Barbara Stanley, Ph.D., of Columbia University and colleagues enrolled 1,640 adults who had been admitted to one of nine Veterans Administration EDs who had had a suicidal crisis (but who did not subsequently require inpatient hospitalization) between 2010 and 2015. Four of the EDs continued to provide their usual care for the patients, while the other five implemented a safety-planning intervention combined with telephone follow-up.
Safety planning provides patients with a written safety plan that includes coping skills, strategies to make their environment safer, and a list of people who can provide support. The telephone follow-up consisted of at least two postdischarge contacts with a patient to monitor suicide risk, review the safety plan, and encourage continued treatment.
Six months after ED discharge, fewer patients in the safety planning group engaged in suicidal behavior compared with the usual care group (3.03% vs. 5.29%, respectively). Recipients receiving the safety-plan intervention and follow-up also had more than double the odds of attending at least one outpatient mental health visit after discharge.
The increased visits with outpatient mental health services were not solely responsible for the reduced suicidal behaviors, the authors noted; other components of the safety-planning intervention were also contributing to patient improvements.
“Our findings are promising and indicate that safety planning and active outreach—a set of low-burden strategies—are useful components of effective suicide prevention,” Stanley and colleagues wrote. “Importantly, using the low-burden intervention in this project and others was associated with about the same reduction in suicidal behavior as more intensive and costly psychosocial interventions. If implemented broadly, [this intervention] has the potential to reduce suicidal behavior and enhance behavioral health treatment engagement, particularly during high-risk periods following ED discharge.”
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