‘Safety planning’ has traditionally been used by frontline professionals (medical staff; education staff; counsellors etc) who deal with people engaging in suicidal or deliberate self harm behaviours.
A traditional safety plan goes something like this:
*Bobby*, I need you to make a plan with me of what you will do if you have suicidal or self harm urges in the future.
Let’s identify what you can do rather than hurting yourself:
Tell a teacher/ parent or trusted adult
Distract yourself
Call 000, Lifeline or go to the Emergency Department
Now sign here to give me your word that you’ll do those things if you feel unsafe & that you won’t harm yourself…….
Bobby signs & the professional feels like they’ve done their job.
File that piece of paper & send Bobby out into the world!!!
Can you see what’s wrong with this process?!?!
I’ve worked in health settings where these types of safety plans were common place. These were issued by well-meaning professionals, but SURELY WE CAN DO BETTER!
Problem #1: Not understanding the REAL problem
We might be tempted to see the problem in Bobby’s situation as the self harming or suicidal behaviours. THESE ARE NOT THE PROBLEM, BUT IN FACT THE PERSON’S SOLUTION TO THE PROBLEM.
It is easy to get distracted by the behaviours, because they can be dramatic & scary. But don’t let the behaviours distract you from the REAL problem!
The REAL problem Bobby is facing is very high distress & no other options to manage that distress. A traditional safety plan like the one outlined above gives him no new skills & leaves him with the same dilemma.
Problem #2: Traditional safety planning communicates a lack of understanding… or worse
This type of safety planning tells the person that we really don’t understand their predicament. So the Bobby’s of the world leave this conversation feeling even more misunderstood & isolated than before.
Even worse than feeling misunderstood, Bobby might feel like we really don’t even care. He might think we're just 'covering our ass'- which maybe we are, because we don't know what else to do.
Problem #3: It doesn’t work
A plan like the one above doesn’t keep a person safer. It actually makes them less likely to seek help in the future. In Australia, our suicide rates are going UP. We need to accept the way we have done things before ISN’T WORKING.
Giving their ‘word’ that they won’t engage in suicidal or self harm behaviours means nothing to someone when they are overwhelmed by distress & believe nothing will ever get better.
We need a plan that gives people new skills & a different solution!
Solution Step #1: Building rapport by showing understanding
Building connection & rapport is essential to helping any person who is struggling. In order to have them listen & try the skills we’re going to encourage, we need them to think what we have to say might have some merit.
Solution Step #2: Validate emotions without validating problematic behaviours
Learning to validate can drastically increase how effective our support is. We validate by reflecting back understanding of the person’s perspective. We don’t have to agree with their perspective to validate it- we simply are acknowledging that we understand that’s how they feel.
I could validate the distress someone is experiencing whilst not validating self harm as a great option to solve their problem.
Solution Step #3: Figure out how to teach them skills
The person stuck in this predicament does not have the skills they need to respond to their distress differently. So the next logical step is to figure out how to teach them new skills that will actually work.
Skills to get through strong distress & urges are called ‘distress tolerance skills’. Distress tolerance skills arise from dialectical behavioural therapy (DBT) & have been shown to be very effective in helping reduce self harming & suicidal behaviours.
When someone starts to use distress tolerance skills, they will begin to build up tolerance to future distress. Therefor, it gets easier & easier the more they use the skills.
Basic distress tolerance skills can take as little as 15- 30 minutes to teach.
If you would like to learn distress tolerance skills, check out our ebook
Or if you are a professional, check out our Safety Planning That Works training packages for education & allied health professionals
Solution Step #4: Write a plan with the person for when they will use their new skills
Customise the plan with the person & the skills they identify as things they can try.
First we ask the person to rate their distress, then we prompt the skills to correlate with that level of distress.
It makes it easy to encourage the right skills at the right time
Want to learn more about distress tolerance skills & how to use them?
Check out our ebook, 'How to Survive an Emotional Crisis'
For education professionals, we have a self-paced training package, 'Safety Planning That Works' that will show you how to use & teach distress tolerance skills
Stay tuned for more training & education resources on this topic in the future!
Alex.
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