Brief interventions for managing suicidal crises

Brief interventions have been shown to be effective at reducing risk and helping people live through high-risk periods. When a person is in a crisis, cognition (thinking) becomes less flexible and they don’t have access to their usual ways of coping. This is not the ideal time to come up with solutions to reduce their pain and problem solve. The ultimate goal of these brief interventions is to prevent suicide with a short-term goal of providing options other than suicidal behavior. Each of these interventions offer alternate actions or activities that can be determined by the person so that they have their own self-selected (and therapist supported) strategies prepared and documented in advance. The person can invite a trusted person such as a family member or friend into the safety planning process as needed. These brief interventions provide solid options to use at different phases of a suicidal crisis and serve to help people through the desperation of wanting to stop the pain.

Review the brief interventions specifically for managing suicidal crises listed below and visit our interventions and treatments page to learn more about the benefits of long-term therapy and medications.

Safety Planning Intervention (SPI) was developed by Drs. Barbara Stanley and Gregory Brown and involves a collaboration between an individual and a mental health care provider. The Safety Plan is personal, unique and includes the individual’s identification of the thoughts, feelings and experiences just prior to a decline in mental health that they can learn may signal an impending suicidal crisis; and helpful and effective actions they have found helpful at earlier times of distress in their life. The Safety Plan steps can be written down or contained in one of many apps. It is most effective when an individual creates their plan with someone who is knowledgeable about the goals and components of a Safety Plan. The plan is feasible and accessible with the goal of providing options when the suicidal person may feel like there are none. A Safety Plan is personal and lists things the person will actually do when in distress. In this way, the person is actually trusting their own knowledge, being an expert on their own experiences and what helps them best. People are in fact using Safety Plans and research has shown that when they are used, suicidal behavior can be averted.

The Safety Plan Intervention involves:

• Warning signs that a suicidal crisis may be developing
• Specific things — activities and/or places — that will distract a person’s attention away from suicidal thoughts
• People who can help an individual distract themselves
• People with whom they can discuss their distress and suicidal thoughts and feel heard or supported
• Professionals available for consultation
• Emergency contacts such as the 988 Suicide & Crisis Lifeline (988) and the Crisis Textline (text ‘TALK’ to 741741) and other relevant help lines
• A plan to reduce access to lethal means in the home or immediate environment
• The person’s unique hopes for the future and reasons for living

The basic goal of Lethal Means Counseling (LMC) is to reduce risk of suicide by engaging the individual and/or family in securing and reducing access to every form of lethal means possible, especially in the home environment. If a person does not have access to lethal means they will not die from self-harm behavior. It’s about helping a person stay alive through a crisis and therefore removal of lethal means may be temporary. A suicidal crisis can escalate quickly and the time between the decision to end one’s life and taking action is often brief, even when people have thought about suicide for a long time. The crisis usually passes, and this allows the person to come back to a mental space where they can consider other coping strategies. Since it is difficult to predict when a suicidal crisis will occur and because in a suicidal crisis the individual develops tunnel vision and cannot see alternatives for ending the pain, putting time and distance between the suicidal person and lethal means can save a life. It allows for the crisis moment to pass, and also makes it more likely that a supportive person can intervene and provide help.

Lethal Means Counseling involves these steps:

• Express concern for the patient’s safety
• Let them know what they can do to create a safe environment
  • Remove or secure any type of lethal means from the home (or work) environment
  • This can include items such as firearms, medications (prescribed and over-the- counter), toxic substances like cleaning supplies, sharp objects
• Explain how lethal means safety works
  • Can’t predict crises
  • During moments of acute risk, need to reduce access to lethal means they have honed in on
  • People usually don’t switch quickly to a different method since thinking is less flexible in that moment
  • If attempt does occur, other methods are likely to be less lethal

Crisis Response Planning (CRP) was developed by Drs. David Rudd and Craig Bryan and focuses on understanding behavior, thoughts, feelings and health and environmental factors that predispose someone to suicide when faced with stressors, also known as triggers. Examples of predisposing factors include symptoms such as depression, anxiety, suicidal thoughts and substance use as well as difficulty with social skills, negative self-image, impulsivity and other maladaptive traits. When the person experiences and perceives significant stress they may over-react, under-react or engage in rejecting thoughts, feelings, actions and behaviors such as anger, fear, anxiety and self-harm. The suicidal crisis reflects ambivalence about staying alive. In the process of Crisis Response Planning, the individual provides a personal detailed narrative about how they got to their suicidal behavior in terms of risk factors, stressors, plans and preparations as well as the nature of their suicidal desire and ideation. Through collaboration, a written set of strategies is developed to be used as a reminder and tool for managing and surviving suicidal crises.

Crisis Response Planning components include:

• Personal warning signs
• Strategies for self-management
• Reasons for living
• Social supports
• Crisis / emergency steps