Crisis response planning may be more effective than contracts for safety in suicide prevention
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What actually works in suicide prevention?
How can you reduce suicide attempts in the actively suicidal?
Suicide is the 10th most common cause of death worldwide.
And if you’ve worked with suicidal people, or the bereaved, you probably want more definitive answers on what will help prevent another suicide.
A new study suggests crisis response plans are more effective in reducing suicide attempts than contracts for safety.
Researchers led by the US National Center for Veterans Studies followed 97 soldiers with active suicide ideation or a lifetime history of attempted suicide over a six-month period.
The soldiers were offered one of the three interventions that allowed the researchers to compare the effectiveness of two common suicide risk management strategies – crisis response plans and contracts for safety.
The study found that crisis response plans reduced suicide attempts by 75% versus contracts for safety.
The study also found that crisis response planning was associated with a significantly faster decline in suicidal thoughts and fewer inpatient hospitalization days.
Another important finding from the study is that adding an explicit discussion of the participant’s reasons for living did not improve the effectiveness of the standard crisis response plan (that’s another popular element of suicide prevention training).
So what are crisis response plans and contracts for safety?
Both are commonly used interventions when working with suicidal people.
- Contract for safety – this focuses on getting a commitment from a suicidal patient to avoid self harm (i.e. what not to do).
- Crisis response planning – this involves writing on an index card the steps for identifying one’s personal suicide warning signs along with coping strategies, social support and professional services to use in a crisis (i.e. what to do).
It’s worth noting that the crisis response plan is a central ingredient of another successful treatment for suicide – brief cognitive behavioural therapy (aka Brief CBT, CT).
Brief CBT was found to reduce suicide attempts by 60% in a 2015 study of active duty soldiers by the National Center for Veterans Studies.
Lead researcher Craig J. Bryan, an associate professor of psychology and director of the US National Center for Veterans Studies commented:
Our previous results showing a significant reduction in suicide attempts were based on a treatment that heavily emphasized crisis response planning.
This time around, we tested crisis response planning by itself and found that it reduced suicide attempts as well.
This bolsters our confidence in the technique’s effectiveness.
The other good thing about the crisis response plan is that it’s short and simple.
That means the intervention could be made available in a range of medical settings by different health care professionals.
As Bryan pointed out:
Suicidal individuals don’t always visit mental health clinics when in crisis.
They also visit emergency departments and primary care clinics or talk to friends and family members.
Crisis response planning could be a practical and effective way to connect those in greatest need of potentially life-saving treatment.
It’s important to note that the relatively small size of the study means that its results are most applicable to military populations.
Further research will be needed to extend the findings to other populations.
The study was published in The Journal of Affective Disorders, (Bryan et al., 2017)
Image credit: kevinmd.com
If you would like to know more about suicide prevention then please check out The National Center for Veterans Studies at the University of Utah. The center has developed and tested the only scientifically supported methods to prevent suicidal behavior among military personnel. It’s also a leading center for suicide prevention and PTSD research and treatment.