Developing and Implementing a Safety Plan 7/11/2019

Often when a patient is in crisis, we talk about putting a “safety plan” in place. It may not be clear to all providers what a safety plan is or why it might be helpful. The goal of this e-weekly is to discuss what a safety plan is, how to develop and implement one, and the role it can play in treatment especially during a crisis.

The idea behind a safety plan is something in writing outlining crisis resources and a crisis plan for a patient with a mental health or behavioral emergency. In a crisis, it can be difficult to stay calm and rationale and having a step-by-step written action plan can be helpful to know what the next steps are to maintain safety.

One common scenario is a patient who was recently evaluated in the emergency room for suicidal ideation but did not meet criteria for psychiatric hospitalization. The social worker in the emergency room might develop a safety plan with the patient on what to do if she feels suicidal again. The plan can include coping skills that the patient has developed in therapy that are helpful as distractions to calm oneself down (activities to engage in, people to call, etc) when feeling particularly sad and/or suicidal. For the patient’s family, the plan might include keeping things that the patient could harm herself with away from her (knives, medications, cleaning supplies, guns if they are in the home). The family might also be asked to figure out if the patient has intent and/or a plan when she is expressing suicidal ideation. The safety plan would include information on when to seek immediate medical attention by calling the police/PERT (Psychiatric Emergency Response Team) or going to an emergency room or psychiatric urgent care. The safety plan would importantly include contact information for treating providers and emergency numbers so they are readily available in a crisis situation.

Safety plans are also useful for patients with serious mental illness like schizophrenia, bipolar disorder and other disorders that can include aggression and homicidal ideation. They can play a role for people in domestic violence relationships. They can be helpful for families with children with severely impacted Autism Spectrum Disorders.

Here is an example of safety plan template:

There are also apps available to create a safety plan on one’s phone. Examples include:

  1. Suicide Safe by SAMHSA
  2. OscER San Diego
  3. OscER Jr San Diego (for children and families)

In summary the idea behind a safety plan is to make sure that a patient and family know how to handle a psychiatric crisis situation if and when it comes up. Primary care providers might be in the position of having to create a safety plan with a patient and family or be part of the safety plan as a treatment provider. The next e-weekly will review some crisis resources that are available locally in San Diego for psychiatric emergencies.

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