From Plan to Practice: Embedding Safety Planning in Inpatient Mental Health Care

Post-discharge suicide risk remains highest among psychiatric inpatients, yet structured safety planning is rarely embedded into inpatient care. As part of a quality improvement project, in 2022, a major metropolitan hospital in Australia rolled out the 7 SAFE STEPS Programs to address this gap. The training included safety conversations and safety plans, which were introduced to become part of the discharge process. This mixed-methods study evaluated whether the structured safety planning was embedded into inpatient routine practice and explored staff and consumer experiences to identify barriers and enablers to meaningful implementation. A numerical count of the safety plans was undertaken. The quality of safety plans produced was assessed through an audit and benchmarking these to the essential components (recognising early warning signs, identifying adaptive internal coping mechanisms, engaging external supports, accessing professional services, addressing means restriction, and reaffirming reasons for living). Safety plans were given a numerical value based on if these were present or absent. Qualitative data about their experiences with the safety plans was also gathered through interviews and focus groups with nursing staff, peer workers, and recently discharged consumers. The qualitative component of the study was designed and reported according to the EQUATOR Network guidelines for qualitative research (COREQ). While there was an increase in the number of safety plans completed on the ward, the overall quality of these was low (average score of 7.67 out of 22). Themes from the qualitative data identified barriers to the introduction, which included time pressures, training gaps, and procedural drift. Nursing staff and consumers discussed the value of these plans and made suggestions for changes.