Safety Planning for Suicide Prevention in the Emergency Department

Over the past couple of weeks, Ive had the privilege of offering a suicide prevention training to my social work colleagues at Beth Israel Deaconess Medical Center (BIDMC) in Boston. Hospital social workers help patients and their families through the emotional and practical issues that may come up during time in the hospital. At BIDMC, we have social workers on medical and surgical floors and in the emergency department, those who specialize in working with women whove just given birth or who are in the hospital for gynecological procedures, those whove spent years working with cancer patients, and those who work with patients in acute mental health crises. I share all of this to say that, as is often the case in my work, suicide prevention in emergency settings has been on my mind. Even as I trained staff in risk and protective factors and safety planning, I found it hard to translate some of the tried-and-true concepts of suicide prevention to a setting in which people are often in and out quickly. Thats why I was happy to see new research on safety planning in emergency settings. The Safety Planning Intervention (SPI) offers the chance for patients and clinicians to work together to determine practical steps a patient can take in a suicidal crisis. According to the research brief in the Suicide Prevention Resource Centers (SPRC) e-newsletter, the SPI was developed as an alternative to two interventions often used for suicidal patients whose condition is considered not serious enough for hospitalization: (1) providing the patient with a referral to mental health services (which he or she may not use) and (2) creating a no suicide contract (an intervention which has never been rigorously evaluated and shown effective). What can clinicians and patients look at together?

 What are the warning signs of an impending suicidal crisis? What thoughts, moods, thinking styles, and behaviors are going on when thoughts of suicide occur? What are coping strategies that can be done alone, in case there isnt anyone to turn to immediately? When there are people to turn to, who are those people? What social settings could someone go to that might help them feel better? (These social contacts and settings are used for distraction from suicidal thinking, not crisis intervention.) When a crisis is imminent, who is a trusted person to be honest with about being in a suicidal crisis? What mental health providers are available? How can help be sought? What lethal means (or methods for attempting suicide) can be restricted, and how? The authors of the article (citation below) emphasize that the SPI should be as detailed and as concrete as possible. Given that I had just talked up the benefits of collaborative safety planning with our social work staff, Im very pleased to see this new tool, which is now in the Best Practices Registry, coordinated by SPRC, and the American Foundation for Suicide Prevention. I see the SPI building on existing safety planning resources and approaches. In particular, I am glad to see acknowledgment that referral to a mental health provider and no suicide contractsvery vague interventions that often, unfortunately, go nowheremight be replaced by more concrete and patient-empowering strategies. Citation: Stanley, B., & Brown, G. (2012). Safety Planning Intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264.