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How a 'safety plan' can help a person who is suicidal

“The situation isn’t irretrievable – there are simple, practical measures that everyone can do to turn it around.”

File photo
File photo
Image: Shutterstock/Rido

A WRITTEN PLAN including tips to stay as calm as possible and reasons to live can be “extraordinarily helpful” when a person feels suicidal, one expert has said.

So-called ‘safety plans’ are a simple but effective tool to help a person cope when they are distressed, consultant psychiatrist Dr Justin Brophy said.

“When people are distressed or in crisis, they don’t think clearly. When you’re so addled, a simple written plan can be extraordinarily helpful,” Brophy explained to TheJournal.ie.

“We get lost in our own worlds when we feel like this, we’re not very sensible when this happens. We become overwhelmed by what we’re feeling, the plan is a way of bringing you back.

“The plan telescopes the horizon to now. When a person is suicidal, they may be seeing a problem down the road or thinking about something from the past that they feel is very bad or inescapable.

“Safety plans help a person in the present moment – what can you do this evening before the GP surgery opens in the morning to see you through?

That telescoping of time is the single most important aspect of it. Everyone is projecting madly, focusing on the future, the plan helps bring them back. ‘What can I do this evening? Is there something I can do tonight?’

People can create the plans by themselves or with the help of a loved one or doctor. Examples can be viewed here and here.

Brophy, who is the chairperson of the Irish Association of Suicidology, has the following suggestions for what to include in a safety plan:

  • Contact details of people you can call to talk
  • A list of things that are important to you
  • Photos of people, animals and places that you feel connected to
  • Coping mechanisms
  • Things you can do to calm or distract yourself

He said photos in particular can be “very powerful prompts in a crisis”.

Advice for GPs

Brophy said the healthcare professionals most likely to see a suicidal person are GPs, even if that is not the reason the patient gives for attending a clinic.

He said doctors can sometimes be reluctant to raise the issue of suicide, insteading waiting for the patient to bring it up.

“Some GPs are hesitant about raising it, there’s a sense that it would inappropriate in some way to ask the question.

“It can be raised in a way that doesn’t force the person to identify how they are feeling but signals that were that to happen they could tell their GP, who would respond sympathetically and set in train the preventative measures necessary,” Borphy explained.

He noted that many GPs are trained in the area of suicide assistance but others are not. A survey carried out by the National Office for Suicide Prevention (NOSP) in 2018 found that most GPs would like to be upskilled in this area.

The Irish College of General Practitioners has developed suicide assistance training and is working with NOSP to roll it out nationwide. Brophy, a former Clinical Lead Advisor to NOSP, said there has been “good engagement” and “openness” from GPs in this regard.

“Many GPs are almost overwhelmed at the thought of trying to manage this by themselves. It’s a very difficult position to find oneself in, in a room with someone who is saying [they are suicidal], it can raise very considerable anxiety.

The sense among GPs is that they’re not quite sure if it is raised where to go with it, you can’t just bounce it off to mental health services, you have to build trust and confidence with the patient.

“It’s a time commitment and GPs are under a lot of pressure. You need to see that person a few times in quick succession to follow-up, that’s often not easy as a GP,” Brophy said.

He noted that patients “will often feel embarrassed” and be worried about what people, even their doctor, will think of them if they say they are suicidal or depressed. However, he added: “The GP surgery is the perfect place to confide that, this needs to be made clear.”

Brophy said, in comparison, revealing suicidal ideation in the “very stressful” environment of an emergency department can be an “ordeal”.

“They are open 24 hours a day and there is a programme in place to respond appropriately but, even so, it can be a big emotional ask to reveal this in an ED,” he said, noting that such a scenario can’t always be avoided.

‘The situation isn’t irretrievable’ 

If necessary, a patient will be referred to see a psychiatrist or engage with other mental health services.

Concerns have consistently been raised about the impact recruitment and retention issues are having on mental health services around the country. Brophy said, in general, such services see people “very quickly”.

“When it comes to urgent care, waiting lists are infinitely faster than they are in the general hospital setting, particularly if a person is suicidal.”

He added that there may be a delay in accessing mental health services in a certain locality or that a person may not wish to engage with services, possibly because they have had a difficult experience in the past.

Brophy said GPs should set up “a channel of communication” with their patient, adding: “This isn’t a once-off thing, it’s an ongoing conversation.”

Another way to help the person includes involving a family member or friend, once the patient has given consent. “See if the person will agree to recruit others into the situation, such as a trustworthy family member,” Brophy advised. 

He acknowledged this can be “quite a delicate conversation” but, in his experience, family members usually “signal they want to be told and be supportive”.

GPs generally also give the patient information about helplines and websites that could help.

“All of these things sound very simple but it’s remarkable how often they’re overlooked, one of the myths about suicide is that simple measures won’t make a huge difference,” Brophy said.

When a person is suicidal they have a sense of terrible isolation. They feel they won’t or can’t tell anyone, they fear that there will be terrible recriminations if they do, that they will never be treated the same way, they will never get insurance again, their GP will think less of them, their wife or husband will think less of them.

Brophy said GPs and other healthcare professionals have to help patients “work through that negative aspect of expectations”.

“The situation isn’t irretrievable – there are simple, practical measures that everyone can do to turn it around,” he added.

Today is World Mental Health Day. Dr Justin Brophy will deliver a talk about practical measures to prevent suicide in clinical and community healthcare settings at Aware’s conference ‘The Future of Depression & Bipolar Disorder’ in University College Dublin on Saturday. More information can be read here.

Need help? Support is available:

  • Aware 1800 80 48 48 (depression, anxiety)
  • Samaritans 116 123 or email jo@samaritans.ie
  • Pieta House 1800 247 247 or email mary@pieta.ie (suicide, self-harm)
  • Teen-Line Ireland 1800 833 634 (for ages 13 to 18)
  • Childline 1800 66 66 66 (for under 18s)

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About the author:

Órla Ryan

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