step; ID potential obstacles, and problem solve.
  • Role play and rehearsal can be very useful in this step.

Step 6: Making the Environment Safe

  • Ask patients which means they would consider using during a suicidal crisis.
  • Ask: “Do you own a firearm, such as a gun or rifle??” and “What other means do you have access to and may use to attempt to kill yourself?”
  • Collaboratively identify ways to secure or limit access to lethal means: Ask: “How can we go about developing a plan to limit your access to these means?

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