What Is Crisis Response Planning? A Brief, Evidence-Based Intervention for Suicide Prevention
When someone is experiencing suicidal thoughts, knowing what to do in the moment matters.
Crisis Response Planning, or CRP, is a brief, evidence-based suicide prevention intervention designed to help a person recognize when a crisis may be developing and identify specific strategies for getting through it safely.
Unlike a generic checklist or a form handed to a patient, a Crisis Response Plan is developed collaboratively between a trained clinician and the person at risk. The result is a highly personalized plan that can be used when suicidal thoughts or intense emotional distress arise.
Research on CRP and closely-related interventions has shown significant reductions in suicidal thoughts and behaviors, including a randomized clinical trial in which CRP was associated with a 76% reduction in suicide attempts compared with contracts for safety.
What Is a Crisis Response Plan?
A Crisis Response Plan is a personalized strategy for recognizing and responding to periods of heightened suicide risk.
In his Crisis Response Planning training, suicide prevention researcher Dr. Craig J. Bryan describes a CRP as a memory aid for identifying emotional crises early, a checklist of personalized strategies to use during those crises, a problem-solving tool, and a collaboratively developed strategy for managing acute periods of risk.
The plan is typically small enough to keep readily accessible, such as on an index card or a person's phone.
A CRP generally helps an individual identify:
- personal warning signs that a crisis may be developing
- strategies for reducing or managing emotional distress
- personal reasons for living
- people who can provide social support
- professional and crisis resources to contact when additional help is needed
The process is intentionally collaborative. The clinician does not simply tell someone what to do. Clinician and patient work together to identify strategies that are personally meaningful and realistic for that individual.
That distinction is important.
Crisis Response Planning Is Not a "No-Suicide Contract"
For many years, clinicians sometimes used "contracts for safety" or "no-suicide contracts," in which a patient agreed that they would not attempt suicide.
CRP is fundamentally different.
Dr. Bryan and his team of psychologists who train mental health professionals in CRP explicitly distinguish a Crisis Response Plan from a no-suicide contract, no-harm contract, or contract for safety.
And research supports that distinction.
In a randomized clinical trial of 97 active-duty U.S. Army soldiers experiencing suicide risk, researchers compared Crisis Response Planning with contracts for safety.
Over six months, participants who received CRP were significantly less likely to attempt suicide. The study estimated a 76% reduction in suicide attempts, along with a significantly faster decline in suicidal ideation and fewer inpatient hospitalization days.
That study became an important part of the evidence supporting Crisis Response Planning.
But the evidence for CRP does not rest on a single study.
What Does the Research Say About Crisis Response Planning?
CRP and related coping-card interventions have now been evaluated across multiple randomized clinical trials and different patient populations.
Dr. Bryan's current CRP training summarizes the research this way:
“CRP and related ‘coping card’ protocols have been researched the most and have garnered the greatest amount of supporting evidence from multiple RCTs with diverse samples.”
The 2017 CRP Randomized Clinical Trial
The landmark randomized clinical trial by Dr. Bryan and colleagues involved 97 active-duty Army soldiers who presented for an emergency behavioral health appointment.
Participants receiving CRP had fewer suicide attempts than those receiving a contract for safety. The estimated difference represented a 76% reduction in suicide attempts, and CRP was also associated with a faster decline in suicidal ideation.
A Meta-Analysis of Safety-Planning-Type Interventions
In 2021, a meta-analysis examining safety-planning-type interventions for suicide prevention found that these interventions were associated with a 43% reduction in suicidal behavior overall compared with control conditions. The analysis included the CRP trial as part of the evidence base.
Importantly, the authors did not find a significant overall effect on suicidal ideation and noted limitations in the available evidence. This is one reason it is important to distinguish what individual CRP trials have found from conclusions about safety-planning-type interventions as a broader category.
CRP During PTSD Treatment
More recent research has examined whether CRP can help when incorporated into ongoing mental health treatment.
In a randomized clinical trial of 157 U.S. military personnel and veterans receiving Cognitive Processing Therapy for PTSD, participants received either CRP or self-guided safety planning before treatment.
Among participants experiencing suicidal ideation at the beginning of treatment, those receiving CRP experienced significantly larger and faster reductions in suicidal ideation. Ongoing research done after the trial saw fewer suicide attempts in the CRP condition over the 12-month follow-up.
CRP Can Also Be Delivered Through Telehealth
A 2024 randomized clinical trial provides additional evidence that CRP can be delivered remotely.
The study randomized 82 adults at elevated suicide risk to clinician-guided CRP or self-guided safety planning delivered entirely through videoconferencing.
Both interventions reduced suicidality. Participants receiving CRP also reported a stronger therapeutic alliance with their clinician, used their plan more frequently, and perceived it as more useful. The researchers concluded that CRP is a promising approach for delivering suicide prevention through telehealth.
Together, these studies help demonstrate that Crisis Response Planning is not simply a crisis-management worksheet. It is an intervention supported by a growing body of research across different settings, populations, and methods of delivery.
Why Does Collaboration Matter?
One of the defining features of CRP is the way the plan is created.
CRP is not simply a template completed by a clinician or handed to a patient. It is developed through a conversation.
That process helps the clinician understand how a particular person's suicidal crisis develops and helps the individual identify strategies they are actually willing and able to use.
Recent research suggests that this collaboration may itself matter.
In the 2024 telehealth study, people who developed a CRP collaboratively with a clinician reported a stronger therapeutic alliance and used their plan more often than participants using self-guided safety planning.
That makes clinician training especially important. The effectiveness of an intervention is not only about what is included in the plan, but also how the intervention is delivered.
That is also one of the central conclusions Dr. Bryan highlights in his CRP training: how interventions are delivered can affect their effectiveness.
Why Train Clinicians in Crisis Response Planning?
Mental health professionals routinely encounter people experiencing suicidal thoughts, yet many clinicians receive limited specialized training in evidence-based interventions specifically designed to reduce suicide risk.
Crisis Response Planning gives clinicians a practical intervention they can integrate into their work with patients at risk for suicide.
Training clinicians also creates a multiplier effect.
A clinician does not use CRP with only one person. Once properly trained, that clinician can use the intervention with patients throughout their career.
That is the idea behind Love You Adam's Crisis Response Planning training initiative.
Love You Adam funds evidence-based CRP training for mental health professionals so that cost does not prevent clinicians and organizations from accessing this specialized suicide prevention education.
To date, more than 400 therapists across the United States and Canada have received CRP training through Love You Adam, including clinicians at organizations that otherwise could not afford to provide this training to their teams. Every clinician trained has the potential to bring these skills to many more people over the course of their career.
View our therapist directory to find a clinician in your area or one who offers virtual appointments.
About Dr. Craig J. Bryan
Dr. Craig J. Bryan is a clinical psychologist and internationally recognized suicide prevention researcher whose work has focused extensively on identifying and developing effective approaches for preventing suicidal behavior.
He is one of the principal researchers behind Crisis Response Planning and has led or contributed to multiple randomized clinical trials examining CRP and other suicide-focused interventions.
Love You Adam partners with Dr. Bryan to provide clinicians with intensive training in Crisis Response Planning, including the research behind the intervention and the clinical skills necessary to use it effectively.
Help Put Evidence-Based Suicide Prevention Into Practice
Research can identify interventions that work.
But research alone does not put those interventions into the hands of the clinicians sitting across from someone in crisis.
Training does.
Every $200 raised by Love You Adam provides one mental health professional with Crisis Response Planning training.
That clinician can carry those skills forward throughout their career, potentially reaching hundreds of people experiencing suicidal thoughts.
$200 trains one therapist. One trained therapist can help save many lives.
Research cited
Bryan CJ, Mintz J, Clemans TA, Leeson B, Burch TS, Williams SR, Maney E, Rudd MD. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64–72. DOI: 10.1016/j.jad.2017.01.028.
View the study on PubMed
Bryan CJ, Bryan AO, Khazem LR, Aase DM, Moreno JL, Ammendola E, Bauder CR, Hiser J, Daruwala SE, Baker JC. (2024). Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. Journal of Anxiety Disorders, 102, 102824. DOI: 10.1016/j.janxdis.2023.102824.
View the study on PubMed
Lohani M, Baker JC, Elsey JS, Dutton S, Findley SP, Langenecker SA, Do AS, et al. (2024). Suicide prevention via telemental health services: insights from a randomized control trial of crisis response plan and self-guided safety planning approaches. BMC Health Services Research, 24, 1389. DOI: 10.1186/s12913-024-11739-w.
Read the open-access study
