I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are ready to explore the fifth step, Professional and Agency Contacts to Help Resolve Suicidal Crises.

If the prior four steps are ineffective in resolving the suicidal crisis, the person in crisis is encouraged to contact a mental health professional (MHP) or helping agency.  Thus, the fifth step consists of identifying MHPs, helping agencies, or hotlines to assist the person in crisis.  List their contact information, their telephone numbers, and locations.

The list of MHPs or helping agencies can be prioritized. If the person is actively engaged in mental health treatment, the Safety Plan should include the name and phone number of this provider. However, the Safety Plan should also include other professionals or agencies who may be reached especially during non-business hours.

I strongly recommend the plan include the National Suicide Prevention Lifeline: 1-800-273-8255 (TALK).  If the person in crisis is a veteran, recommend they press 1 after they dial the other numbers.  This will take them to a person who understands veteran’s needs.

The person in crisis may be reluctant to contact MHPs and disclose their suicidal thoughts for fear of being hospitalized or rescued. The clinician should discuss the person in crisis’ expectations when they contact MHPs and helping agencies for assistance, then discuss any challenges in doing so. Are there any concerns or other obstacles that may hinder the person from contacting an MHP or helping agency? Only those MHPs whom the person is willing to contact during a crisis should be included in the Safety Plan.

In my next blog, we’ll cover the last step, Reducing the Potential for Use of Lethal Means.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are moving on to the fourth step, Social Contacts for Assistance in Resolving Suicidal Crises.

The first three steps are Recognition of Warning SignsInternal Coping Strategies, and Socialization Strategies for Distraction and Support.  If these three strategies are not effective in reducing the suicidal crisis, the next step in this process is encouraging the individual to ask for assistance from family members or friends.  This is the first time the individual may be revealing they are in crisis.

If the individual is working with a therapist or Chaplain, this is a great time to discuss with whom they might feel comfortable discussing their thoughts about suicide.  This could be a spouse/SO, close friend/buddy, Chaplain/faith leader, parent, sibling, or AA (or equivalent) sponsor.  Ask, “Among family or friends, who could you talk to during a crisis or when you are under a lot of stress?”

Two follow-up questions for this step are important. First, how likely is the individual to actually contact the person they have named?  Second, what are potential obstacles in contacting this person?  For example, perhaps the suicidal individual isn’t sure how to bring up the topic or fears the response they might receive.  Brainstorming or role playing possible words to use and potential responses may address these concerns.

It is a good idea to help the individual develop a short list of people they are willing to contact, in case their first choice is unavailable during the crisis.

In my next blog, we’ll cover the fifth step, Professional and Agency Contacts to Help Resolve Suicidal Crises.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are moving on to the third step, Socialization Strategies for Distraction and Support.

The first two steps are Recognition of warning signs and Internal coping strategies such as internal distractions – favorite music or movies, exercise, walking, hobbies, etc..  If these strategies are not effective in reducing suicidal ideation, Socialization Strategies encourage the individual to spend time in social settings as a way to distract themselves from their suicidal thoughts.  Being in social settings may also help the individual stop ruminating or worrying excessively about their current problems or challenges, and focus on something more positive.

What are some healthy options for socialization?  Spending time with friends and/or family is one option.  Other social settings might include places where people naturally gather, such as malls, coffee shops, libraries, book stores, parks, or at a public performance.  Also, attending self-help meetings such as a 12-step group or similar gatherings may be a positive distraction.

Places where alcohol or other substances are present would be locations to avoid in favor of healthier social settings.

In this step, the person with suicidal thoughts does not need to share these thoughts with the people with whom they are socializing.  Nor is this intended to be a way to seek help.  The purpose of this step is distracting the individual from their suicidal thoughts and life problems.  As a corollary, socialization may help individuals feel more connected with others or increase their sense of belongingness.

In my next blog, we’ll cover the fourth step, Social Contacts for Assistance.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are moving on to the second step, Internal Coping Strategies.

The question for the person considering suicide in this second step is “What can you do, without involving anyone else, if you begin thinking suicidal thoughts again?  What can you do to help yourself not act on those thoughts?”

Two benefits to this strategy are 1) developing their own list of coping strategies can boost their sense of self-efficacy and support the belief that they are able to overcome their suicidal urges and, 2) these coping strategies may serve as a distraction from their crisis and suicidal thoughts plus interfere with the suicidal thoughts escalating into actions.

Examples of internal coping strategies are displayed in the graphic above this article.

The effectiveness of these strategies or techniques will vary from person to person, so ideally the person themselves will be involved in developing their own individualized list.  This collaborative, problem-solving approach may also help build the rapport between the person and their healthcare professional, if they are working with one.

Remember that people may also use apps called MY3 and Safety Plan to develop their plan.  Both are free and available from the Apple app store or Google Play.

Once their list is developed, a further refinement would be to have the person select the top three options they are most likely to use.  Then, follow-up with “How likely are you to use these strategies in time of crisis?”  If any potential roadblocks are identified, help the person develop workarounds for the roadblocks.

Next, we’ll cover step three, Socialization Strategies for Distraction and Support.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are looking at the first step, Safety Plans: What am I looking for?

In 2005, The American Association of Suicidology published an acronym of major warning signs to look for:

I – Ideation

S – Substance Abuse

 

P – Purposelessness

A – Anxiety

T – Trapped

H – Hopelessness

 

W – Withdrawal

A – Anger

R – Recklessness

M – Mood Changes

In the early 1990’s I realized that the reason so many people say after a suicide that they had no idea their friend, relative, coworker, etc. was considering suicide was because they didn’t know the warning signs.  How can you know what to look for if you’ve never learned the warning signs?  So I began teaching courses on suicide awareness, detailing what to look for and what to do when you see these warning signs.

You may have heard a recording at your airport saying, “If you see something, say something.”  The same statement applies in suicide awareness.  If you see the signs listed above, do something – talk to the person, listen to them, help them get to a higher level of care – whatever that means in your situation.

Within the context of Safety Plans, we want people who are thinking about suicide to recognize these signs in themselves, and move on to the next step in the Safety Plan – Internal Coping Strategies.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract and The Safety Plan Initiative, and how it is an improvement over the no-harm/no-suicide contract.

The first step in the Safety Plan is recognition of warning signs.  Within the field of suicidology, we distinguish between warning signs and risk factors.  Warning signs apply only to individuals, and indicate an immediate risk for suicide.  Risk factors may apply to individuals or groups, and indicate a heightened risk for suicidal behaviors.

Think of what you’ve learned about heart attacks, perhaps thru public service announcements.  Risk factors for heart attacks include physical inactivity, obesity, high LDL cholesterol, and tobacco use.  For people who have these risk factors, their overall risk for a heart attack is higher, but not necessarily imminent.  Similarly, with suicide, risk factors include substance abuse, mood disorders, access to lethal means and prior attempt(s).  These signs mean the risk for suicidal behaviors is higher, but not necessarily imminent.

Warning signs, however, do indicate immediate risk.  In heart attacks, we’ve learned that chest pain, shortness of breath, nausea, and lightheadedness indicate a heart attack may be imminent.  Urgent action is highly recommended.  Likewise, in suicide, feelings of hopelessness, increased substance abuse, threats of self-harm, and seeking lethal means indicate suicidal behaviors may be imminent.

One of the things I have always emphasized in my writings and trainings is to please take both warning signs and risk factors seriously.  I believe we always want to err on the side of caution.

Next time, we’ll talk more about warning signs, and I’ll share an acronym to help remind you of the most important signs.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract and The Safety Plan Initiative, and how it is an improvement over the no-harm/no-suicide contract.

The Safety Plan consists of 6 steps:

Recognition of warning signs

Internal coping strategies

Socialization strategies for distraction and support

Social contacts for assistance in resolving suicidal crises

Professional and agency contacts to help resolve suicidal crises

Means restriction

For a copy of the Safety Plan form or for the manual, go to suicidesafetyplan.com and request access.  The Safety Plan form is also included in the manual, along with ‘brief instructions’ which are very helpful.  The manual is for the VA, but can be used in any setting.

Two points about the Safety Plan.  First, it can be completed either on paper, as referenced above, or there are at least 2 apps available for smartphones or tablets.  Due to the ease of use and the fact that most people carry their phones everywhere these days, I recommend the app version.

The 2 apps are named MY3 and Safety Plan.  Both are free and available from the Apple app store or Google Play.

The second point is the Safety Plan can be completed by the patient or client themselves or with a healthcare professional.  My recommendation is for the latter, as the healthcare professional can assist with brainstorming recommendations to complete the 6 steps, as you’ll see as we explore these steps in future blogs.

Next time, we’ll look at the first step of the Safety Plan: recognition of warning signs.

If you are interested in my upcoming trainings or background, or want to review my CV, please visit my website at criticalconcepts.org.

In my last post, Tear up that no-harm/no-suicide contract, I discussed contracts as a suicide prevention tool and recommended the Safety Planning Initiative (SPI) approach.  Developed by Stanley & Brown, the SPI process prompts the individual to develop an escalating series of self-care steps.

The Safety Plan has a distinct advantage over the no-harm/no-suicide contract because the Safety Plan helps patients develop a plan for how to care for themselves while the no-harm/no-suicide contract is a “promise” not to try to end their life.

The Safety Plan is often a collaborative effort between the healthcare professional and the patient or client, developing the lists of options for each step.  One method is to encourage the patient/client to write on paper what they intend to do at each step, using their own words (download a Patient Safety Plan Template).  There are also apps for smartphones that can be used to develop the plan digitally.  We’ll talk about the digital option further into this topic.

One of the aspects of SPI that I really like is that the plan is developed when the patient is not in acute crisis.  When someone is in acute crisis and actively contemplating suicide, the individual is often not thinking clearly.  In that state of mind, often referred to as “tunnel vision,” thinking of options regarding who to talk with or what to do to take care of myself can be very difficult.  Developing the strategy or plan before you need it makes a lot more sense.

Next, we’ll look at the first step of the SPI, recognition of warning signs.

If you are interested in my upcoming trainings or background, or want to review my CV, please visit my website at criticalconcepts.org.

 

Many of you are likely familiar with the venerable no-harm/no-suicide contract, also called a contract for safety.  Created in the early 1970’s, this tool was often used to prevent or delay an individual’s suicidal act.  Much has been written about this tool, both for and against it.

Originally, the oral or written no-harm/no-suicide contract was designed as a way to forge an agreement with an individual to not make a suicide attempt for a specific time period, and was based on the therapeutic relationship.  The healthcare professional asked the individual to promise to not attempt to take their life without reaching out to several individuals or organizations – typically the therapist, another individual, a suicide prevention hotline, 911, or the ED.

Over the years, the no-harm/no-suicide contract deteriorated almost to the point of an afterthought: “Hey, would you agree to not try and take your life before I see you again – I can’t let you leave until you do so.”  This may create an illusion of safety, and ignores the need for a therapeutic relationship between the patient and healthcare professional.

Problems with the no-harm/no-suicide contract include that it has no legal standing, may hurt a healthcare professional’s case if they are sued after the death of their patient, and the danger of healthcare professionals becoming complacent in its use, replacing a formal suicide risk assessment with the ‘contract’.

A “new” tool is replacing the no-harm/no-suicide contract.  The Safety Plan Initiative, or Safety Plan, is a multi-step process to assist suicidal individuals in developing a personalized plan before they need it.  Developed by Stanley & Brown, this process prompts the individual to develop an escalating series of steps for self-care.

Over the next several blogs, I’ll step you through developing a Safety Plan with individuals contemplating suicide (complete references available on request).

If you are interested in my upcoming trainings or background, or want to review my CV, please visit my website at criticalconcepts.org.

My last several posts have talked about resolutions or changes you may be trying to implement.  The last time, we talked about getting back on track when you lose your way.  This time, I have a couple suggestions, or ‘cheat codes,’ to assist you if you are struggling.

If you are struggling to stick with your goal(s), are you trying to change too much at one time?  If you are trying to change multiple habits at one time – like lose weight, quit smoking, get in shape – it may be helpful to focus on changing only one or two habits concurrently.  When you have succeeded at changing those first two habits, add another one or two.  Success often fuels success.

If your challenge is that your goal is too large or complex, try breaking it down into smaller ‘chunks.’  For example, writing a 15 page paper may seem overwhelming.  However, if you break this paper into smaller chunks, or goals, these smaller chunks feel easier to complete.  Divide that paper into sections – an introduction, a couple points in the body, and a conclusion.  Maybe you need a title page and a reference section or bibliography.  Now you have 7 smaller chunks.  Instead of writing “The Paper” (cue scary music), now you can focus on one small chunk at a time.

James Clear has a wealth of articles on habits and change behavior at JamesClear.com. In The 3 R’s of Habit Change: How To Start New Habits That Actually Stick, he recommends pairing a new habit with something you are already doing.  His example was starting the habit of flossing, and his tactic was to pair it with brushing his teeth, a habit he already had.  He facilitated his new flossing habit by placing flossers next to his toothbrush, making it easy to remember to floss after brushing.

If you are interested in my upcoming trainings or background, or want to review my CV, please visit my website at criticalconcepts.org.