Develop Safety Plans

I worry about cutting. I worry that sometimes I’m not enough. I’ve become more aware of what needs to be done, empowering others to speak-up. I wish their was a crisis hub in our area to help develop safety plans. Others may share what could be done, but if you don’t have someone guiding choices, it may not get done. Recognize proven approaches, evaluate current programs and strategies and grow.

Develop a safety plan for when suicidal thoughts reemerge instead of a no suicide contract. In the plan, identify risky behaviors, warning signs, coping strategies, how to distract, how to get help (who to contact, check in with, support professionals) and ways to limit access to lethal means. Incorporate the importance of life, agree not to die by suicide, and add signatures by all parties. This and in combination with follow-up calls are most effective (www.suicide.org; Truecki et al, 2019)

Use of a volitional help sheet can help identify problems and solutions, options for change and includes possible assessments to teaches emotional regulation and coping skills (Truecki et al, 2019).

There are biological, clinical, psychological, social, cultural and environmental risks to suicide. Recognize how negative experiences, social rejection, social isolation, social exclusion, personality traits, unbearable pain, substance abuse, cognitive deficits, inability to problem solve, impaired memory, decreased positive thinking, previous self-harm behaviors, mental illness, socio-economic class, job loss, low income, and debt interplay with suicide and suicide ideation. Improvement of suicide is best by examining standard suicide risk scales, school and university programs, screening at emergency rooms or primary care doctors, and using follow-up calls to check on adherence to safety plan. Universal interventions such as banning pesticides, stopping the glamorization of suicide in the media, limiting online information, and reporting what to do if you need help. Selective interventions such as pharmacological intervention for predisposition, the detection of mental health disorders, tailoring bullying programs to subgroups and training practitioners and community members can be an asset. Restricting access to lethal means can prevent suicide. Engagement in therapy such as Cognitive Therapy and Cognitive Behavioral Therapy with a family component had positive effects on self-harm behaviors. Dialectic Based Therapy with weekly skills groups may also have some benefits. Acceptance and Commitment Therapy and mindfulness-based interventions are growing. Teaching flexibility and problem solving as part of interpersonal psychotherapy program has shown to reduce suicidal ideation. Suicide specific treatment, brief psychosocial interventions, the attempted suicide short intervention program targets behaviors as opposed to symptoms of suicide help bring awareness to problems and facilitates crisis safety planning, how to seek help, and strategies to connect with social and professional support. The attempted Suicide Short Intervention Program, involves 3 face-to-face therapy sessions and regular participation for 24 months. Additionally, examining serotonin levels, cortisol release under stress, neutrophic pathways, changes in glutamatergic neurons, glial cells, the volume of the hippocampus, inflammation, gut microblome can give us more insight into who is likely to be at risk for suicide. There are also pharmacological interventions available to help minimize suicide (Truecki et al, 2019).

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