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James Donaldson on Mental Health – Safety Plans are Effective at Reducing Suicidal Behavior. So Why Aren’t More People Getting Them?
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James Donaldson on Mental Health – Safety Plans are Effective at Reducing Suicidal Behavior. So Why Aren’t More People Getting Them?
In addition to making suicide screening more accessible and widespread, successful implementation of safety plans is critical — here are 3 recommendations that care teams can implement.
Every year roughly 12.3 million people struggle with suicidal thoughts, yet the vast majority don’t receive the life-saving intervention they desperately need. According to a recent study released by the Joint Commission, 39% of Joint-Commission-accredited hospitals didn’t implement safety plans during the discharge process for those admitted with suicidality. These straightforward documents outline warning signs of suicidal ideation, coping strategies, and support networks individuals can contact when they are in crisis. Only 19% incorporated every component of safety plans, as laid out by the Joint Commission, and only 4% met the full criteria for implementing recommended suicide prevention activities at the time of discharge.
Considering that a person is at greater risk of attempting suicide in the days and weeks post-discharge, and that safety plans can reduce suicidal behaviors by 43%, this is unacceptable. Safety plans are a critical tool to save lives and prevent harmful escalations that lead to costly emergency room visits and inpatient stays.
As a result of this study, the Joint Commission is looking into making safety plan and suicide prevention recommendations part of its requirements for accreditation. This is imperative, as the life-saving impact of safety plans are clear.
How can I create a safety plan?
The goal of a safety plan is to provide the tools an individual needs during a crisis so that they can access help and stay alive. The Joint Commission outlines several elements that a safety plan must cover. It should help individuals:
Identify and document warning signs
Document internal coping strategies
Identify people and social settings that provide positive distractions
Identify personal contacts to ask for help as well as professionals to contact during a crisis
Develop a plan for lethal means safety.
In addition to creating a safety plan, which is typically a simple, one-page document, the Joint Commission recommends providing warm handoffs to outpatient care and following up with patients after discharge. Despite the efficacy of these straightforward documents, they are sorely underutilized – only 8% of hospitals incorporated all of the recommended practices, including creating a safety plan, developing a plan for lethal means, providing a warm handoff to outpatient care, and following up with patients post-discharge.
Why are safety plans overlooked?
In my fifteen years of working with individuals struggling with suicidal thoughts, the absence of safety plans always struck me as surprising. Based on my experience, those without safety plans are more likely to be impulsive and isolated during crises. For instance, I recall a teenage girl who had recently attempted suicide telling me that she didn’t reach out to someone because she didn’t know who would care. A safety plan would have made that clear.
Despite the effectiveness of safety plans, and the relative ease with which they can be created, there are systemic barriers to their implementation.
For one, many healthcare organizations rely on antiquated methods like in-person screeners to determine who could benefit from a safety plan. While this approach is certainly better than nothing, it relies on individuals physically showing up for appointments and being willing to answer personal questions openly and honestly. Reliance on these in-person screeners also exacerbates discrepancies in access to healthcare for marginalized communities, as they often have less access to insurance and transportation.
Lack of training also makes it difficult for individuals to receive safety plans. One study showed that 70% of mental healthcare providers indicated a desire for more training on safety plans. This may indicate that many health care professionals lack confidence in developing safety plans, which means that fewer individuals at risk will receive them.
Perhaps the greatest barrier to individuals accessing safety plans is our overburdened healthcare system. Healthcare professionals in hospital settings are constantly triaging patients with complex physical and mental healthcare needs. Recently, I spoke with a doctor who lamented about having to prioritize patients with physical concerns over those with mental ones. While this decision is understandable, it leads to fewer safety plans and more suicide attempts, which means costly mental and physical healthcare services down the road.
How to implement the Joint Commission’s recommendations
Safety plans are only effective if we can get them into the hands of the right people. That is why we must enhance accessibility to suicide screening. This is where advancements in technology can play a major role. Instead of depending solely on in-person screeners, remote tools can enable people to take assessments from their own homes using their preferred device. This approach not only removes the barriers associated with transportation and insurance, but it also fosters a more comprehensive understanding of risk for individuals within large and diverse populations.
In addition to making suicide screening more accessible and widespread, successful implementation of safety plans is critical. Here are a few general recommendations that care teams can implement:
Take time to explain the purpose of the safety plan and how it can be used to prevent the escalation of suicidal thoughts and behaviors.
Explore ways that the individual can easily access their safety plan. Some examples include making it a “favorite” picture on their phone or keeping it in their pocket.
With permission, involve another person in the construction of the safety plan. Including a parent, partner, or friend can help the individual consider alternative ways to keep themselves safe and remind them of the people they can rely on when distressed.
Safety plans are a critical component of suicide prevention and every person experiencing suicidal ideation should have access to this resource. Organizations motivated to save lives and precious resources have a new tool at their disposal. Technology can seamlessly connect at-risk individuals to much needed assessments and support and make safety plans a widespread resource for those experiencing suicidal ideation. This will result in more safety plans being used, fewer suicide attempts and ED utilization, and countless lives saved.
#James Donaldson notes: Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes. Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use. Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.#http://bit.ly/JamesMentalHealthArticle Find out more about the work I do on my 501c3 non-profit foundation website www.yourgiftoflife.org Order your copy of James Donaldson’s latest book, #CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
James Donaldson is a Washington State University graduate (’79). After an outstanding basketball career with WSU, he went on to play professional basketball in the NBA with the Seattle Supersonics, San Diego/L.A. Clippers, Dallas Mavericks, New York Knicks, and Utah Jazz. He also played for several teams in the European Leagues in Spain, Italy, and Greece, and he toured with The Harlem Globetrotters to wrap up his career. James was an NBA All-Star in 1988 while playing center for the Dallas Mavericks. In 2006, James was inducted into the Pac-10 Sports Hall of Fame and also the Washington State University Athletic Hall of Fame. In 2010, James was elected as a board member for the NBA Retired Players Association.
James frequently conducts speaking engagements (motivational, inspirational, educational) for organizations, schools, and youth groups.
In 2010, James was the recipient of the NBA Legends of Basketball ABC Award, awarded for outstanding contributions in Athletics–Business–Community.
He believes in being a role model for success and professionalism to the scores of young people to whom he devotes so much of his time. He currently serves on several boards and committees and is a member of many organizations.
James believes in developing relationships that create a “Win-Win” environment for everyone involved, and in being the best he can be!
For more information about James Donaldson or to request he speak at your event, contact him at:
James Donaldson is the author of “Standing Above The Crowd” and “Celebrating Your Gift of Life” and founder of the Your Gift of Life Foundation which focuses on mental health awareness and suicide prevention, especially pertaining to our school aged children and men.
If you’re interested in having James come and speak to your group of young adults, business entrepreneurs, aspiring political and community leaders, and athletic teams, please contact him at jamesd@yourgiftoflife.org and or leave a personal message for him at 1-800-745-3161. Keep up with him and read about how he is reaching out and making a difference in the lives of so many around the world at www.yourgiftoflife.org
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