Craig Bryan, PsyD, ABPP
CRP for suicide prevention is a brief safety planning-type intervention that can be used to reduce an individual's risk for suicidal behavior. CRP is a collaborative process in which someone helps a suicidal person develop a personalized checklist of strategies that can be used during periods of intense emotional distress. Checklists are typically handwritten on an index card for easy, convenient access during times of need. At its core, the CRP helps someone remember what to do when they feel emotionally overwhelmed.
CRP is comprised of five key sections:
CRP usually takes less than 30 minutes to create. An important part of CRP is helping individuals to successfully cope with intense levels of distress when faced with problems that seem unsolvable and/or never-ending.
Originally developed for use by mental health clinicians and other healthcare providers, CRP can also be used by non-healthcare professionals like peer specialists, faith leaders, crisis call center staff, and other members of the community to help people in crisis until they can initiate mental health treatment. CRP is not a replacement for formal mental health treatment; it is a brief strategy designed to reduce short-term risk for suicide, similar to how cardiopulmonary resuscitation, the Heimlich maneuver, and automated external defibrillators (AEDs) are not replacements for formal medical treatment but can help keep someone alive during a crisis.
CRP is a specific kind of safety planning-type intervention that has been shown to reduce suicide attempts by up to 76% as compared to traditional crisis management procedures (Bryan et al., 2017). That same study showed that CRP also results in faster reductions in suicidal ideation. A recent meta-analysis of 6 published treatment studies of safety planning-type interventions (Nuij et al., 2021) found that, on average, safety planning-type interventions reduce suicide attempts by 43%.
To date, CRP is the only safety planning-type intervention with demonstrated efficacy for reducing suicide risk resulting from a randomized clinical trial, the highest standard of scientific evidence for an intervention or procedure.
Negligence and malpractice liability in the case of a patient death by suicide are largely determined by foreseeability, which typically refers to the procedures used by the clinician to assess the likelihood and possibility of suicidal behavior prior to the act, and reasonable care, which typically refers to the procedures used by the clinician to reduce this risk (Berman, 2006). To address foreseeability and reasonable care, mental health clinicians are expected to:
Owing to their demonstrated effectiveness for reducing suicide attempts, CRP and other safety planning-type interventions are recommended standard of care practices in mental healthcare settings for clinicians working with suicidal patients (Bryan, 2019).
Berman, A. L. (2006). Risk management with suicidal patients. Journal of Clinical Psychology, 62(2), 171-184.
Bryan, C. J. (2019). Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients. Behavioral Sciences & the Law, 37(3), 247-258.
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 US Army soldiers: a randomized clinical trial. Journal of affective disorders, 212, 64-72.
Nuij, C., van Ballegooijen, W., De Beurs, D., Juniar, D., Erlangsen, A., Portzky, G., ... & Riper, H. (2021). Safety planning-type interventions for suicide prevention: meta-analysis. The British Journal of Psychiatry, 219(2), 419-426.