MN661 Unit 9 safety planning document example

Safety Plan and Rationale Using the Stanley-Brown Safety Planning Intervention for a 44-Year-Old Contractor After Separation

[Student Name]

Purdue University Global

MN661: PMHNP Psychopathological Disorders and Psychotherapy

Unit 9 Assignment

[Instructor Name]

[Date]

Composite patient written as a model document. Every name, number and place that could identify a person is bracketed.

Part 1: The Plan, in His Words

Step 1. Warning signs that a crisis may be starting: "Sitting in my truck in the driveway after dark and not going inside. Not answering my brother's texts. Drinking alone after work."

Step 2. Things I can do on my own to take my mind off my problems: "Walk the dog around the reservoir. Work on the carburetor in the garage. Listen to the ball game on the radio."

Step 3. People and places that help me get my mind off things: "[The diner on Route 9] for breakfast. [My cousin's garage] on Saturday mornings."

Step 4. People I can ask for help: "[Brother's name], [phone number]. [Friend from the crew], [phone number]."

Step 5. Professionals and agencies I can contact: "[My clinician at the outpatient clinic], [phone number], weekdays. 988 Suicide and Crisis Lifeline, call or text 988, any time. [Nearest emergency department], [address]."

Step 6. Making my surroundings safer: "[Brother's name] is holding my rifle at his house until [date]. I am keeping only a week of my sleep medicine at home; [brother's name] has the rest."

The one thing most important to me and worth living for: "[My daughter's graduation in June]."

Part 2: Rationale

Why this format. The Safety Planning Intervention is a brief, collaborative intervention in which the clinician and patient write a prioritized list of coping strategies and supports to use during a suicidal crisis (Stanley & Brown, 2012). It is completed together, in his words, and he keeps a copy in his wallet and a photograph on his phone.

Why the steps are in this order. The order is the method. The plan moves from what he can do alone, through other people, to professionals, so that each step is tried before the next and he has several things to do before a crisis peaks.

Why his words. A warning sign phrased as he experiences it, sitting in the truck in the driveway, is more likely to be recognized in the moment than a clinical term such as withdrawal, because it describes what he will actually notice. He identified the truck himself; he said it is where he goes when he cannot face the empty house.

Why distraction and people are separate. Step 3 lists places and people that offer distraction without requiring him to talk about his feelings, which he finds hard; Step 4 lists people he can ask directly for help. Separating them lets him use company even on days he cannot yet ask.

Why the firearm step names a person and a date. Reducing access to lethal means is one of the most important parts of the plan. A vague intention to "put the rifle away" is less protective than a specific agreement that his brother holds it at his house until a named date, when the plan will be reviewed. His brother agreed by phone during the session. Limiting the amount of sleep medicine at home follows the same reasoning.

Why a reason for living. Naming what matters most to him gives the plan a purpose he can hold on to. He chose his daughter's graduation without prompting.

How the Plan Was Built

The plan was written during his second visit, after a risk assessment in which he described passive thoughts that his daughter "would be better off" without him, a rifle in the house and heavier drinking since his wife moved out. He had no plan or intent and had never attempted suicide. The clinician began by asking him to tell the story of the worst night since the separation, then worked backward to find the first moment he could have noticed things getting worse; that moment became the first warning sign. Each later step was filled in by asking what had helped, even a little, on hard nights before. He crossed out one suggestion, calling his ex-wife, as more likely to make things worse. The session ended with him reading the plan aloud and rating how likely he was to use it, 7 out of 10, and identifying the step he was least sure about, calling his brother.

Evidence and Limits

In emergency departments, the Safety Planning Intervention combined with follow-up telephone calls was associated with fewer suicidal behaviors over six months and with greater engagement in outpatient treatment compared with usual care (Stanley et al., 2018). The 988 Suicide and Crisis Lifeline provides round-the-clock access by call or text (Substance Abuse and Mental Health Services Administration, n.d.). A safety plan is not a no-suicide contract. It does not ask him to promise anything; it gives him steps to take. It also does not replace ongoing assessment: his risk will be reassessed at every visit, and the plan will be reviewed at each session and revised as his circumstances change.

References

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001

Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry, 75(9), 894-900. https://doi.org/10.1001/jamapsychiatry.2018.1776

Substance Abuse and Mental Health Services Administration. (n.d.). 988 Suicide and Crisis Lifeline. https://988lifeline.org