Effect of Crisis Response Planning on Patient Mood and Clinician Decision Making: A Clinical Trial With Suicidal U.S. Soldiers

Abstract

The CRP immediately reduces negative emotional states among acutely suicidal soldiers. Discussing a patient's reasons for living during a CRP also reduces the likelihood of inpatient psychiatric admission.

Use of crisis management interventions among suicidal patients: Results of a randomized controlled trial

“…Although that study found no differences in suicide ideation and attempts between a standard CRP (S‐CRP) and a CRP enhanced with a facilitated discussion of reasons for living (E‐CRP), subsequent analyses indicate the E‐CRP leads to significantly larger decreases in negative affective state combined with significantly larger increases in positive affective state (Bryan, Mintz, Clemans, Burch, et al., ). In a separate study utilizing a quasi‐experimental, interrupted time series design (Miller et al., ), patients presenting to one of several emergency departments were 20% less likely to engage in suicidal behavior during follow‐up if they received the Coping Long‐Term with Active Suicide Program, which entailed a self‐guided safety plan combined with several follow‐up phone calls (Boudreaux et al., ) as compared to patients who received TAU and patients who received enhanced suicide risk screening as a part of TAU.…”

Integrating crisis response planning for suicide prevention into trauma‐focused treatments: A military case example

“…Research has shown that the CRP, used as a one‐time intervention, reduces suicidal behavior by 76%, reduces suicidal ideation, decreases the number of psychiatric inpatient days, and increases optimism as compared to treatment as usual (TAU; Bryan, Mintz, Clemans, Leeson et al, 2017; Bryan, Mintz, Clemans, Burch et al, 2017, Rozek et al, 2018). Additionally, the CRP has been integrated into treatment protocols including brief cognitive behavioral therapy for suicide prevention (BCBT), which has been shown to reduce suicide attempts by 60% compared to TAU (Bryan & Rudd, 2018; Rudd et al, 2015).…”

Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients

“…Other studies have supported the efficacy of treatment protocols containing various combinations of the procedures contained within CBT‐SP. For example, the crisis response plan (also known as the safety planning intervention) has been found to reduce suicide attempts by 45–76% among suicidal patients as compared with treatment as usual when used as a stand‐alone intervention (Bryan, Mintz, Clemans, Burch, et al, ) or in combination with follow‐up phone calls (Stanley et al, ). In addition, the Attempted Suicide Short Intervention Program (ASSIP; Michel & Gysin‐Maillart, ) has been shown to reduce suicide attempts by 80% among patients who recently attempted suicide (Gysin‐Maillart, Schwab, Soravia, Megert, & Michel, ).…”

“…Reductions in the severity of suicidal ideation post‐intervention are significantly correlated with two components of the CRP, self‐management strategies and social support networks (Bryan et al, ), a finding that suggests these procedures are key to reducing suicide risk. Evidence also suggests that the CRP's efficacy might be enhanced with the addition of a component focused on identifying a suicidal patient's reasons for living (Bryan, Mintz, Clemans, Burch, et al, ). In this enhanced version of the CRP, clinicians ask patients to identify their reasons for living (or for not killing oneself) and then engage patients in a brief discussion about these reasons for living.…”

“…Of those who die by suicide, half are actively engaged in mental healthcare at the time of their deaths (Fawcett, ), suggesting that a significant proportion of suicides could be prevented by improving the quality of mental healthcare for at‐risk individuals. Emerging data accumulated over the past decade suggest that relatively brief variants of cognitive behavioral therapy for suicide prevention (CBT‐SP) and procedures extracted from these treatments can lead to rapid and significant reductions in suicidal behaviors when used in a range of healthcare settings (Brown et al, ; Bryan et al, ; Miller et al, ; Rudd et al, ; Stanley et al, ). In recognition of these issues and emerging data, the National Action Alliance for Suicide Prevention (NAASP, ) recently published several recommendations for standard care with suicidal individuals across the following domains: identification and assessment, safety planning, means reduction, and caring contacts (see Table ).…”