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Safety Plans are Effective at Reducing Suicidal Behavior. So Why Aren’t More People Getting Them?

Safety Plans are Effective at Reducing Suicidal Behavior. So Why Aren’t More People Getting Them?

Every year roughly 12.3 million people struggle with suicidal thoughts, yet the vast majority don’t receive the life-saving intervention they desperately need. According to a recent study released by the Joint Commission, 39% of Joint-Commission-accredited hospitals didn’t implement safety plans during the discharge process for those admitted with suicidality. These straightforward documents outline warning signs of suicidal ideation, coping strategies, and support networks individuals can contact when they are in crisis. Only 19% incorporated every component of safety plans, as laid out by the Joint Commission, and only 4% met the full criteria for implementing recommended suicide prevention activities at the time of discharge.

Considering that a person is at greater risk of attempting suicide in the days and weeks post-discharge, and that safety plans can reduce suicidal behaviors by 43%, this is unacceptable. Safety plans are a critical tool to save lives and prevent harmful escalations that lead to costly emergency room visits and inpatient stays.

As a result of this study, the Joint Commission is looking into making safety plan and suicide prevention recommendations part of its requirements for accreditation. This is imperative, as the life-saving impact of safety plans are clear.

How can I create a safety plan?

The goal of a safety plan is to provide the tools an individual needs during a crisis so that they can access help and stay alive. The Joint Commission outlines several elements that a safety plan must cover. It should help individuals:

  • Identify and document warning signs
  • Document internal coping strategies
  • Identify people and social settings that provide positive distractions
  • Identify personal contacts to ask for help as well as professionals to contact during a crisis
  • Develop a plan for lethal means safety.

In addition to creating a safety plan, which is typically a simple, one-page document, the Joint Commission recommends providing warm handoffs to outpatient care and following up with patients after discharge. Despite the efficacy of these straightforward documents, they are sorely underutilized – only 8% of hospitals incorporated all of the recommended practices, including creating a safety plan, developing a plan for lethal means, providing a warm handoff to outpatient care, and following up with patients post-discharge.

Why are safety plans overlooked?

In my fifteen years of working with individuals struggling with suicidal thoughts, the absence of safety plans always struck me as surprising. Based on my experience, those without safety plans are more likely to be impulsive and isolated during crises. For instance, I recall a teenage girl who had recently attempted suicide telling me that she didn’t reach out to someone because she didn’t know who would care. A safety plan would have made that clear.

Despite the effectiveness of safety plans, and the relative ease with which they can be created, there are systemic barriers to their implementation.

For one, many healthcare organizations rely on antiquated methods like in-person screeners to determine who could benefit from a safety plan. While this approach is certainly better than nothing, it relies on individuals physically showing up for appointments and being willing to answer personal questions openly and honestly. Reliance on these in-person screeners also exacerbates discrepancies in access to healthcare for marginalized communities, as they often have less access to insurance and transportation.

Lack of training also makes it difficult for individuals to receive safety plans. One study showed that 70% of mental healthcare providers indicated a desire for more training on safety plans. This may indicate that many health care professionals lack confidence in developing safety plans, which means that fewer individuals at risk will receive them. 

Perhaps the greatest barrier to individuals accessing safety plans is our overburdened healthcare system. Healthcare professionals in hospital settings are constantly triaging patients with complex physical and mental healthcare needs. Recently, I spoke with a doctor who lamented about having to prioritize patients with physical concerns over those with mental ones. While this decision is understandable, it leads to fewer safety plans and more suicide attempts, which means costly mental and physical healthcare services down the road.

 How to implement the Joint Commission’s recommendations

Safety plans are only effective if we can get them into the hands of the right people. That is why we must enhance accessibility to suicide screening. This is where advancements in technology can play a major role. Instead of depending solely on in-person screeners, remote tools can enable people to take assessments from their own homes using their preferred device. This approach not only removes the barriers associated with transportation and insurance, but it also fosters a more comprehensive understanding of risk for individuals within large and diverse populations. 

In addition to making suicide screening more accessible and widespread, successful implementation of safety plans is critical. Here are a few general recommendations that care teams can implement:

  1. Take time to explain the purpose of the safety plan and how it can be used to prevent the escalation of suicidal thoughts and behaviors. 
  2. Explore ways that the individual can easily access their safety plan. Some examples include making it a “favorite” picture on their phone or keeping it in their pocket. 
  3. With permission, involve another person in the construction of the safety plan. Including a parent, partner, or friend can help the individual consider alternative ways to keep themselves safe and remind them of the people they can rely on when distressed.

Safety plans are a critical component of suicide prevention and every person experiencing suicidal ideation should have access to this resource. Organizations motivated to save lives and precious resources have a new tool at their disposal. Technology can seamlessly connect at-risk individuals to much needed assessments and support and make safety plans a widespread resource for those experiencing suicidal ideation. This will result in more safety plans being used, fewer suicide attempts and ED utilization, and countless lives saved. 

Photo: Wacharaphong, Getty Images

Blaken Wamsley, LMFT is a clinical supervisor with over 15 years of experience in mental health support for children, families, and adults in crisis. His passion lies in suicide prevention and holistic mental wellness, informing his efforts at NeuroFlow to support individuals at risk of suicide.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

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