This program is for individuals who are in crisis and are considering suicide.

Crisis Response Planning (CRP), a community-based program, is designed to reduce the intensity of suicidal ideation and the risk of suicide attempts by helping participants learn to manage intense feelings during difficult situations.

One internal randomized controlled trial (RCT) was conducted among a sample of active duty Army Soldiers who were randomized to standard CRP (S-CRP), enhanced CRP (E-CRP) that included a module focused on identifying reasons for living, or a contract for safety (CFS) control group. Results indicated that the S-CRP and E-CRP groups experienced significant reductions in suicide attempts, significantly faster decline in suicide ideation, and fewer inpatient hospitalization days, compared to the CFS group, at a 6-month follow-up. A second internal RCT with a 1-year follow-up was conducted among U.S. military personnel and veterans. Participants were randomized to receive CRP or self-guided safety planning (SP) before beginning cognitive processing therapy for PTSD. Among those endorsing suicidal ideation at baseline, reductions in severity of suicidal ideation were significantly larger and faster among those in CRP compared to SP. PTSD symptoms significantly decreased over time in all participants, with no differences between groups.

CRP is a safety planning intervention that intends to help participants learn to cope with intense levels of distress when they are dealing with problems they feel will never end or that have no resolution. In a collaborative process, participants create a personal checklist to follow when they are feeling overwhelmed. This process begins with a narrative assessment where the participant shares his or her most recent suicidal crisis with a trained facilitator. The checklist is then created by the participant and facilitator and is typically hand-written on an index card for easy and convenient access during a crisis. CRP consists of the following five key components:

• Personal warning signs – identify individual indicators of an impending emotional crisis and help to recognize when someone is heading towards a crisis;
• Self-management strategies – implement strategies that can help reduce stress levels or provide a distraction during times of intense emotion;
• Reasons for living – identify things that provide a sense of meaning and purpose in a person’s life;
• Social support – establish a network or people who can provide support or boost one’s mood during difficult times; and
• Professional crisis support – obtain contact information for healthcare providers, crisis hotlines, and emergency services.

CRP was developed in the mid-1990s by David Rudd. The program is recommended in the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for Suicide Risk Management and has been implemented in medical settings and mental health clinics across the United States. Utah has implemented CRP in all community mental health clinics and mobile outreach teams, the latter of which is required via legislative action.

This program can be delivered by lay individuals or professionals who have regular contact, or might have contact, with individuals in distressing circumstances such as mental health professionals, physicians and nurses, crisis hotline workers, teachers, faith leaders, college student personnel, and criminal justice staff. In-person and online training workshops are available. Please visit https://suicidepreventiontherapy.com/training to learn more.

Considerations for implementing this program include obtaining participant buy-in, recruiting facilitators and ensuring they receive training, and finding time for the therapist and participant to create the CRP together.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email clearinghouse@psu.edu

If you are interested in implementing CRP, the Clearinghouse is interested in helping you! Please call 1-877-382-9185 or email clearinghouse@psu.edu

CRP typically takes less than 30 minutes to create.

Information on implementation costs was not located. Please use details in the Contact section to learn more.

To move CRP to the Effective category on the Clearinghouse Continuum of Evidence at least one additional evaluation must be performed that demonstrates sustained, positive effects on primary outcomes lasting at least one year from program completion. This study must be conducted independently of the program developer.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email clearinghouse@psu.edu

Contact the Clearinghouse with any questions regarding this program. Phone: 1-877-382-9185 Email: clearinghouse@psu.edu

You may also contact Suicide Prevention Therapy by visiting https://suicidepreventiontherapy.com/contact-us

https://suicidepreventiontherapy.com/crisis-response-planning-1, https://afsp.org/brief-interventions-for-managing-suicidal-crises/, https://msrc.fsu.edu/blog/msrc-common-data-elements-cde/

Bryan, C. J., Mintz, J., Clemans, T. A., Burch, T. S., Leeson, B., Williams, S., & Rudd, M. D. (2018). Effect of crisis response planning on patient mood and clinician decision making: A clinical trial with suicidal U.S. soldiers. Psychiatric Services, 69(1), 108-111. https://doi.org/10.1176/appi.ps.201700157

Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., ... 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., Tabares, J. V., Butner, J. E., Daruwala, S. E., Bozzay, M. L., & Gorka, S. M. (2024). Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. Journal of Anxiety Disorders, 102. https://doi.org/10.1016/j.janxdis.2023.102824

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Bauder, C. R., Hay, J. M., McClung, J. G., Starkey, A. G., & Bryan, C. J. (2022). Content analysis of warning signs identified as part of crisis response planning in a community sample of gun owners and non-owners. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.867332

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