Integral to the AIM model is the principle that suicide risk should be targeted directly with suicide-specific interventions. The Intervene component offers evidence-based guidelines and tools for suicide prevention; treatment goals and objectives should focus on reducing modifiable risk factors and increasing protective factors. Effective interventions enable at-risk individuals to call on a range of strategies to delay acting on suicidal urges.
Universal Precautions for Suicide Prevention
It is well established that individuals with mental illness and/or substance use disorders are at increased risk of suicide. Unfortunately, an estimated 50% of suicide deaths occur among individuals making their first attempt i.e. their first attempt is a lethal attempt.4 Studies suggest that for many the time between first wanting to die and acting on that thought or impulse can be very short—minutes or hours, not days.5 Despite our knowledge of risk factors, we simply are not good at predicting which individuals will die by suicide.
For all these reasons, we recommend ensuring that all patients receive basic psychoeducation on suicide risk and how they (and their friends and family members) can get immediate crisis support. This can be tailored to reflect each individual’s unique circumstances and risk and protective factors, but at a minimum should include:
- The fluid nature of risk of suicide – how things can change quickly
- The immediate period post-discharge from CPEP or Inpatient is a particularly high-risk time
Please see the Universal Precautions Guide for Clinicians for more information.
Safety Planning Intervention
The Safety Planning Intervention for suicide prevention, developed by Drs. Barbara Stanley and Gregory Brown, is a prioritized list of six strategies for coping with suicidal urges typically developed collaboratively by an at-risk individual and their provider.6 As illustrated in this sample template, these steps include internal coping skills or distractions, social distractions, and the engagement of mental health professionals. Drs. Stanley and Brown also developed the “Safety Plan Intervention Brief Checklist” to assist clinical providers in completing the intervention.
Safety and Counseling
A critical part of the Safety Planning Intervention is reducing access to lethal means as well as clinician competency with counseling people at risk of suicide regarding their immediate safety. Because many suicide attempts occur with little planning during a short-term crisis, if the means to make the attempt have been temporarily removed/ secured or are made more difficult to access, it is likely that the suicidal urge will dissipate before any attempt is made. Therefore, putting time and distance between those at risk and access to any lethal means is critical to preventing suicide among those at-risk. This includes safe storage of firearms, prescription medication, and other high-risk items. Including family, friends and other supports, if appropriate, can be helpful in developing a plan to create safer environments around those who are at-risk for suicide. Poison Control is a good resource for helping providers, people at risk, and supports in identifying what medications, household cleaners and other substances could be toxic and/or lethal. For more information on how Poison Centers can help providers, please see “Poison Centers: Information For Mental Health Providers.” For more information on lethal means safety and reduction counseling, please see “A Guide for Clinicians: Means Reduction Counseling.”
ASSIP (Attempted Suicide Short Intervention Program) is a promising, short-term intervention that has demonstrated a significant reduction in subsequent suicide attempts. Requiring only 3-4 sessions, the goals are for clinicians to listen to an individual’s story, help the person understand what led to their suicidal crisis, and find ways to establish effective coping strategies for the future. ASSIP is now available via Telehealth to individuals 18 years of age and above who are residents of New York State as part of ongoing research. It is designed to complement, not replace, other recommended treatment; the ASSIP team will coordinate with the client’s primary treatment team. For more information on ASSIP, please click here.
Evidence-based Treatment Approaches
There are several evidence-based treatment models that target suicidal behavior; most are designed for long-term, outpatient treatment, though some have been adapted for short-term settings, such as Inpatient:
For more on evidence-based treatment, please click here.