Safety Planning for Suicide Prevention

Opinion statement

The Safety Plan was developed to help individuals at risk of suicide to prevent and/or manage suicidal crises. The risk of suicide is elevated for people with serious mental illness, that is, a mental illness that interferes with the ability to carry out one or more major life activities. Serious mental illness makes it difficult to think clearly, make decisions, and take positive action. In other words, it impairs executive functioning. A wide variety of diagnoses, including depression (unipolar or bipolar), borderline personality disorder, post-traumatic stress disorder, and schizophrenia, are associated with this kind of impairment. A Safety Plan in easy reach reduces the burden of problem-solving when a crisis is looming and the ability to think clearly is impaired. There is no need to figure out what to do to interrupt a darkening mood, because strategies that may help are already written out. There is no need to look up emergency contact information, because it has already been compiled. Essential as this information can be, a well-constructed Safety Plan is more than just a list of strategies and contacts. When the items are individualized and described in detail, they can be potent reminders of cherished memories, simple pleasures that give comfort, and people who care who are in reach and can be counted on to respond when needed. In other words, a well-constructed Safety Plan can reassure its owner that s/he is neither helpless nor alone. Since 2008, the construction of a Safety Plan has been mandated for every patient at risk of suicide at every facility under the auspices of the Department of Veterans Affairs (VA). Today, 8 years since the issuance of this mandate, VA clinicians have not only become accustomed to developing and reviewing Safety Plans in the medical record but also, as this review will suggest, begun to discover for themselves how helpful a Safety Plan can be. As it is not yet known which patients (e.g., with respect to age, sex, or diagnosis) are likeliest to benefit, or whether the impact varies with the timing of its construction (e.g., at time of discharge, or the day before), setting, (e.g., in the emergency department or the inpatient unit), and/or mode of delivery (e.g., in group or individual sessions), these and other questions that aim to optimize Safety Plan effectiveness merit further investigation.