Safety Planning Intervention in Swedish Healthcare: A Multisite Study for Suicide Prevention
Phase: NA
Conditions: Suicide Attempt
Sponsor: Region Skane

Safety Planning Intervention in psychiatric services: A 
Swedish implementation study- Research plan 
Last updated April 4 2025  
Summary 
Suicide is one of the leading causes of premature death and a prioritized public health concern. 
Safety Planning Intervention (SPI) is a method with strong international research support for 
reducing suicidal behaviour by enhancing individuals' strategies for crisis management and 
improving access to support. SPI is a single-session intervention lasting approximately 45 minutes, 
which any healthcare provider can deliver after a brief training. Despite promising results, the 
implementation of SPI in Swedish healthcare remains limited. This project examines how SPI can be 
integrated into various healthcare settings and evaluates its impact on suicide-related emergency 
visits, psychiatric hospitalizations, and healthcare utilization. 
Data and Methods 
Stepped-Wedge implementation study in specialist psychiatry, where SPI is gradually introduced in 
psychiatric units. This study design allows for a robust evaluation of effects while ensuring all units 
eventually receive the intervention. As part of this study, a survey among healthcare professionals 
will be conducted to assess their experiences with feasibility, usability, and implementation barriers. 
Data will be collected from QlikView healthcare utilization data. Poisson regression models with 
mixed effects will be used to analyze the impact of SPI on emergency visits and psychiatric 
hospitalizations. A health economic analysis will be conducted to evaluate the cost-effectiveness of 
SPI. 
Societal Relevance and Impact 
The project contributes to Sweden’s national suicide prevention strategy by: 
1. Scientifically evaluating the feasibility and effects of SPI in Swedish healthcare. 
2. Developing training programs for healthcare professionals in suicide prevention. 
3. Informing policy decisions and national guidelines. 
4. Analyzing the cost-effectiveness of SPI from a societal perspective. 
Implementation 
The research team includes experts in suicide prevention, psychiatry, epidemiology, patient safety, 
and health economics, creating a strong multidisciplinary foundation. 
The Stepped-Wedge design ensures an ethically and methodologically sound evaluation of SPI. 
Gradual implementation allows for time-based comparisons, minimizes selection bias, and ensures 
all patients receive the intervention. 
The project is conducted in close collaboration with healthcare providers and policymakers to ensure 
that research findings can be integrated into clinical practice and strengthen suicide prevention 
efforts in Sweden. 

Background 
Suicide as a Public Health Crisis and the Need for Systemic Interventions 
Suicide remains one of the leading causes of premature mortality worldwide, accounting for over 
720,000 deaths annually (1). Despite significant advancements in healthcare, efforts to reduce 
suicide rates have not kept pace with those targeting infectious and chronic diseases. Suicide is a 
multifaceted issue, influenced by biological, psychological, and social determinants, and often occurs 
in individuals who have recently interacted with healthcare services. 
As previous work by our research group has shown, individuals at risk of suicide frequently seek help 
across various healthcare settings, including medical emergency care, primary care, and psychiatric 
services, highlighting the need for effective and integrated interventions (2). Further, research from 
our group has demonstrated that individuals admitted to medical emergency inpatient units have a 
23-fold increased suicide risk compared to the general population, a risk that persists for decades (3, 
4).  
Suicide Prevention Efforts and Challenges in Swedish Healthcare 
Despite Sweden’s national suicide prevention strategy, significant gaps remain in suicide risk 
assessment, intervention accessibility, and follow-up care across hospital care, primary care, and 
psychiatric services. Reports from the National Board of Health and Welfare and the Public Health 
Agency of Sweden highlight systemic deficiencies in suicide prevention efforts, emphasizing the need 
for structured interventions to improve patient safety and care continuity (5, 6). 
Hospital Care: High-Risk Periods and Limited Follow-Up 
Patients hospitalized for intentional self-harm or suicide attempts face a heightened risk of suicide 
immediately following discharge. A 2023 report from the National Board of Health and Welfare  
revealed that only 13% of patients discharged after hospitalization for self-harm received a follow-up 
appointment within the recommended seven-day period (7). This is concerning, given that the 
immediate post-discharge period is one of the highest-risk timeframes for suicide. 
Moreover, short hospital stays further complicate suicide prevention efforts. 65% of patients 
admitted for intentional self-harm are discharged within 24 hours, and 80% are discharged within 
five days, highlighting the limited time available for structured suicide prevention interventions (7). 
Additionally, only 40% of patients hospitalized for self-harm undergo a structured suicide risk 
assessment, demonstrating a lack of standardized suicide prevention procedures in hospital care. 
Primary Care: Insufficient Risk Assessment and Lack of Standardized Approaches 
Primary care plays a crucial role in suicide prevention, as it often serves as the first point of contact 
for individuals experiencing mental health distress. According to the National Board of Health and 
Welfare, it is essential that primary care providers identify early signs of mental illness and suicide 
risk and offer appropriate interventions. However, many primary care clinics lack standardized 
protocols for suicide risk assessment, leading to inconsistencies in clinical practice and missed 
opportunities for intervention (7). A literature review on primary care personnel’s experiences with 
suicide prevention highlighted several major barriers, including lack of structured training, resource 
constraints, time pressure, and the absence of clear guidelines for handling suicidal patients (8).  
Psychiatric Services: Resource Limitations and Challenges in Continuity of Care 

Despite psychiatric services being a key access point for individuals at high risk of suicide, resource 
shortages, long waiting times, and a lack of structured follow-up strategies pose significant 
challenges to effective suicide prevention. The National Board of Health and Welfare (7) reports that 
one-third of individuals who die by suicide had an active contact with psychiatric services before 
their death, yet many lacked a structured care plan or documented suicide risk assessment. 
A growing body of evidence suggests that suicide prevention strategies should not be limited to 
psychiatric care but should be integrated into primary and medical emergency care, where many at-
risk individuals seek help. The Lancet Psychiatry report "Gone Too Soon"(9) highlights that 
individuals with mental illness or distress experience a significantly reduced life expectancy, with 
men losing on average 10.2 years and women 7.3 years, due to both suicide and physical health 
comorbidities. The report identifies fragmented care structures, diagnostic overshadowing, and 
stigma as key barriers to effective suicide prevention, emphasizing the urgent need for evidence-
based interventions that can bridge the gap between primary, medical, and psychiatric care. 
Shifting from Risk Prediction to Therapeutic Risk Management 
Traditional suicide prevention efforts have often relied on risk stratification models, where 
individuals are categorized as low, medium, or high risk based on clinical assessments. However, 
research has increasingly challenged the reliability of risk prediction models. A review by Hawton et 
al. (10) found that suicide risk assessments lack predictive validity, with many studies demonstrating 
that risk classification does not accurately distinguish individuals who will attempt suicide from 
those who will not. Similarly, Fortune & Hetrick (11) argue that even the most sophisticated risk 
prediction models have a positive predictive value of only 5.5%, meaning that for every 100 
individuals classified as high risk, fewer than six will actually attempt suicide. These findings suggest 
that focusing on risk categorization alone is insufficient and that interventions should instead 
prioritize therapeutic risk management strategies. 
Safety Planning Intervention (SPI): A Brief, Scalable Suicide Prevention Tool 
Safety Planning Intervention (SPI), developed by Stanley & Brown (12), is a brief, structured suicide 
preventive intervention designed to help individuals identify warning signs, develop coping 
strategies, and establish emergency contact pathways. SPI is a single-session intervention that 
typically lasts approximately 45 minutes and is delivered in clinical or emergency care settings. It is 
designed to help individuals identify warning signs, develop coping strategies, and establish a 
concrete plan for seeking support during a suicidal crisis. Unlike traditional risk assessments that 
focus on predicting suicide risk, SPI actively engages individuals in managing crises before they 
escalate. The intervention consists of six core steps: 
1. Recognizing warning signs – Helping individuals identify early indicators of a suicidal crisis. 
2. Developing internal coping strategies – Encouraging self-management techniques to reduce 
distress without external intervention. 
3. Utilizing social support – Identifying trusted contacts who can provide emotional and 
practical assistance. 
4. Contacting professionals and crisis services – Establishing direct links to mental health 
providers, crisis hotlines, and emergency services. 
5. Restricting access to lethal means – Implementing evidence-based strategies to limit access 
to firearms, medications, or other means of suicide. 

6. Enhancing motivation and commitment – Reinforcing the patient’s agency and ability to 
manage distress effectively. 
Empirical Evidence Supporting SPI Effectiveness 
1. Randomized Controlled Trial in Emergency Departments (Stanley et al., 2018, JAMA 
Psychiatry) 
A multisite randomized controlled trial (RCT)(13) involving 1,640 suicidal patients across 9 Veterans 
Health Administration emergency departments (EDs) found that SPI+ (SPI with structured follow-up) 
reduced suicide attempts by 45% over six months compared to usual care. Additionally, SPI+ patients 
were twice as likely to engage in mental health treatment post-ED visit (OR = 2.06, p < .001). 
2. Effectiveness of SPI in Outpatient Care (Zonana et al., 2018) 
Zonana et al. (14) examined the impact of Safety Planning Intervention (SPI) in an outpatient mental 
health clinic, finding a 69% reduction in total inpatient days (p = .04) and a 47% decrease in 
psychiatric emergency visits (p = .09). While the drop in suicide attempts (from five to one, p = .10) 
was not statistically significant, SPI was linked to increased engagement with crisis services and an 
18% rise in scheduled outpatient appointments, indicating improved continuity of care. However, 
missed appointments increased by 34%, particularly among patients with schizophrenia or 
schizoaffective disorder, suggesting that some groups may need additional support to fully benefit 
from SPI. 
3. Findings from Fergusson et al. (2022): A Systematic Review of SPI Effectiveness 
Fergusson et al. (15), conducted a systematic review of 26 studies across emergency departments, 
inpatient psychiatric units, outpatient mental health services, and community-based care, making it 
one of the most comprehensive evaluations of Safety Planning Intervention (SPI) to date. The review 
found consistent reductions in suicidal ideation and behaviour, with several studies reporting 
decreased suicide attempts and lower hospitalization rates, reinforcing SPI’s role in preventing crisis 
escalations. Treatment adherence improved significantly, particularly when SPI was combined with 
structured post-discharge follow-up. Qualitative findings indicated that SPI was well-accepted by 
both patients and clinicians, who appreciated its structured, patient-centred approach.  
Meta-Analysis of SPI Effectiveness (Nuij et al., 2021) 
The meta-analysis by Nuij et al. (16) is one of the most comprehensive evaluations of Safety 
Planning-type interventions, synthesizing data from six RCTs with 3,145 participants across 
emergency departments, inpatient psychiatric units, and primary care clinics. The study found that 
SPI or adaptations of SPI reduced suicide attempts by 43%, significantly improved treatment 
adherence, and increased engagement with mental health services post-discharge. The greatest 
effects were observed when SPI was combined with structured follow-up contacts, highlighting the 
importance of continued support beyond the initial safety planning session. The intervention was 
particularly effective for high-risk populations with a prior history of suicide attempts. Nuij et al. 
(2021) concluded that SPI is one of the most effective brief interventions for suicide prevention, 
reinforcing the need for its integration into routine clinical practice to provide structured and 
evidence-based support for individuals at risk. 
Challenges Related to Feasibility and Healthcare Integration 
Chesin et al.  (17) examined the feasibility of Safety Planning Intervention (SPI) implementation in 
five U.S. Veterans Affairs emergency departments (EDs), finding that 98% of ED staff viewed SPI as 

acceptable and beneficial, particularly in enhancing patient safety during discharge. However, initial 
concerns about workload, logistical feasibility, and workflow disruptions were raised. These 
concerns diminished over time as SPI became routine practice, especially when training and 
administrative support were provided. This suggests that successful implementation in Sweden’s EDs 
would require structured training, workflow integration, and leadership support to ensure long-term 
sustainability. 
Conclusion: The Need for SPI in Swedish Healthcare 
Despite Sweden’s well-developed healthcare system and national suicide prevention strategy, 
significant gaps remain in the identification, management, and follow-up of individuals at risk of 
suicide. Recent reports from the National Board of Health and Welfare and the Public Health Agency 
of Sweden (5, 7) highlight major deficiencies across hospital care, primary care, and psychiatric 
services, including limited suicide risk assessments, inadequate post-discharge follow-up, and a lack 
of structured suicide prevention protocols. These challenges underscore the need for evidence-
based, scalable interventions that can be effectively integrated into routine healthcare practices. 
Safety Planning Intervention (SPI) offers a structured, practical, and effective solution to strengthen 
suicide prevention in Sweden. SPI has demonstrated significant reductions in suicide attempts and 
improved treatment adherence (Nuij et al., 2021; Stanley et al., 2018; Fergusson et al., 2022). Unlike 
traditional suicide risk assessments that focus on predicting risk, SPI provides a personalized and 
actionable safety plan for patients, ensuring they leave healthcare settings with concrete strategies 
for crisis management and structured follow-up pathways. 
By implementing SPI in psychiatric services, Sweden has the opportunity to address critical 
weaknesses in suicide prevention, improve continuity of care, and reduce the burden of suicide-
related hospitalizations and emergency visits. This study will be the first systematic evaluation of SPI 
in Sweden, providing crucial evidence on its feasibility, effectiveness, and implementation 
challenges. The results will serve as a foundation for national-scale implementation and contribute 
to improving Sweden’s suicide prevention framework, ensuring that individuals at risk receive 
timely, structured, and sustained support. 
Theoretical framework of the study 
The theoretical foundation of this study integrates multiple perspectives on suicide prevention. SPI 
aligns with the Interpersonal Theory of Suicide (Joiner, 2012), addressing perceived burdensomeness 
and thwarted belongingness by strengthening social support and self-management skills. 
Additionally, the Stress-Vulnerability Model (Mann & Arango, 1992) highlights the need for 
interventions like SPI that enhance resilience in high-risk individuals. 
The Stress-Vulnerability Model (18) posits that suicidality arises from an interplay between individual 
vulnerabilities and environmental stressors. When an individual’s coping capacity is overwhelmed, 
the risk of suicidal behaviour increases. SPI mitigates this risk by equipping individuals with strategies 
to recognize early warning signs, develop coping mechanisms, and establish supportive networks, 
thereby enhancing resilience and reducing vulnerability to stress-related triggers. 
Complementing this, the Interpersonal Theory of Suicidal Behavior (19) highlights the role of social 
disconnection and perceived burdensomeness in the emergence of suicidality. Individuals who feel 
alienated or believe they are a burden on others may develop a stronger desire for death. SPI 
directly counters these factors by fostering connections with supportive individuals, reinforcing a 

sense of belonging, and guiding individuals toward resources that reaffirm their value and role in 
their social environment. 
Another key perspective is the Evolutionary Theory of Defeat and Entrapment (20) which suggests 
that suicidal behaviour is driven by a perceived inability to escape distressing circumstances. When 
individuals feel trapped in unbearable situations without viable solutions, suicidality may emerge as 
a perceived escape route (21). SPI provides structured pathways for breaking these negative cycles 
by helping individuals shift their perspective, identify alternative coping strategies, and create 
actionable steps that instil a renewed sense of agency and hope. 
Furthermore, the Person-Centred Care Approach strengthens the foundation of SPI by emphasizing 
the importance of treating individuals as active participants in their own care. Rooted in Carl Rogers’ 
theory of person-centred therapy, this approach prioritizes empathy, authenticity, and respect for 
the individual's lived experience (22). By aligning with the biopsychosocial model (23) SPI ensures 
that suicide prevention efforts extend beyond symptom management to include psychological and 
social determinants of well-being. Person-centred care also reinforces the necessity of tailoring 
interventions to the individual's unique context, recognizing that effective suicide prevention must 
address the whole person rather than just the crisis moment (24). 
Originality  
This is the first study in Sweden to evaluate the implementation of Safety Planning Intervention (SPI) 
filling a critical gap in suicide prevention research. Despite strong international evidence for SPI, no 
Swedish studies have examined its feasibility or effectiveness in any healthcare setting. Given that 
many individuals who die by suicide have had recent healthcare contact, ensuring effective suicide 
prevention strategies in these settings is crucial. 
This study adopts a stepwise implementation strategy, allowing SPI to be introduced progressively 
while enabling structured evaluation. In specialist psychiatry, a stepped-wedge approach ensures all 
service areas receive SPI while permitting comparisons across different implementation phases. 
The study will identify barriers and facilitators to implementation, assess SPI’s real-world 
applicability, and generate evidence to inform policy and clinical practice in Sweden. 
The results will not only enhance Sweden’s national suicide prevention framework but may also 
serve as a model for broader international adaptation and implementation of SPI in diverse 
healthcare contexts, ultimately preventing unnecessary loss of life. 
Objective 
The project aims to assess the feasibility, implementation, and outcomes of Safety Planning 
Intervention (SPI) within psychiatric services. The study will evaluate the impact of SPI on suicide-
related healthcare utilization in psychiatric services. 
Research Questions 
Effectiveness and Outcomes in Psychiatric Services 
RQ1: What effect does SPI have on emergency visits and inpatient admissions due to suicide 
attempts in psychiatric services, when introduced using a stepped wedge implementation? 
RQ2: What is the health-economic impact of implementing the Safety Planning Intervention (SPI) in 
psychiatric services, in terms of budget impact and cost-effectiveness based on healthcare costs, 
productivity gains and prevented suicide attempts compared to usual care? 

Study design and methods 
Stepped Wedge Implementation Study in Adult Specialist Psychiatry 
SPI is currently used in psychiatric services within Region Skåne by some practitioners. The 
intervention is planned to be introduced more broadly to all psychiatric units. The Stepped-Wedge 
implementation study is designed to systematically introduce SPI in adult psychiatric services while 
ensuring rigorous evaluation of its effectiveness. This approach allows for phased implementation 
while simultaneously generating high-quality data on clinical and economic outcomes. In this 
project, we will investigate the effect of SPI on emergency visits, conduct a cost-effectiveness 
analysis and a staff survey of implementation. 
Research Question Addressed 
RQ1: What effect does SPI have on emergency visits and inpatient admissions due to suicide 
attempts when introduced using a stepped wedge implementation? 
RQ2: What is the health-economic impact of implementing the Safety Planning Intervention (SPI) in 
psychiatric care, in terms of budget impact and cost-effectiveness based on healthcare costs, 
productivity gains and prevented suicide attempts compared to usual care? 
Study 1: The effect of SPI on emergency visits and inpatient admissions due to suicide attempts 
SPI will be implemented progressively across the four public psychiatric clinics in Skåne, comprising 
all adult psychiatric emergency care and inpatient care in the county. A stepped wedge 
implementation design will be used so that the implementation occurs at 6-month intervals (Table 
1). During the first four weeks of the implementation phase at each site, SPI training will be provided 
in groups to the staff of all inpatient units and emergency units at the site. The study design is 
illustrated in Figure 1 below. 
Data extraction 
Data on emergency unit visits and inpatient admissions coded with diagnoses that indicate suicidal 
behaviour (ICD-10: X60-84) and their ICD-11 counterparts if ICD-11 is implemented in Sweden during 
the study) will be extracted from the electronic registry system used in Skåne through QlikView. 
Through this program, such data can be extracted on the aggregate level (only) per month, per site, 
per sex, and age category. We will extract such data for the entire study period of 45 months as well 
as for 48 months before the start of the study to increase the statistical power of the analyses. 
The following data will be collected in aggregated form per month for each participating clinic 
(Malmö, Lund, Helsingborg, Kristianstad) and stratified by gender and age group: 
• 
Number of emergency visits with ICD-10 diagnoses for suicide attempts (X60–X84) and 
events of undetermined intent (Y10–Y34). 
• 
Number of psychiatric inpatient admissions with the same diagnoses. 
• 
Re-visits to the emergency department due to suicide attempts and events of undetermined 
intent within 30 days, six months, and one year. 
• 
Re-admissions to psychiatric inpatient care due to suicide attempts and events of 
undetermined intent within the same three time periods 

Study 2: Cost-Effectiveness Analysis 
A comprehensive cost-effectiveness and budget impact analysis will be conducted to evaluate the 
health-economic value and financial impact of SPI implementation within psychiatric services. This 
analysis will compare intervention costs with potential savings generated from reduced hospital 
admissions, emergency department visits, and outpatient psychiatric care and relate these to 
estimated health outcomes. 
Analysis Methods 
The effect of SPI on emergency visits and inpatient admissions due to suicide attempts 
We will employ mixed-effect Poisson regression models to analyse the effect of the implementation 
on emergency visits and inpatient admissions for suicidal behaviour. The models will use the total 
number of such events for each month as the outcome measure, using the total population in the 
catchment area of each site as an offset variable in order to consider demographic changes and to 
be able to calculate rate ratios. The main variable of interest is the intervention variable, which in 
the basic analysis will take the value 0 for all months prior to the implementation at each site and 1 
for all months from the intervention and onwards. Each site will be given a random intercept to 
model different baseline levels of suicidal behaviour prevalence. We will control for seasonal 
variation by using calendar month as a random intercept, and we will also control for secular time 
trends by using chronological time as an independent variable. 
In more elaborate models, we will use random slopes for sites, as well as study a slope effect during 
the first 6 months after implementation in each site. Such models will be compared to the basic 
model using the likelihood ratio test for nested models and through the use of Akaike and Bayesian 
Information Criteria (AIC and BIC, respectively) for non-nested models. 
In secondary analyses of a more explorative character, we will include interaction effects between 
intervention effect and sex and age group, respectively. This will allow us to assess whether the 
effect of the implementation varies across different demographic groups. We will also broaden the 
outcome measure to include self-harm events of undetermined intent, including poisoning with 
undetermined intent (ICD 10: Y10–Y34) because, arguably, some of those events are in fact suicide 
attempts. 
Calculations of statistical power 
Calculating statistical power in a study design such as this is far more complex than statistically 
simpler studies. However, it can readily be done by simulating data in R and running the analyses on 
simulated data repeatedly (R code available on request). The total number of patients admitted to 
inpatient units for suicide attempts in Sweden was 7383 in 2022 (25). Assuming that the rate of 
suicide attempts is the same in the four catchment areas of the psychiatric clinics in Skåne, and 
assuming that implementation of the SPI intervention reduces this amount by 10%, the statistical 
power can be calculated to 92.6 %. The simulation does not include variations of suicide attempts 
over time or any seasonal variation, but this is expected to lower the estimated statistical power 
only marginally. We thus conclude that the statistical power is sufficiently high for the planned 
study. 
 Cost-effectiveness analysis 
A comprehensive cost-effectiveness and budget impact analysis will be conducted to evaluate the 
health-economic value and financial impact of SPI implementation within psychiatric services. This 
analysis will compare intervention costs with potential savings generated from reduced hospital 

admissions, emergency department visits, and outpatient psychiatric care and relate these to 
estimated health outcomes. 
Key components of the cost-effectiveness and budget impact analysis: 
• 
Direct healthcare costs: Expenses related to SPI implementation, training, and healthcare 
resource utilization. 
• 
Indirect costs: Potential productivity gains from reduced suicidality and improved mental 
health. 
• 
Cost-effectiveness ratio: The incremental cost per prevented suicide attempt or psychiatric 
hospitalization. 
• 
Sensitivity analysis: Examining variations in costs and outcomes under different 
implementation scenarios. 
• 
Budget impact analysis: Assessing the financial feasibility of scaling up SPI across multiple 
psychiatric units. 
Analysis Method 
• 
Cost-effectiveness analysis: Evaluating health-economic impact using cost-effectiveness 
ratios, budget impact assessments, and sensitivity analyses following standard methods for 
economic evaluation of healthcare (26). 
and outcomes in standard clinical practice remain underexplored. By using a stepped-wedge model, 
this study can provide crucial insights into how SPI functions across diverse healthcare 
environments, informing national implementation strategies and ensuring long-term sustainability. 
 
Ethical Considerations 
In this research project, only aggregated data (number of healthcare contacts per clinic, 
readmissions, gender, and age category) from Region Skåne’s administrative registration systems 
will be analyzed (note: not from medical records). No individuals will be actively included, and no 
personal or individual-level data will be collected or processed. 
The intervention itself, the Safety Planning Intervention (SPI), is being implemented as part of 
routine psychiatric care in Region Skåne, independently of the research project. Any patient 
reactions or other clinical consequences related to SPI will therefore be managed within the 
framework of standard procedures and clinical pathways in psychiatry. 
A potential indirect risk associated with the stepped-wedge implementation design is that some 
patients may gain access to the Safety Planning Intervention (SPI) later than they would have if a 
simultaneous rollout had occurred across the entire region. However, we consider this temporal 
variation not to constitute a significant risk to patients, as psychiatric services already offer a wide 
range of treatment options and structured interventions aimed at reducing suicide risk. 
Consequently, patients will continue to receive care in accordance with existing routines and 
standard clinical practice, regardless of access to SPI at any given time. 
At the same time, the potential benefits of the project are considerable. By scientifically evaluating 
the implementation of SPI in routine clinical settings, the study may contribute to improved suicide 

prevention, more appropriate care, and enhanced patient safety. Moreover, the results have the 
potential to inform practice both nationally and internationally, further increasing the value of the 
project. 
In summary, the scientific and societal value of the project clearly outweighs the minimal risks 
identified, as no identifiable individual data will be processed, and no research-specific procedures 
or treatments will be conducted at the individual level. The project thus meets the requirements of 
the Swedish Ethical Review Act, in which the anticipated benefits must clearly exceed any potential 
risks. 
 
Relevance for society  
Suicide is a major public health concern, with severe consequences for individuals, families, and 
society at large. Effective suicide prevention strategies are critical to reducing unnecessary loss of life 
and alleviating the emotional and economic burden associated with suicide and suicide attempts. 
This project contributes to these efforts by implementing and evaluating Safety Planning 
Intervention (SPI) across psychiatric healthcare settings, ensuring that individuals at risk receive 
structured, evidence-based support at critical points in their care journey. 
By integrating SPI into psychiatric services, the project directly addresses a gap in suicide prevention 
efforts in Sweden. Research has shown that many individuals who die by suicide have had recent 
contact with healthcare services, yet opportunities for intervention are often missed. This study aims 
to bridge that gap by embedding SPI into routine healthcare workflows, improving early 
identification and crisis management for suicidal individuals. 
Beyond its direct impact on patient care, the project has broader societal implications: 
• 
Enhancing healthcare providers’ ability to intervene effectively: By training staff across 
different healthcare contexts, the project strengthens the capacity of the healthcare system 
to respond to suicidality in a structured and proactive manner. 
• 
Reducing healthcare costs associated with suicide attempts: Suicide attempts often lead to 
repeated hospitalizations, emergency visits, and long-term mental health issues. By 
preventing suicide attempts, SPI may contribute to lower healthcare expenditures and more 
efficient resource allocation. 
• 
Informing national suicide prevention strategies: The study’s findings will generate evidence-
based recommendations for the broader implementation of SPI in Sweden’s healthcare 
system. This can guide policymakers in scaling up effective suicide prevention interventions 
at a national level. 
By integrating research into real-world healthcare settings, this project ensures that its findings are 
directly applicable and can be translated into concrete policy recommendations and clinical practice 
improvements. Ultimately, the project contributes to reducing suicide rates, improving mental 
health outcomes, and fostering a more resilient and responsive healthcare system that prioritizes 
suicide prevention as a fundamental component of patient safety and public health. 
 
 

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