2020 Winter GAPNA Newsletter Volume 39 Issue 4

Clinical Pearl: The Utility of a Mental Health Safety Plan in Primary Care

By Deborah Kernohan

COVID-19 has disrupted all aspects of life, resulting in worsening of established life challenges and creating new challenges. Restrictions associated with COVID-19 have increased social isolation and loneliness, disproportionately affecting vulnerable populations such as older adults and those with existing mental illness, isolation, and loneliness.

Social isolation and loneliness adversely affect mental and physical health, such as elevated systolic blood pressure, increased cardiovascular death, reduced sleep efficiency, increased depression, and anxiety. Research has demonstrated loneliness is associated with increased suicide attempts and completed suicide deaths among older adults.

There are approximately 47,000 suicide deaths annually in the United States. Of these, approximately 17% are persons aged 65 years or older. Of the elderly suicide-related deaths, 77% saw their primary care provider within 1 month of their death.

Multiple factors increase the risk of suicide, such as previous suicide attempt, mental disorders, chronic illness, chronic pain, substance use/misuse, anxiety, past trauma, loneliness, social isolation, lack of social support, financial hardship, and personal loss (death/divorce, change in living environment, etc.).

Safety Plans

Safety plans can positively impact mental health crisis outcomes. Implementing a safety plan can reduce suicidal behavior and hospitalization. A safety plan is an individualized, collaborative plan created with the patient identifying and prioritizing interventions to employ when experiencing a crisis. The six steps of safety plan development include:

  • Recognize warning signs.
  • Utilize individual coping skills.
  • Engage social supports.
  • Seek a healthy setting.
  • Contact professional help/resources.
  • Make the environment safe/reduce access to lethal means.

Many templates exist for safety plans, which can be tailored to a variety situations/conditions, such as loneliness, anxiety, feelings of isolation, sadness, fear/worry, substance use, or any identified situation/condition in need of additional management tools.

Creating a safety plan with the patient provides a useful management tool in times of stress/crisis. The plan can be documented/uploaded into the medical record and patient portal for access by other care providers and the patient. Developing a safety plan with the patient takes about 15-40 minutes.

Identifying Risk Factors

Advanced practice nurses are a vital resource for patients. As primary care providers, we are in a unique position to assist patients to identify suicide risk contributors, create a strategic safety plan, and mitigate risk of suicidal death. Aside from providing medical care, the office visit provides social engagement and physical touch which are integral components of physical and mental well-being.

Medical care delivery has transitioned toward virtual/telehealth visits, reducing patients' COVID-19 risk; however, it has also reduced the level of social interaction patients are familiar with during an in-person visit.

Mental well-being should be on the provider's radar during all types of visits. Primary care providers have an opportunity to identify early risk factors during office visits that can lead to crisis. The time invested in development of a safety plan for mental well-being could interrupt early symptoms and reduce the risk of a suicide attempt.

For more information:

Deborah Kernohan, MSN, NP-BC
debbie.kernohan@centrahealth.com

References