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8: Crisis Response Planning

Risk Management and Treatment » Non-pharmacologic Treatments
8: Crisis Response Planning

We suggest completing a crisis response plan for individuals with suicidal ideation and/or a lifetime history of suicide attempts.

Strength:

Weak for

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

  • Crisis Response Plans (CRP) and Safety Plans (SP) are tools that include step-by-step instructions to use prior to or during a suicidal crisis.
  • They are developed in a collaborative, patient-centered manner.
  • Key components shared by CRP and SP include; identifying warning signs, self-management or internal coping strategies, social support networks and professional/crisis services.
  • Although the research is evolving and limitations exist with previous studies, completing a Crisis Response Plan vs. treatment as usual resulted in a significant difference in future suicide attempts (Bryan et al., 2017).
  • Crisis Response Planning and Safety Planning are recommended over "no harm contracts," which have no research support.

Training Resources

This section includes links to recommended trainings about Crisis Response Planning and Safety Planning.

Crisis Response Planning for Suicide Prevention Training Workshops
Stanley-Brown Safety Planning Intervention Training
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Manuals

This section includes links to recommended manuals about Crisis Response Planning and Safety Planning.

Crisis Response Plan Overview
Stanley-Brown Safety Planning Intervention
VA Safety Planning Quick Guide for Clinicians
Center of Deployment Psychology Safety Planning Infographic
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Mobile Apps

This section includes links to recommended mobile apps about Crisis Response Planning and Safety Planning.

PTSD Coach – PTSD: National Center for PTSD (va.gov)
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Videos

This section includes links to recommended videos about Crisis Response Planning and Safety Planning.

What is a Crisis Response Plan (CRP)?
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Webinars

This section includes links to recommended webinars about Crisis Response Planning and Safety Planning.

CPG Webinar graphic Empowering Veterans through Crisis Response Planning & The Safety Planning Intervention Presented by Drs. Craig Bryan & Wendy Batdorf
CPG Webinar graphic Safety Planning — Basics and Beyond Presented by Drs. Megan Harvey & Suzanne McGarity
CPG Webinar graphic Safety Planning in the Emergency Department Presented by Dr. Bridget Matarazzo
CPG Webinar Suicide Prevention 2.0 Clinical Telehealth Program Presented by Dr. Jessica A Walker
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Podcasts

This section includes links to recommended podcasts about Crisis Response Planning and Safety Planning.

Podcast icon What if Suicide Prevention is Simple? Crisis Response Planning Interview with Dr. Craig Bryan
Short Takes on Suicide Prevention logo Rocky Mountain Short Takes on Suicide Prevention: A mobile safety-planning app with Dr. Pearl McGee-Vincent
Short Takes on Suicide Prevention logo Rocky Mountain Short Takes on Suicide Prevention: Safety Planning in the Emergency Room (It Works!) with Drs. Barbara Stanley, Greg Brown and Lisa Brenner
Short Takes on Suicide Prevention logo Collaborative Safety Planning for Older Adults with Drs. Elizabeth Conti and Ali Abbas Asghar-Ali
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Articles

This section includes links to recommended articles about Crisis Response Planning and Safety Planning.

Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., Maney, E., & Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. Journal of affective disorders, 212, 64-72. https://doi.org/10.1016/j.jad.2017.01.028
Bryan, C. J., Corso, K. A., Neal-Walden, T. A., & Rudd, M. D. (2009). Managing suicide risk in primary care: Practice recommendations for behavioral health consultants. Professional Psychology: Research and Practice, 40(2), 148-155. https://doi.org/10.1037/a0011141
Green, J. D., Kearns, J. C., Rosen, R. C., Keane, T. M., & Marx, B. P. (2018). Evaluating the Effectiveness of Safety Plans for Military Veterans: Do Safety Plans Tailored to Veteran Characteristics Decrease Suicide Risk?. Behavior therapy, 49(6), 931-938. https://doi.org/10.1016/j.beth.2017.11.005
Rozek, D. C., & Bryan, C. J. (2020). Integrating crisis response planning for suicide prevention into trauma-focused treatments: A military case example. Journal of clinical psychology, 76(5), 852-864. https://doi.org/10.1002/jclp.22920
Stanley, B. & Brown, G. K. (2012). Safety Planning Intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001
Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018). Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA psychiatry, 75(9), 894-900. https://doi.org/10.1001/jamapsychiatry.2018.1776
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