Implementing a Suicidal Ideation Crisis Response Plan

In this Q&A, Craig Bryan, PsyD, ABPP, addressed some additional questions from his recent Psych Congress session, “Helping Your Patient Manage Suicidal Ideation and Behavior: Crisis Response Plan.”

In his session, Dr Bryan discussed how to develop and implement a crisis response plan (CRP) to assist clinicians treating patients with suicidal ideation and behavior stemming from post-traumatic stress disorder, as well as other mental health disorders, including depression.

Question: Please describe the difference between suicidal ideation and intent.

Answer: Suicidal ideation involves thoughts about engaging in suicidal behavior or ending one’s life whereas suicidal intent refers to the motives associated with self-injurious behaviors. In particular, suicidal intent involves a desire to die as a result of one’s behavior and/or an expectation that one’s actions will result in death.

Q: Can you briefly describe what a crisis response plan (CRP) is for your patients?

A: The CRP is a brief psychological intervention designed to reduce a patient’s risk for suicidal behavior by helping them to outline a series of steps to follow when experiencing intense emotional distress and/or a suicidal crisis. The CRP is typically handwritten on an index card so it can be kept in a pocket, bag, or other convenient location for easy access and use. The CRP has been shown to significantly reduce the likelihood of patients attempting suicide as compared with standard crisis management interventions and contains several key sections: (1) personal warning signs, (2) self-management strategies, (3) reasons for living, (4) sources of social support, and (5) professional/crisis services.

Q: Do you believe all clinicians working within the psychiatry space should be trained in crisis response plan development, and, if so, do you feel that there is adequate training for clinicians in this area?

A: Yes, I think all clinicians (and event nonclinicians) working in psychiatric and behavioral health settings should be trained to administer this procedure effectively with their patients. Unfortunately, high-quality training is not yet widely available to most clinicians. We are currently working on several methods to improve the availability and reach of CRP training.

Q: Overall, what impact has having a crisis response plan had on your patients with PTSD?

A: Many of our patients with PTSD are also experiencing suicidal thoughts, so the CRP has proven to be a very practical and helpful way to help manage these thoughts and impulses while they undergo trauma-focused therapy. We are currently conducting multiple studies to see if integrating the CRP within trauma-focused therapies leads to faster reductions in suicidal ideation and reduces the risk of suicidal behaviors relative to standard trauma-focused therapies.

Q: Do you feel that a crisis response plan would be beneficial for people suffering from other mental health disorders, such as schizophrenia or depression?

A: It could be. The CRP is designed as a transdiagnostic procedure to help patients respond more effectively to intense emotional distress. These periods of heightened distress do not necessarily need to involve a suicidal crisis, though. In these situations, the CRP can be adapted to focus on other prominent features of the patient’s mental health disorder. For patients with substance use disorders, for example, the CRP may help them to respond more effectively to urges and/or other warning signs for relapse. For patients with depression, however, the CRP may help them to engage in cognitive and behavioral strategies that could improve their mood during times of low motivation. Overall, the procedure is very highly adaptable to different clinical situations. The key is customizing the content of the intervention to the unique needs and presentation of each patient.