In memoriam Barbara Stanley, influential suicide researcher, dies at 73

LONDON: Barbara H. Stanley, a psychologist and researcher who developed a simple, effective tool for suicide prevention, died on Wednesday in a hospice in Scotch Plains, N.J. She was 73. Her daughter, Melissa Morris, said the cause was ovarian cancer. Dr. Stanley, a professor of psychology at Columbia University and the director of suicide prevention training at New York State Psychiatric Institute, helped propel a major shift in the field of mental health as researchers began to view suicide as a distinct problem that could be directly addressed, rather than as a symptom of another disorder.

Her most prominent contribution was an idea that is deceptively simple. The Stanley-Brown Safety Planning Intervention asks patients struggling with suicidal urges to compose a written plan that lists coping strategies, as well as sources of support or distraction that could help them weather a suicidal crisis.

The idea of a written document was not new. For years, clinicians had asked patients to sign a “no-suicide contract,” effectively promising their doctors not to engage in self-harm. But there was little evidence that these agreements had much effect, said Gregory K. Brown, Dr. Stanley’s research partner and the director of the Penn Center for the Prevention of Suicide at the University of Pennsylvania.

In 2008, when they first tested the written safety plans, Dr. Stanley and Dr. Brown envisioned them as a short-term measure to tide adolescent patients over while they waited for slow, labour-intensive courses of therapy — the real treatment — to have an effect. But patients right away singled out the written safety plan as so helpful that the team developed it as a free-standing intervention. The researchers often compared the written plans to “stop, drop and roll” fire-safety training, or to the safety cards distributed on airplanes — a way to provide very simple instructions to help people make sound decisions in the midst of overwhelming emotions.

“There is something about this kind of intervention,” Dr. Stanley said in a 2019 interview, “that helps them get through that period of time.” Patients, she said, “actually really like the piece of paper.” She recalled hearing from two separate patients who, while standing on bridges considering suicide, changed their minds because they pulled out their safety plan and read it. Even years after composing a safety plan, she said, “almost everybody could tell you the exact location, where it was at that exact moment.” “Over two-thirds of the people had used their safety plan at least once,” she said. “So it was a living, breathing document for them.” Clinicians treating veterans showed immediate interest, and the researchers were inundated with requests for training programs, manuals and handouts, even before the technique’s effectiveness could be demonstrated in randomised controlled trials.

Research did eventually bear out their enthusiasm. In 2018, a study of 1,640 suicidal patients at Veterans Affairs hospitals around the country found that two simple interventions in emergency departments — a written safety plan combined with follow-up phone calls — reduced suicidal behavior by 45 percent. The patients were also twice as likely to receive mental health treatment in the six months following their visit.