Safety Planning Intervention

Domain II · Behavioural & cognitive · Stanley, Brown · 2008

What it is

The SPI is a brief, single-session clinical intervention, usually 20–45 minutes. Clinician and client collaborate on a written, prioritised list of the client's warning signs, coping strategies, people, professional resources, steps to make the environment safer, and a reason for living. The client…

Format

• The SPI is a brief, single-session clinical intervention, usually 20–45 minutes. Clinician and client collaborate on a written, prioritised list of the client's warning signs, coping strategies, people, professional resources, steps to make the environment safer, and a reason for living. The client…

Who practises it, and how they are trained or regulated

• The SPI is one session, not a multi-phase course. When follow-up is added (SPI+), the plan is revisited by phone. Phases A–F below are the tasks of a single session in Brown's training sequence, plus follow-up.
• Version followed: the Stanley-Brown Safety Planning Intervention (SPI) as described by Stanley & Brown (2012, Cognitive and Behavioral Practice). It uses the six-step Stanley-Brown Safety Plan template (©2008), which also carries a reasons-for-living line, and the task sequence Gregory Brown teaches in current Penn Center training (2023 workshop handouts). For follow-up, it adds the structured telephone contacts of…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Automatic "yes" answers. Probe with a concrete scenario.
• Points where the client hesitates. Revise those entries.
• Templates filled with generic entries. Empty means-safety sections.
• A plan left in the clinic. At follow-up, ask whether they could find it.
• The client listing services they don't trust. Out-of-date numbers. Verify them.

Problems the guide addresses

• The client won't engage with or refuses the plan
• Low likelihood of use (ambivalence)
• The client can't identify warning signs or coping strategies (stuck)
• Overwhelm or rising distress during the session
• Short on time (ED, crisis line)
• No one to contact (isolation or conflict)
• Fear of services (admission, police)
• Resistance to means safety
• Non-adherence: the plan wasn't used in a later crisis
• Rupture: the client feels processed or coerced

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.