What are foreseeable changes and contingency plans?

Watch our 4-minute Foreseeable Changes Mini-Module

What are foreseeable changes? 

Foreseeable changes are events, which, if they occurred, could reasonably be expected to quickly and significantly increase suicide risk. Assessments of suicide risk capture a single moment in time, but things can change quickly. Identifying foreseeable changes aids communication about current risk and facilitates planning to reduce vulnerability to sudden increases in suicide risk.

If foreseeable changes seem likely and coping skills and other resources and supports are few, the person might be at higher risk.

How do you identify foreseeable changes? 

As part of a comprehensive risk assessment, we recommend identifying two foreseeable changes. Consider, especially, foreseeable changes that would make the person feel out of control, alone, worthless, humiliated, or trapped.

These phrases can be asked of the person and their family/carer:

Let’s think together about a couple of events that could be really big “oh no” moments.

Something that might make you feel overwhelmed or suicidal.

What is a specific change or event that could make you feel out of control, alone, or embarrassed?

I know this might be something you don’t want to think about, but it’s important.

Could we get even more specific? Could you help me get a movie in my head about what could happen?

 What is a contingency plan? 

A contingency plan is a specific plan for each foreseeable change that states what the person, family member and staff will do if those “what ifs” occur.

Contingency plans usually include something the person can do for him or herself and an action an available resource can take.  Because foreseeable changes can mean immediate danger, contingency plans also often include professional contact and reassessment.

Example

Context: Jaime’s beloved dog is aging and ailing and likely to pass soon.

Foreseeable Change: Dog’s condition worsens and he passes.

Contingency Plan: Jaime will call her therapist to schedule a first available appointment and contact her sister (available resource) and ask her to come to stay for a few days. Jaime’s sister has agreed she will come and stay when the dog passes.

Contingency plans are often one component of a broader plan for safety that includes addressing lethal means safety as well. The person and anyone else who has a role in the plans should be provided a summary they can have ready access to, either in written or electronic form.