# A nurse is collaborating with a patient who screened positive for suicidal ideation but has no immediate plan. The patient is stable and being discharged today with a follow-up appointment. The nurse uses the Stanley-Brown Safety Plan. Which elements should be included? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372761&lang=en > language: en > subject: Crisis Intervention > category: PSI ## Question A nurse is collaborating with a patient who screened positive for suicidal ideation but has no immediate plan. The patient is stable and being discharged today with a follow-up appointment. The nurse uses the Stanley-Brown Safety Plan. Which elements should be included? Select all that apply. 1 Have the patient sign a written "no-suicide contract" promising not to harm themselves until the next appointment. 2 List the patient's own internal coping strategies that the patient can use without contacting another person. 3 List professional and crisis resources, including the 988 Suicide & Crisis Lifeline and instructions for restricting access to lethal means at home. 4 Identify the patient's personal warning signs of an emerging crisis (mood, thoughts, situations, behaviors). 5 Identify trusted social contacts and settings the patient can use for distraction and connection during a developing crisis. ## Explanation The Stanley-Brown Safety Plan is a brief, evidence-based intervention used at discharge or in clinic visits for individuals at risk of suicide. It has six elements: (1) warning signs; (2) internal coping strategies; (3) social contacts and settings for distraction; (4) family or friends who can help (different from #3 — these are people the patient can ask for direct support); (5) professionals and agencies (including 988); (6) means safety counseling — restricting access to lethal means at home (firearms, medications). The classic "no-suicide contract" (choice 1) is NOT evidence-based, has not been shown to reduce suicide, and may give a false sense of security; safety planning has replaced contracts. ## In-depth explanation The Stanley-Brown Safety Plan is a brief, evidence-based intervention used at discharge or in clinic visits for individuals at risk of suicide. It is collaboratively developed and consists of six elements: warning signs that signal a developing crisis (mood, thoughts, situations, behaviors); internal coping strategies the patient can use alone; social contacts and settings useful for distraction and connection; trusted family or friends to ask for direct support; professional and agency resources, including the 988 Suicide and Crisis Lifeline; and means safety counseling — practical steps to restrict access to lethal means at home such as firearms or medications. "No-suicide contracts" are not evidence-based, have not been shown to reduce suicide, and have been replaced by safety planning. Means restriction is one of the most effective single interventions to reduce suicide deaths. ## Clinical scenario A nurse is collaborating with a **patient who screened positive for suicidal ideation but has no immediate plan**. The patient is **stable and being discharged today with a follow-up appointment**. The nurse uses the **Stanley-Brown Safety Plan**. ## Key concepts - **Stanley-Brown Safety Plan** — Brief, evidence-based suicide-prevention tool used at discharge or in clinic. Six collaboratively developed elements: warning signs, internal coping, social contacts/settings for distraction, trusted contacts for support, professional/crisis resources, means safety counseling. - **Means Safety Counseling** — Practical restriction of access to lethal means in the home — firearms (lock, store off-site), medications (lock box, dispose of unused), alcohol, sharp objects. One of the most effective single interventions to reduce suicide deaths because attempts are often impulsive and method-substitution does not always occur. - **Why Not "No-Suicide Contracts"** — Older practice. Not evidence-based. Have not been shown to reduce suicide and may give clinician and patient a false sense of safety. 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