Barbara Stanley and Gregory K Brown developed the Safety Planning Intervention tool (SPI 2011) which is recognised as best practice by the Suicide Resource Centre (www.sprc.org). The SPI was developed to help lower the imminent risk of suicidal ideation and or behaviour, by providing a list of individualised coping strategies, people and or services that a ‘Person holding Hope’ can contact when they identify they need help to alleviate a suicidal crisis.
It is a step down list of strategies and supports which include a) recognising triggers and or warning signs of an impending suicidal crisis, b) a list of internal coping strategies to draw upon, c) a list of social contacts and settings that can be used to distract oneself, d) people in ones personal life that can help resolve the crisis, e) professional services and support, and lastly f) reviewing their environmental safety.
Why do we use it?
The SPI aligns with Recovery Oriented Practice in that it is developed collaboratively with the ‘Person holding Hope’, guided by what they believe will work thus giving them a sense of control, self efficacy and hope. It recognises that the ‘Person holding Hope’ knows themselves, their needs and their strengths better than anybody else, so why wouldn’t we draw on this depth of knowledge?
By working alongside the ‘Person holding Hope’, they and we can identify strengths and resources they currently have, and also if needed we can assist in providing others that may be beneficial. The stages are a step down model but the ‘Person holding Hope’ is the one who decides how significant the triggers are, how much at risk they are and what strategies will work.
Some suicidal crises may be relatively short lived and people with lived experience often describe it like a wave with a crest of intensity, and then a trough of peace. If we are able to develop strategies and interventions that are person-centered and meaningful, these can be useful to ride the crest and overcome the suicidal ideation. We can also identify barriers or obstacles that may stop them using their SPI, and develop ways to overcome these.
How do we use it?
We use our app “Be Safe Suicide” to step them through a safety plan that they feel will work for them. As mentioned this is a step by step process and is written in their words not ours.Search these three words ‘be safe suicide’ in your app store and look for a large blue square with a big white ‘C’ in the centre and download the app. It is free and available to the public. The 6 steps in the Be Safe app are explained in more detail below:
Step 1:Recognising Triggers and or Warning signs – what things normally precede a suicidal crisis, these may include personal situations, thoughts, images, thought patterns, moods or behaviours. What we want to achieve in this stage is to identify an imminent crisis and how to avoid it.
Step 2:Internal Coping Strategies – resilience and personal coping strategies. What have they done in the past that helps when they have experienced the triggers and or warning signs above? Can they overcome these without the help of others and so building their self belief and self determination? Ideas include exercise, meditation, cleaning, music, praying etc.
It is important to identify these strategies but also to establish how likely it is that they will use them, and what they can do to overcome any barriers that may stop them.
Step 3: Social contacts or places that can distract – people or places in their natural social environment that may provide a level of safety or distraction. They are riding a wave so, can they use these people or places to overcome this wave? We strongly recommend that these connections do not include alcohol or other drugs. In this step the fact that they are experiencing suicidal thoughts does not need to be shared. This is where they connect with people or places to distract them from their thoughts. In Recovery Orientated Practice one of the founding principles is social inclusion and belonging.
Step 4: People in ones personal life that can help resolve a crisis – if the above strategies didn’t work then the next step is to contact people in their personal life that know they are struggling with suicide and specifically ask them for help. These may or may not be the same people listed in step 3. A good idea at this stage is if they haven’t told these people about their struggles is to find ways for this to occur prior to them being contacted during a crisis.
Step 5: Professional services and supports – if none of the above helped or if the crisis is imminent and immediate assistance is required, then they implement step 5. Do they currently have supports, will they use these? Can we provide Helplines or other options that may be beneficial, for example if it is out of hours and or if their preferred contacts aren’t available?
Some people don’t want to reach out to agencies because they may be worried about the consequences, such as hospitalisation or police coming to their home, so talk with the ‘Person holding Hope’ about these barriers and ways to overcome them.
Step 6: Their environment safety – when or if the next wave of suicidal ideation appears, it is important that we have put in as many safety factors as we can. This includes looking at ways of making their environment safer, for example getting rid of anything that could be used to end their life or anything that may make them vulnerable such as alcohol/drugs.