Edinburgh Napier & NHS Lothian

Lothian Safety Plan and Lothian Safekeeping Plan

What we've done and how it embodies Time Space Compassion

Suicide prevention among children and young people (CYP) is crucial. Safety planning, a widely used brief intervention, involves healthcare professionals (HCPs) working collaboratively with CYP to develop a plan that identifies coping strategies and sources of support.

A systematic scoping review conducted for this thesis identified unique requirements for CYP safety planning, including the need for a parent-specific safety plan. In response, the Lothian Safekeeping Plan© (LSP) was developed. This work was undertaken within my PhD and shown within my thesis introduces the LSP, followed by a two-phase research study investigating the LSP.

Informed by my published scoping review, the two phase research aimed to assess the acceptability and feasibility of the LSP among HCPs and stakeholders identified as working for corporate parents (CP), who work with vulnerable CYP. Additionally, the research sought to identify enablers and barriers to implementing the LSP in ways that acknowledge and incorporate diverse caregiving roles and responsibilities.

The adaptation of safety plan for children and young people and how after completing my systematic scoping review, I developed the Lothian Safekeeping Plan© (LSP). This was to include parents and carers within the process of safety planning for CYP.

The LSP fills a key gap where previously parents were often left out of the discussion on safety planning and has now created meaningful parental engagement around emotional support when there is a suicidal crisis. Furthermore, the LSP offers a safety planning framework for parents and enables HCPs and CPs to provide more time, space and compassion, allowing the parents to be listened to and have a voice.

This needs to occur within a context of a caring and compassionate approach, with training for HCP and CP, and organisational support. 

How people felt

The CPs believed that the caring aspect when completing the LSP was part of the relationship building and the role of listening was a key factor within this.

The LSP helps parents to reflect on their own listening skills and discuss alternative ways with HCPs of addressing issues with their CYP.

Most participants reported that the design of the LSP was accessible for people to easily use. They commonly reported its ease of use, because of the simplicity of its layout and its clear and concise presentation. The design of the LSP was deemed to be dynamic in nature, as the framework designed so practitioners could move from box to box, writing in things that were discussed.

It was thought that the presentation of the design and the use of the artwork, which is neurodiverse friendly, allowed for an inclusiveness of use. The term, ‘well-structured’, was used by both the HCPs and the CPs and it was considered to have a very approachable design in the overall layout.

What difference it made

From my two-phase research, triangulation of the findings revealed three key themes: the helpfulness of the LSP, its design and potential for development, and its role in managing risk and containment.

Involving parents in the broadest sense in safety planning was deemed essential.

The LSP was viewed as a simple, well-designed, yet comprehensive framework addressing key concerns, thus making it acceptable and feasible to be delivered and developed. It was also valuable for both HCPs and other professionals in managing risk and containment issues.

The LSP represents a clinically led innovation in suicide prevention, providing a specific, parent-focused safety planning framework that complements the Lothian Safety Plan for CYP.

The LSP has now been implemented in one NHS Child and Adolescent Mental Health Service and holds significant potential for wider implementation, offering an additional resource to enhance suicide prevention efforts.