Safety Planning with Suicidal Individuals: A Quick Therapeutic Intervention Barbara Stanley, Ph.D....

Safety Planning with Suicidal Individuals: A Quick Therapeutic Intervention Barbara Stanley, Ph.D. Director, Suicide Intervention Center Beth Brodsky, Ph.D. Associate Clinical Professor of Medical Psychology Emily Biggs, M.A. Assistant Research Scientist New York State Psychiatric Institute Columbia University Department of Psychiatry College of Physicians and Surgeons

Suicide Statistics More than 35,000 people in the United States die by suicide each year Third leading cause of death in young people 10,000 more people die by suicide in the US than homicide each year Every day approximately 90 Americans take their own life These figures are probably an underestimate sometimes difficult to determine if a death is a suicide (e.g. automobile accidents) coroners will sometimes not identify suicide as the cause of death to protect the family

Demographics of Suicide Sex: Males are three to five times more likely to die by suicide than females. Age: Elderly Caucasian males have the highest suicide rates. Changing landscape

Suicide by Method (U.S. 2008) Source: CDC vital statistics

Suicidal Thoughts and Behavior among Adults Aged 18 or Older United States, 2008 2.3 Million Made Suicide Plans 1.1 Million Attempted Suicide 0.9 Million Made Plans and Attempted Suicide 8.3 Million Adults Had Serious Thoughts of Committing Suicide 0.2 Million Made No Plans and Attempted Suicide Source: SAMHSA National Survey on Drug Use and Health (NSDUH) * During the 12 months preceding the survey ^One or more times

Risk Factors for Suicide Psychiatric Disorders At least 90 percent of people who kill themselves have a diagnosable psychiatric illnesses: Major Depression Bipolar Disorder Schizophrenia Alcohol or drug abuse, particularly when combined with depression Posttraumatic Stress Disorder Bulimia or anorexia Borderline Personality Disorder

Risk Factors for Suicide Past History of Attempted Suicide Between 20 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made serious suicide attempts are at a much higher risk for actually taking their lives. Familial/Genetic Predisposition Family history of suicide, suicide attempts, depression or other psychiatric illness.

Suicide Attempts There are 3-10 suicide attempts for every suicide About 2,300 people in the US attempt suicide each day Underestimate Many attempts never come to the attention of mental health professionals or physicians Suicide attempts are the strongest known risk factor for suicide

Adult Suicidal Behavior and Ideation 3.7% of US population had serious suicide ideation in the prior year 1.0% made a suicide plan.5% made a suicide attempt 62.3% received medical attention for their attempts 46% stayed overnight or longer in the hospital

Question: Since we havent made much of a dent in the suicide figures, is it an impossible task?

Two Paths to Prevention of Suicide Large scale population prevention efforts: Public service announcements Hotlines Screening for individuals at risk Intervention with at risk individuals: Depressed Prior suicidal behavior Chronic suicide ideation Other forms of self injurious behavior

Suicide is not a random occurrence Most people who commit suicide have at least one serious psychiatric disorder People who commit or attempt suicide have considered over long periods of times Suicidal behavior runs in families The risk for both suicide and attempt suicide is greatly increased if a parent has engaged in the behavior. Brent et al. 2002 Offspring of attempters had a 6-fold increased risk of suicide attempts relative to offspring of nonattempters. If its not random then we have a good chance at preventing it

Components for Suicide Prevention Population- based Prevention Population Screening Identification & Assessment Emergency Care: ED and Hotlines Psychiatric Hospitalization Specialized Psychotherapy and Pharmacological Tx Brief Interventions: Safety Planning

Points of Intervention to Prevent Suicide Points of Intervention to Prevent Suicide Population Prevention Public Health Measures Population Prevention Public Health Measures Screening Screening Individualized Risk Assessment Triage/Referral Triage/Referral Hospitalization vs. Outpatient Care vs. Case Management vs. No Care Safety Planning Intervention (and other brief interventions to enhance safety Safety Planning Intervention (and other brief interventions to enhance safety) Treatment: Individual Treatment:

Rationale for Brief Interventions Identification is vital but then what???? Ongoing outpatient treatment is not for everyone- -- Been there, done that. Stigma. Not my cup of tea. Inaccessible. At risk individuals are difficult to engage in outpatient psychotherapy (Lizardi & Stanley, 2010; Trusz, et al., 2011)

Rationale for Brief Interventions Adolescents tend to have attitudes that are inconsistent with long term therapy: The past is the past. It wont reoccur. When mood improves, its hard for them to imagine that it could worsen again We have empirically supported psychotherapies but the rate of suicide has not decreased (WISQARS, 2012) ----Many reasons

Suicidal Individuals and Treatment 11% to 50% of attempters refuse outpatient treatment or drop out of outpatient therapy quickly (Kurz & Moller, 1984). Up to 60% of suicide attempters attend < 1 week of treatment post ED discharge (Granboulan, et al., 2001; King et al., 1997; Piacentini et al., 1995; Trautman et al., 1993; Taylor & Stansfield, 1984). Of those who do attend treatment, 3 months after hospitalization for an attempt, 38% have stopped outpatient treatment (Monti et al., 2003). High risk period---3 months following an attempt

Suicidal Individuals and Treatment After a year, 73% of attempters will no longer be in any treatment (Krulee & Hales 1988) Its important to intervene whenever they are accessible and most in danger (ex. ED)

Rationale.. Poor treatment attendance coupled with--- Period of high risk---about 3 months following an attempt and Period of high risk---about 3 months following an attempt and Sentinel event/teachable moment opportunity (Boudreaux, 2012); strike while the iron is hot Fills the missing spoke in the suicide prevention process LOW cost, LOW burden, easy to implement Therefore, its important to intervene whenever suicidal individuals are accessible and most in danger

Intervention with Suicidal Individuals More than 50% of suicidal individuals who commit suicide do so on their first attempt Many suicide attempts are not seen in the emergency room or other urgent care settings The most frequent professional contact prior to suicide is the primary care physician, not a mental health professional

Typical Strategy for Crisis Intervention Assess imminent danger Refer for treatment But, given the limited success of referrals, alternative strategies that include immediate intervention ought to be considered Crisis contact may be the ONLY contact the suicidal individual has with the mental health system May be able to increase its therapeutic capacity

Impact on Clinicians Working with suicidal individuals is inevitable Prior suicidal behavior increases risk but SI alone is also important Can cause anxiety and fear which may both improve and impair judgment Many clinicians are likely to experience a suicide of at least one of their patients > 1/3 therapists experienced extreme distress following patient suicide (Wurst et al, 2010) Clinician reactions to patient suicide---shock, guilt, shame, grief, fear of blame, self-doubt, anger, sense of betrayal

At the same time, its important to not expect miracles from brief interventions. They should be considered one aspect of suicide prevention, e.g. cholesterol lower drugs for cardiac disease.

New York State Office of Mental Health Bureau of Inspection and Certification Clinic Standards of Care Anchor Element http://www.omh.ny.gov/omhweb/clinic_standards/care_anchors.html

2.21 Safety Plan Standards: Adequate The clinic actively assists recipients to consider, and when desired, to develop an individualized safety plan that contains at least the following elements: Identification of triggers Warning signs of increased symptoms Management techniques or calming activities Contact information for supportive persons Plan to get emergency help if needed and Recipients are given a copy of their safety plan. and All at risk recipients have a safety plan developed with their input. and Clinic routinely educates recipients/ families about community supports as well as crisis services.

2.21 Safety Plan Standards: Exemplary (in addition to Adequate) The clinic has criteria for identifying a recipient at risk, has a safety plan developed with each of these recipients, and administration/ supervisor closely monitors those so identified. Safety plans are reviewed with the recipient periodically and when utilized; revisions are made as needed. The clinic actively assists recipients to consider and, when desired, to develop Wellness Self Management Plans, WRAP plans, Behavioral Advance Directives (BAD), or other mechanisms to support wellness and self determination. The clinic actively assists recipients to consider and, when desired, to develop Wellness Self Management Plans, WRAP plans, Behavioral Advance Directives (BAD), or other mechanisms to support wellness and self determination.

Safety Plan Standards: Needs Improvement No at risk recipients have a safety plan. or Safety plans are not individualized or created with the input of the recipient.

Origin of Safety Planning Intervention (Stanley & Brown) To maintain safety of high risk patients in outpatient treatment trials (Penn CT study for adults (Penn); TASA study for suicidal adolescents(Columbia)) Expanded and modified as a stand alone intervention for the VA and in civilian Eds Compilation of evidenced-based strategies- distraction, social support, means restriction

Theoretical Approaches Underlying SPI Three theoretical perspectives: 1. Suicide risk fluctuates over time (e.g., Diathesis-Stress Model of Suicidal Behavior, Mann et al., 1999) 2. Problem solving capacity diminishes during crises---over-practicing and a specific template enhances coping (e.g. Stop-Drop-Roll) 3. Cognitive behavioral approaches to behavior change (Emphasize on behavioral) Behavioral strategies to identify individual stressors that have precipitated suicidal behavior in the past. Therapist and patient collaborate to determine cognitive-behavioral strategies patient can use to manage suicidal crises.

Effectiveness of the Strategies used in SPI Treatment study using EMA Participants queried 6X/day before treatment about SI, coping strategies and effectiveness of strategies Four strategies reduced SI: Distracting activities; Socialization; Self-care/self- soothing; Focused on positive thoughts One strategy increased SI: sitting with the feelings

Safety Planning Intervention (SPI) To reduce suicide risk and enhance coping To increase treatment motivation and enhance linkage

Reconcile the Difference Between Clinicians Goal: Prevent suicide Suicidal Individuals Goal: Eliminate psychological pain via suicidal behavior

It is Critical to Communicate Ending the individuals emotional pain is an important goal and is possible. Coping skills can be identified and used effectively. Preserving the patients life is essential. Support and encouragement that therapy will be helpful.

The Basics of a Safety Plan What is it? What its not? When is it done? Who develops it? Why do it?

What is a Safety Plan? Prioritized written list of coping strategies and resources for use during a suicidal crisis Helps provide a sense of control Uses a brief, easy-to-read format that uses the patients own words Encourages a commitment to coping (and staying alive) Provides a way to survive and actively counteract a suicidal crisis; alternative to the white knuckle approach

No-suicide contracts ask people to promise to stay alive without telling them how to stay alive. No-suicide contracts may provide a false sense of assurance to the counselor and the institution. Safety Plan Intervention: What it is not? No-Suicide Contract Safety Plan Intervention: What it is not? No-Suicide Contract

Safety Plan: Why do it? Development and implementation of a safety plan IS treatment Should be the first intervention with a suicidal patient Helps to immediately enhance patients sense of control over suicidal urges and thoughts and conveys a feeling that they can survive suicidal feelings Similar to fire drill or rehearsal

Safety Plan: Who develops it? Developed in a collaborative manner between the mental health professional and the suicidal individual Relevant family members or friends can be involved Can be for long term or immediate use

Who Can Benefit from a Safety Plan? Patients who have made a suicide attempt. suicide ideation. psychiatric disorders that increase suicide risk. otherwise been determined to be at risk for suicide.

Safety Plan: When its done During the first contact It should be the first intervention with a suicidal patient For crisis counselors, it may be the only intervention If emergency rescue is not required Patient ends the interaction with at least a rudimentary strategy for coping with suicidal urges and ideation For ongoing treatment, the plan can be fleshed out in follow up appointments

Safety Planning Settings EDs, especially if individuals are not hospitalized Prior to discharge from inpatient facilities At intake and in ongoing outpatient care (e.g., counseling, case management, medication management) with individuals who struggle with suicidal crises Crisis call centers

Suicide Risk Curve: SPI used to prevent risk from rising too high

Typical Approach to Initial Outpatient Appointments Obtain presenting complaint Take psychosocial and psychiatric history Determine appropriate follow-up Schedule next appointment Treatment????

Typical Approach to Suicidal Patients in Acute Setting Assess imminent dangerconduct a risk assessment Triage---hospitalization vs. discharge to community If discharged, refer for treatment Is this approach acceptable with other problems presented in the urgent care settings?

Contrast the Urgent Care Patient with a Suicide Attempt and the ED Patient with a Fracture

Do we have an equivalent intervention for the suicidal patient?

Patient with apparent fracture Patient with apparent fracture Diagnose----exam and x ray Treat---apply a cast Refer for follow-up

What do clinicians need to know before implementing the SPI? SPI is relatively easy to learn and easy to implement BUT Clinicians have to remember this is NOT simply a form to complete; its a collaborative intervention Clinicians need training---In person trainings, webinars, VA manual, DVDs, Stanley-Brown article in Cognitive and Behavioral Practice, practice by doing role plays.

How Do You Do It? In a clinical setting, the clinician and suicidal individual should sit side-by- side, use a problem solving approach, and focus on developing the safety plan. The safety plan should be written.

Beginning the Safety Plan: Telling the Story The Safety Plan starts with the individuals warning signs; the story helps to identify them. Have individuals describe the events and situations and their reactions to these events in as much detail as possible that led up to the suicidal crisis. Beginning of the story: Major decision point associated with increased suicide risk Strong emotional reaction to a specific event External event such as a significant loss Internal event such as an automatic thought Follow backwards in time

Telling the Story 1.Understand the function of suicidal behavior or thinking from the patients perspective; that the behavior makes sense to the individual in the context of his or her history, vulnerability, and circumstances. 2.Empathize with the strong feelings and desire to reduce distress. 3.Refrain from trying to solve the individuals problems before understanding the motivations for suicide. 4.Dont rush the interview!

Developing the Plan After the risk assessment is done and the patient describes the suicidal crisis, the SPI can be developed Solicit agreement to develop a plan Explain the rationale for such a plan and when to use the SPI

Overview of Safety Planning: 6 Steps 1.Recognizing warning signs 2.Employing internal coping strategies without needing to contact another person 3.Socializing with others who may offer support as well as distraction from the crisis 4.Contacting family members or friends who may help to resolve a crisis 5.Contacting mental health professionals or agencies 6.Reducing the potential for use of lethal means 1.Recognizing warning signs 2.Employing internal coping strategies without needing to contact another person 3.Socializing with others who may offer support as well as distraction from the crisis 4.Contacting family members or friends who may help to resolve a crisis 5.Contacting mental health professionals or agencies 6.Reducing the potential for use of lethal means

Step 1: Recognizing Warning Signs Safety plan is only useful if the individual can recognize the warning signs. The clinician should obtain an accurate account of the events that transpired before, during, and after the most recent suicidal crisis. Ask, How will you know when the safety plan should be used?

Step 1: Recognizing Warning Signs Ask, What do you experience when you start to think about suicide or feel extremely distressed? Write down the warning signs (thoughts, images, thinking processes, mood, and/or behaviors) using the individuals own words

Step 1: Recognizing Warning Signs Examples Thinking Processes Having racing thoughts Thinking about a whole bunch of problems Mood Feeling depressed Intense worry Intense anger Thinking Processes Having racing thoughts Thinking about a whole bunch of problems Mood Feeling depressed Intense worry Intense anger

Step 1: Recognizing Warning Signs Examples Behavior Crying Isolating myself Using drugs Behavior Crying Isolating myself Using drugs

Step 1: Recognizing Warning Signs 57%Low mood/crying 36%Irritability/anger 43%Social Isolation 29%Increased sleep 29%Anhedonia/loss of interest in activities 29%Feeling overwhelmed 14%Feeling numb 14%Loss of energy 14%Changes in appetite 7%Physical pain 7%Anxiety 7%Poor concentration

Step 2: Using Internal Coping Strategies Identify activities that individuals can do without contacting another person Activities function as a way to help individuals take their minds off their problems and regulate their emotions Coping strategies prevent suicide ideation from escalating

Step 2: Using Internal Coping Strategies It is useful to have patients try to cope on their own with their suicidal feelings, even for a brief time Ask What can you do, on your own, if you become suicidal again, to help yourself not to act on your thoughts or urges?

Step 2: Using Internal Coping Strategies Ask How likely do you think you would be able to do this step during a time of crisis? 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

Step 2: Using Internal Coping Strategies Examples: Go for a walk Listen to inspirational music Take a hot shower Walk the dog

Step 2: Internal Coping Strategies 58%Watching TV 43%Reading 29%Music 21%Browsing the Internet 21%Video games 21%Exercising/Walking 14%Cleaning 14%Playing with Pets 7%Cooking

Step 3: Using Socialization as a Means of Distraction and Support Coach individuals to use Step 3 if Step 2 does not resolve the crisis or lower risk. Suicidal thoughts are not revealed in this step. Remember: socialization here is designed to take your mind off your problems. Two options in this step: Go to a healthy social setting Family, friends, or acquaintances who may offer support and distraction from the crisis.

Step 3: Socializing with Family Members or Others Ask Who do you enjoy socializing with? Ask Who helps you take your mind off your problems at least for a little while? Ask individuals to list several people, in case they cannot reach the first person on the list Identify social settings that people can go to in order to be around others; this is helpful if they do not have a lot of people in their lives Settings should be healthy (not bars)

Step 3: Healthy Social Settings Ask, Where do you think you could go thats a healthy environment to have some social interaction? Ask, Are there places or groups that you can go to that can help take your mind off your problems even for a little while? Ask individuals to list several social settings Remember to emphasize healthy settings, e.g. the local neighborhood bar is not usually a safe setting for suicidal individuals

Step 3: Social Settings that Provide Distraction 23%Bookstore/library/coffee shop 23%Gym 23%Shopping 23%Park 23%Church 15% Friend s Home

Step 4: Contacting Family Members or Friends for Help Coach individuals to use Step 4 if Step 3 does not resolve the crisis or lower risk Ask How likely would you be willing to contact these individuals? Identify potential obstacles and problem solve ways to overcome them Differs from prior steps in that in this step, people identify that they are in distress

Step 5: Contacting Professionals and Agencies Coach individuals to use Step 5 if Step 4 does not resolve the crisis or lower risk Ask Which professionals should be on your safety plan? Identify potential obstacles and develop ways to overcome them

Step 5: Contacting Professionals and Agencies List names, numbers and/or locations of: Clinicians Local urgent care services VA Suicide Prevention Coordinator (if VA patient) Crisis Hotline 800-273-TALK (8255), press 1 if Veteran or Service Member

Step 6: Reducing the Potential for Use of Lethal Means Ask individuals what means they would consider using during a suicidal crisis Regardless, the clinician should always ask whether there is access to a firearm; particularly problematic in the military

Step 6: Reducing the Potential for Use of Lethal Means For methods with low lethality, clinicians may ask individuals to remove or restrict their access to these methods themselves For example, if individuals are considering overdosing, discuss discarding any unnecessary medication

Step 6: Reducing the Potential for Use of Lethal Means For methods with high lethality, collaboratively identify ways for a responsible person to secure or limit access For example, if individuals are considering shooting themselves, suggest that they ask a trusted family member, friend or person in authority to store the gun in a secure place

Step 6: Means Restriction 50% Give pills to a friend or family member 20% Seek company 10% Place knife in a location that is difficult to access 10% Discard razor blades 10% Store pills at workplace 10% Avoid areas with bridges and trains when warning signs are present

Sample Safety PlanSample Safety PlanSample Safety PlanSample Safety Plan

Implementation: What is the Likelihood of Use? Ask, Where will you keep your safety plan? Ask, How will you remember that you have a safety plan when you are in a crisis? Ask, How likely is it that you will use the safety plan when you notice the warning signs that we have discussed? Ask, How can you fight the urge, if present, to avoid helping yourself?

Implementation: What is the Likelihood of Use? Ask, What might get in the way or serve as a barrier to your using the safety plan? Help the individual find ways to overcome these barriers. May be adapted for brief crisis cards, cell phones or other portable electronic devices must be readily accessible and easy-to-use. Identify cues to use the safety plan.

Implementation: Review the Safety Plan Periodically Periodically review, discuss, and possibly revise the safety plan after each time is it used and on follow up calls. The plan is not a static document. It should be revised as individuals circumstances and needs change over time.

Decide with whom and how to share the safety plan Discuss the location of the safety plan Discuss how it should be used during a crisis Safety Plan Use

Example of Safety Plan 1. Remove exacto knives, razors and scissors (Cleanse environment) 2. Go online and play Tetris (Internal) 3. Listen to IPOD (skip morbid tunes) 4. Go for walk in park contd.. contd..

Safety Plan (contd) 5. Call friends to check in and as distraction: Jennifer, Amy, Joanie (External people as distractors) 6. Contact grandmother or aunt Joanie to ask for help (External---low level, natural support group) 7. Contact therapist to ask for help---Phone and Pager #s (External) 8. Contact mother (External) 9. Go to ER---Name of closest hospital and address (External---Professional)

Important Caveats Individuals may not want to do one step; encourage them to try but dont insist on completing every step Sometimes people cant think of anything or anyone People know that certain strategies just dont work for them. Let individuals know that this is a tool to help them, and although there are prescribed steps, if they feel in imminent danger they should seek the level of care that will keep them safe.

What the Safety Plan Does and Doesnt Do It doesnt substitute for treatment It doesnt help if the individual is in imminent danger of committing suicide It does arm a person with strategies to fight suicidal urges It does increase the possibility of self-reliance

Adaptations Self administered SPI Workbook SPI Groups Buddy-to-buddy support when access to mental health professionals is limited Online, interactive version

Qualitative Evaluation Preliminary Findings: Veterans Participant Demographics (N=100) Average age: 45.13 + 13.9 91% Male 42% Black; 40% White, 9% 2+ race, 3% Asian, 1% Hawaiian Native or Pacific Islander, 5% other 77% Non-Hispanic

Qualitative Evaluation of SPI by Veterans: Acceptability When asked whether they remembered completing the safety plan in the ED: 98 participants remembered receiving the Safety Planning Intervention without prompting. Most participants (N=87, 88%) still knew where their safety plan was.

Qualitative Evaluation of SPI by Veterans: Acceptability (contd) Sixty-one percent of Veteran participants (n=61) had used the safety plan. Sixteen percent (n=10) used the safety plan daily; 66% (n=40) used it when they had a difficulty, and 16% (n=10) used it a few times. Those who used the safety plan said it helped them recognize their warning signs (n=13, 21%), reminded them of their internal coping skills (n=16, 26%), and/or facilitated reaching out to supportive or helpful personal contacts (n=24, 39%) or professional resources (n=28, 46%). When asked to rate their overall satisfaction with the safety plan on a scale of 1-5, with 1 meaning very satisfied and 5 meaning unsatisfied, Veterans gave the intervention an average score of 1.34 (sd= 0.54).

Qualitative Evaluation of SPI by Veterans: Perceived Effectiveness When asked which aspects of the safety plan were most useful, 99 Veterans offered the following responses: 82% (n=81) identified some component of the safety plan (e.g., identifying warning signs or contacts) 12% (n=12) identified the structure of the Safety Plan (e.g., having a written list of prioritized crisis survival skills) 12% (n=12) said feelings of self-efficacy provided by completing and using the Safety Plan 12% (n=12) said contact with the ASC When asked if any aspect of the safety plan was unhelpful, 95% (n=95) of participants said no. The five participants that did find aspects of the safety plan unhelpful said it was too long, repetitive; it did not target his or her anger management issue; the part about trying to think about something pleasant was unhelpful, and [its] too hard to do things when really depressed.

Qualitative Evaluation of SPI by Veterans: Impact Impact/Effectiveness: SAFE VET Most participants felt the safety plan and follow up calls were very helpful in making them feel connected to and cared for at the VA, though one individual felt the contact was a hassle. It helped a lot, because it's not like I came here and got pushed aside. I see that they really must be concerned because [the ASC] still calls me. When asked whether they would recommend participating in a safety plan and receiving follow up calls to a friend in the same position, most Veterans said they would. One offered, I would tell them it saved my life. The majority of participants felt the safety plan and follow up calls were very helpful in helping them attend follow-up appointments. It helped me not to be such a tough guy and actually go for the help that I needed.

Qualitative Evaluation of SPI by Veterans: Impact (contd) Most participants felt the safety plan and follow up calls were helpful in keeping them safe: I think the program saved my life actually. I wasn't actually paying attention much in the past, but [my clinician] pointed in the right direction. I probably wouldn't be here right now, to tell you the truth.

Suicidal Individuals Reactions I think it is very helpful, especially with people going through depression, with showing you and telling you how to use different coping skills when you are feeling depressed. Gave me the opportunity to more clearly define signs, when my mood is beginning to deteriorate and when to start taking steps to prevent further worsening of my mood. I like the safety plan. I could hang it on my room wall because I could look at it and it helps me remember how to deal with things. It hadnt occurred to me before that I could do something about my suicidal feelings.

Contacts and Resources Barbara Stanley, PhD [email protected]; 212 543 5918 [email protected]; 212 543 [email protected] Co-Developer: Gregory K. Brown, PhD [email protected] [email protected] Stanley, B. & Brown, G.K. Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral. Practice, Volume 19, Issue 2, May 2012, p. 256-264. www.suicidesafetyplan.com

Safety Planning with Suicidal Individuals: A Quick Therapeutic Intervention Barbara Stanley, Ph.D....

Documents

Transcript of Safety Planning with Suicidal Individuals: A Quick Therapeutic Intervention Barbara Stanley, Ph.D....