Academic journal article Journal of Mental Health Counseling

Adapting the Safety Planning Intervention for Use in a Veterans Psychiatric Inpatient Group Setting

Academic journal article Journal of Mental Health Counseling

Adapting the Safety Planning Intervention for Use in a Veterans Psychiatric Inpatient Group Setting

Article excerpt

The Department of Veterans Affairs (VA) recently has adopted the Safety Planning Intervention (SPI; Stanley & Brown, 2011), a brief collaborative intervention, for use with veterans who are at high risk of suicide. The SPI is a hierarchical list of strategies for veterans to use in coping with a suicidal crisis. Its developers recommended that it be used with individual psychiatric inpatients working toward discharge, but its utility in a group format has not previously been addressed. This article describes the facilitation of a safety planning group with psychiatric inpatients at a large urban VA medical center. It depicts each step in the safety plan and offers case examples, anecdotal support, and specific considerations for its use in groups. Directions for further research are also discussed.

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Suicide, an extreme form of self-directed violence (SDV; Brenner et al., 2010), is a leading cause of death in the U.S. To reduce the number of suicides among its constituents, the U.S. Department of Veterans Affairs (VA) recently adopted the Safety Planning Intervention (SPI; Stanley & Brown, 2011), which is a brief collaborative and comprehensive intervention designed specifically for persons who have been determined as being at high risk for suicide (Stanley & Brown, 2008). When working with suicidal individuals, it can be used as one segment of a more comprehensive mental health care treatment plan. Taking 20 to 45 minutes to complete, the SPI is a hierarchical list of strategies that veterans at high risk can keep on hand to cope more effectively with a suicidal crisis.

The SPI and examples of its use with an inpatient psychiatric group is described here in detail. In the examples, all identifying information has been removed or altered and pseudonyms used instead of actual names.

Although these are many safety planning strategies for working with suicidal persons (e.g., Brown et al., 2005; Jobes, 2006; Linehan, 1993; Rudd, 2006), the focus has been on outpatients. And while Stanley and Brown (2008) emphasized that the SPI should be revised as needed, they thought it might be most useful in more time-limited formats, e.g., when it is unlikely that persons will engage in long-term treatment or when a clinician believes that a simple intervention would enhance the ability to cope with suicidal urges. They therefore recommended that tire SPI be used with inpatients in preparation for discharge, because after discharge from a psychiatric hospitalization people tend not to attend follow-up appointments (Boyer, McAlpine, Pottick, & Olfson, 2000; Compton, Rudisch, Craw, Thompson, & Owens, 2006). However, we know of no other studies of the use of the SPI with inpatients. This article describes use of the SPI with an inpatient group at a large urban VA medical center. Mental health counselors should find the information encouraging if they are interested in facilitating groups in other settings.

BACKGROUND

Suicide accounted for about 36,900 deaths in the U.S. in 2009 (McIntosh, 2012), an increase from recent years. It is the 10th ranked cause of death nationally. In the armed services, suicide is a serious concern. Within the Army alone, if all are confirmed, the 164 reported suicides of active-duty soldiers in 2011 (140 confirmed; U.S. Department of Defense, 2012) would represent the most suicide fatalities on record and a 242% increase over 2004.

However, suicide completions are only part of the problem. According to the 2009 National Survey on Drug Use and Health Report (NSDUH) released by the Substance Abuse and Mental Health Services Administration (SAMHSA; 2009), in 2008 an estimated 8.3 million American adults experienced suicidal ideation and more than one million people attempted suicide. Among U.S. Army personnel, Hoge, Auchterlonie, and Milliken (2006) reported that about 1% of a sample of over 222,000 Operation Iraqi Freedom (OIF) military personnel verified having some degree of suicidal ideation, and 467 participants thought about suicide "a lot. …

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