This post was originally published on this site
Her simple idea, for patients to write down a plan that would help them weather a suicidal crisis, rapidly spread in clinical settings.
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, labor-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 randomized controlled trials.
Research did eventually bear out their enthusiasm. In 2018, a study of 1,200 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.
Dr. Stanley’s work helped shift the focus of suicide research toward practical, concrete and timely interventions, said Paul Nestadt, an associate professor of psychiatry at Johns Hopkins School of Medicine who studies suicide and access to lethal weapons.
“Whether someone dies of suicide comes down to that act,” he said. “Intervening in those most important few minutes, between the decision to die by suicide and the act of suicide, is key. It is one of the few things that makes a difference. She knew that.”
Dr. Stanley went to great lengths to support young scientists, said Kelly L. Green, a senior research investigator at the University of Pennsylvania Perelman School of Medicine.
She recalled being overawed when she met Dr. Stanley for the first time, at an academic conference in Baltimore. Later, when they ran into each other at the railroad station, Dr. Stanley insisted that the two ride the same train back together so they could have time to talk.
“She took such an interest in me, and she didn’t have to,” said Dr. Green, who went on to collaborate with Dr. Stanley for years. “No one else at that conference would have gone up to the ticket counter and said, ‘No, I need her on my train.’”
Dr. Stanley wrote more than 200 papers. She was president of the International Academy for Suicide Research and served on boards and committees of many professional organizations. She also continued her clinical practice, treating patients who struggled with suicidal feelings.
Ms. Morris, Dr. Stanley’s daughter, said that her mother was modest about her professional success but was always thrilled to hear from clinicians in far-flung places who had used the techniques she developed to help patients.
“She was deeply touched by that, no doubt,” she said in an interview. “She found it very, very, very meaningful and very passionate. The work was so fulfilling to her, both on a personal level and on a larger level, to have been of service.”
Barbara Hrevnack was born on Aug. 13, 1949, in Newark. Her father, John Hrevnack, worked as a tool-and-die maker, and her mother, Marie (Wnukowski) Hrevnack, worked in the claims department of an insurance company.
She earned a bachelor’s degree at Montclair State College and a doctorate in clinical psychology at New York University.
She married Michael Edward Stanley, a neuroscientist, in 1970, and the two published a number of research papers together on such topics as informed consent and borderline personality disorder. He died in 1993.
In addition to her daughter, Dr. Stanley, who lived in Chatham, N.J., is survived by her son, Thomas Stanley, and her siblings, John Hrevnack, Michael Hrevnack and Joanne Kennedy.