Crisis service utilization following completion of a suicide safety plan for Veterans with and without affective and nonaffective psychosis

J Psychiatr Res. 2022 Oct:154:219-223. doi: 10.1016/j.jpsychires.2022.07.034. Epub 2022 Aug 5.


Objective: Psychosis is associated with increased suicide risk. Safety planning is a suicide prevention practice that is associated with decreased suicidal behavior and psychiatric hospitalizations. A common feature of safety planning is listing of crisis line numbers. The primary purpose of this study was to compare Veterans with and without psychosis who completed a safety plan in terms of their next year crisis service use, including Veterans Crisis Line (VCL) calls, and suicidal behavior.

Methods: Data were drawn from the VA San Diego's electronic medical record system for (N = 1602) safety plans from 2018 to 2021. Clinical records of crisis services and suicide attempt/death were recorded for one year after the safety plan.

Results: Following completion of a safety plan, Veterans with psychosis were more likely to have a next year psychiatric hospitalization (OR = 4.1), emergency department visit (OR = 2.3), and psychiatric emergency clinic visit (OR = 2.2) than those without psychosis. In contrast, there were no group differences in likelihood of calling the VCL.

Conclusions: Veterans with psychosis who recently completed a safety plan do not show elevated rates of VCL use that are commensurate with increases in crisis service use. Interventions for this high-risk group may focus on understanding the motivation and ability to call the VCL as ways to enhance safety planning.

Keywords: Crisis services; Psychosis; Safety plan; Suicide; Veterans crisis line.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Humans
  • Psychotic Disorders* / therapy
  • Suicidal Ideation
  • Suicide, Attempted / prevention & control
  • Veterans* / psychology