Improving professionals’ sharing of safety plan details with nominated supporters in a community mental health setting

Context More than 720 000 people die by suicide worldwide each year with many more people making suicide attempts (WHO, 2025). While rates of suicide are reducing, the United Kingdom (UK) has experienced a slight increase in incidence over recent years (Samaritans, 2025). It is estimated that 6417 people die by suicide each year in the UK, of which 26% had been in contact with mental health services in the 12 months before their death (NCISH, 2025). Drawing on learning from Australia and United States (Donnelly, 2020), Northern Ireland adopted a ‘Towards Zero Suicide Model’ to measurably reduce deaths by suicide and improve care for people experiencing suicidality (DOH, 2019). The ‘Towards Zero Suicide Model’ involves a system wide commitment to suicide prevention by improving outcomes at all levels and eliminating gaps within the delivery of care (DOH, 2019). Community Mental Health Teams (CMHTs) are a key care provider within this model, and provide mental health treatment and support in a locality-based model to patients aged 18+, 9-5pm Monday to Friday.

One of those teams, the context for this quality improvement project, is CMHT Magherafelt, located in a rural town in Northern Ireland. Based in the town centre, CMHT Magherafelt have a multidisciplinary clinical team of 22 staff, with Consultant and non-Consultant medical staff, Mental Health Practitioners, and Support and Administration staff and provide a service for a population of 19,266 (Statistics NI, 2025). The clinical team have an open caseload of approx. 500 patients providing assessment, pharmacological and psychosocial brief and recovery interventions and monitoring. Their focus is to support service users requiring brief periods of assessment treatment and those with severe and enduring mental illness with some patients remaining with the team for ongoing care and monitoring for longer periods.

CMHTs promote service user and carer involvement in treatment plans. One tool available to clinical staff to mitigate suicide risk is the Suicide Safety Plan (Stanley and Brown, 2012). Safety Plans are an evidenced-based brief tool comprising of six-steps, and are completed in collaboration with the patient and their family/carer/close friends (supporters). The six steps are: 1. Warning signs of an impending suicidal crisis, 2. Internal coping strategies, 3. Social contacts as a means of distraction from suicidal thoughts, 4. Supporters who may help to resolve the crisis, 5. Mental Health Professionals or agencies contacts and 6. Actions to remove access to lethal means. The Safety Plan is intended to be shared with the patient and supporter(s).

Problem Step 4 of the Safety Plan seeks to encourage supporters to be named in safety plan and to be made aware of key details within the safety plan. However, it is commonly reported in the literature, and by coroners investigating deaths by suicide, that those persons close to the patient were unaware of the safety plan, the risks associated with the person who died by suicide, or how to provide meaningful effective support (Coffey, 2021; DOH, 2021). Evidence has highlighted that bereaved families and carers wanted to know details of how best to support their loved ones who were experiencing suicidality (DeBeer et al., 2019). One of the complexities around sharing information with supporters is gaining patient consent to share information with families (DOH, 2021). Sharing this information has been highlighted as critical by service users and supporters informing this project who clearly identify that sharing this information saves lives. Share Guidelines NI have been developed in response to the barrier of staff gaining patient consent to discuss suicide risk and safety plans with supporters (DOH, 2021). Associated training has been rolled out to mitigate this barrier, albeit within services it is understood that uptake has been ad hoc. In response to this problem, the aim of this quality improvement project is to increase the frequency that staff share safety plan key details (crisis contacts and lethal means mitigations) within a CMHT Magherafelt, from 38%* to 75%, by end of May 2026. This approach seeks to utilise willing supporter resources close to patients to maximise patient safety.

*38% of CMHT Magherafelt staff report sharing Safety Plan key details with supporters ‘quite often’ or ‘all the time’ frequency.

Assessment of problem and analysis of its causes: A scoping review (Bingham et al., publication in-draft) has identified a dearth of empirical research on the topic, with most empirical articles discussing supporter involvement as a secondary theme. Key points within empirical papers identify the need for flexibility when engaging supporters, staff training, and guidance, signposting to support groups, and self-care options for supporters to enable them to effectively provide support (Gorman et al., 2023; Dodge et al., 2024). Locally, staff, service users and supporters support these findings. Within CMHT Magherafelt, professionals have highlighted the need for digital solutions to support the recording and sharing of safety plans, an optimisation ask of the relatively new (November 2024) NI patient record system, Encompass. Data on staff engagement with supporters held in Encompass across Mental Health Services suggests patient’s safety plan supporters are either not appropriate, not available, or not present at the appointment, with a few being furnished with carers information. Analysis of this problem including findings from the literature review and input from staff and supporters have been shared with expert group leading this QI project and staff involved in the intervention.

Intervention Three ‘Plan, Do, Study, Act’ cycles (Deming, 1986) will be delivered, with iterative changes to each cycle informed by findings and staff feedback from the previous cycle.

Cycle 1: Raise awareness of quality improvement project; ensure all staff have completed the Share Guideline training; delivery of safety plan training session which will include sharing of carer safety plan support leaflet.

Cycle 2: Safety plan fixes on Encompass (printing and sharing capabilities).

Cycle 3: ‘Safety Plan Task List’ prompt improvements added to Encompass.

Strategy for change

Timescal: September 2025 to May 2026 for identified cycles is considered feasible with scope for project creep if digital changes are not realised in time.

Communication plan:

The Clinical Lead will meet weekly with the professionals in CMHT Magherafelt to gain project feedback. Professionals’ feedback will be captured via feedback forms at each project cycle. Clinical Lead will communicate findings to the Expert Group who will meet monthly. Expert group includes professional staff, including clinical lead, patient, supporter, management. Service users will be encouraged to attend expert group meetings or communication can be facilitated asynchronously as preferred as part of planned and targeted service user involvement.

Measurement of improvement

Outcome Measures:

Number of patient Safety Plans whose key details are shared with supporters (staff reported)

NB: More than one supporter may receive this information per patient, this will only be counted once. Some patients over time may have many versions of Safety Plans, the sharing of each Safety Plan can be counted.

Process Measures:

Self-reported measures will be captured via staff self-deployed feedback surveys (frequency) and Safety Plan Task List on Encompass (number).

Staff asking patients to identify a supporter to list on their Safety Plan.

Staff seeking consent from patients to share their Safety Plan information with nominated supporter.

Staff providing supporters with advice and signposting.

Number of Safety Plans completed by staff in previous 4 weeks.

Number of staff using Encompass Safety Plan Task List evident. CMHT Magherafelt baseline = 1 staff member used for 1 patient. (Jan-Sept 25 (Across 9 CMHTs localities 13 staff members used for 28 patients)

Self-reported reasons why Safety Plan details are not being shared.

Balancing Measures:

There is a risk that clinical staff-patient rapport could be impacted negatively with staff members trying to encourage supporter involvement. Patient and supporter feedback on acceptability of sharing of Safety Plans will be thematically analysed. Resident doctor at CMHT Magherafelt will gain qualitative telephone feedback at a time deemed clinically appropriate. Staff feedback will be captured through feedback at team meetings.

Marked increases in outcome and process measures 1-4 are anticipated. Measuring supporter inclusion and awareness of guidelines is likely to raise the profile and utility of Safety Plans generally.

Patients, carers, family members A patient and supporter will be invited to co-author the scoping review particularly the discussion and implications sections and to aid development of lay summaries. They are also members of the expert group guiding development, implementation and refinement of project. Patients and supporters will be invited to share findings of the project alongside project lead at internal Trust events and conferences. The clinical lead for the project will assess appropriateness of all asks for patients and supporters.

Effects of changes At time of submission of abstract, this is not known. If accepted, the poster will be able to reflect effects of change.

Lessons learned so far The lack of evidence base highlights the need for future research to qualitatively explore consent process, engagement, sharing information and follow up care with supporters. Clear guidelines and policy direction creates a sense of urgency and facilitates buy-in from clinical and management staff alongside the interest and support from service users which has been instrumental to driving project forward.

Messages for others Ensure quality improvement initiatives have a strong policy or evidence base as it facilitates both support from senior leadership and adoption by staff. Plan ahead to enable more complex system build changes to be authorised and put into production when involving patient record systems.

References

Coffey M. (2021) https://www.researchgate.net/profile/Michael-Coffey-8/publication/377843151_Person_centred_safety_planning_in_mental_health_care_assessment_and_management_of_risk_an_evidence_briefing/links/65ba799e1e1ec12eff64eb03/Person-centred-safety-planning-in-mental-health-care-assessment-and-management-of-risk-an-evidence-briefing.pdf

DeBeer BB, et al. (2019). J Mental Health Couns.

Deming, W. Edwards (1986). Out of the crisis. Cambridge, MA

Dodge J, et al. (2024) Families, Systems, & Health.

DOH (2019) https://www.health-ni.gov.uk/sites/default/files/publications/health/pl-strategy.PDF

DOH (2021) https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-share-guide-ni.pdf

Donnelly O. (2020) https://media.churchillfellowship.org/documents/Donnelly_O_Report_2019_Final.pdf

Gorman LS, et al. (2023). B J Psych Open.

NCISH (2025) https://documents.manchester.ac.uk/display.aspx?DocID=75346

Samaritans. (2025) https://www.samaritans.org/ni/about-samaritans/research-policy/suicide-facts-and-figures/latest-suicide-data/

Stanley B, Brown GK. (2012). Cog and Beh Practice.

NISRA (2021) https://explore.nisra.gov.uk/area-explorer-2021/N10000905/

WHO (2025) https://iris.who.int/server/api/core/bitstreams/769d0a45-b50a-4b17-ba40-259bef44d9dd/content