The Towards Zero Suicide (TZS) Programme was introduced in Northern Ireland in 2019. It is a regional programme with a strategic vision committed to patient safety and suicide prevention through implementing best practice and evidence-based interventions.

One of the main workstreams under the TZS programme is the Suicide Prevention Care Pathway.

Suicide Prevention Care Pathway

The purpose of a Suicide Prevention Care Pathway is to identify and respond in a timely way to patients presenting to mental health services who are at risk of suicide.

There are different stages in the Suicide Prevention Care Pathway:

• Chronological Assessment of Suicide Events (CASE) which is an interview strategy to elicit suicidal ideation, planning and intent.
• PISANI Risk Formulation Framework – Pisani’s risk formulation looks at risk status, risk state, available resources and foreseeable changes that may exacerbate risk.
• Conversation on Access to Lethal Means Assessing whether a person at risk of suicide has access to a firearm or other lethal means and working with them and their family/supporter to limit access to these means.
• Safety planning is a core element of the Suicide Prevention Care Pathway and as part of the pathway. There are 2 safety plans currently used as part of the SPCP: Stanley and Brown, and the Collaborative Safety Plan.

Stanley and Brown Safety Plan

The Stanley-Brown Safety Planning Intervention is a widely used, evidence-based, 6-step crisis intervention tool designed to help individuals manage suicidal thoughts and self-harm.

Stanley and Brown have piloted this planning in crisis and mental health liaison services since December 2021 and will continue to use it as a brief intervention tool that provides a person with additional support while waiting on support from another service.

Stanley and Brown safety includes the following steps:

Step 1 – Warning signs of a person becoming unwell, for example a person may be drinking more alcohol than usual, avoiding people or avoiding going out.

Step 2 – Internal coping strategies a person has, for example playing guitar, listening to a podcast, baking or reading to provide some distraction from suicidal thoughts

Step 3 – People and social settings that provide distraction, for example, going to a coffee shop, going a walk with a friend.

Step 4 – People whom a person can ask for help, for example a person may have identified that when they reach this stage that they need specific support from another person. Need to plan with a person that this supporter is available and will be helpful if they are feeling suicidal.

Step 5 – Professionals that a person can ask for help

Step 6 – Making a person’s environment safe. This is a very important conversation to have with a person who is experiencing suicidal ideation as by limiting access to means a person has identified they have thought about using can provide a window of time for a person to access supports and use their safety plan.

Collaborative safety plan

All community and specialist mental health teams will be implementing the collaborative safety plan.

This plan incorporates the areas of Stanley and Brown but has an additional recovery focused wellness plan including:

• Things other people can do to help me.
• What would I say to a friend who is feeling down.
• Who or what keeps me going?
• Three goals I can complete daily
• Hobbies I can begin/continue
• Things I enjoy
• The one thing that is most important to me and worth living for