Exploring the Potential of Large Language Models for Automated Safety Plan Scoring in Outpatient Mental Health Settings

Abstract

The Safety Planning Intervention (SPI) produces a plan to help manage patients’ suicide risk. High-quality safety plans – that is, those with greater fidelity to the original program model – are more effective in reducing suicide risk. We developed the Safety Planning Intervention Fidelity Rater (SPIFR), an automated tool that assesses the quality of SPI using three large language models (LLMs)—GPT-4, LLaMA 3, and o3-mini. Using 266 deidentified SPI from outpatient mental health settings in New York, LLMs analyzed four key steps: warning signs, internal coping strategies, making environments safe, and reasons for living. We compared the predictive performance of the three LLMs, optimizing scoring systems, prompts, and parameters. Results showed that LLaMA 3 and o3-mini outperformed GPT-4, with different step-specific scoring systems recommended based on weighted F1-scores. These findings highlight LLMs’ potential to provide clinicians with timely and accurate feedback on SPI practices, enhancing this evidence-based suicide prevention strategy.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was supported by the National Institute of Mental Health P50 MH127511 and R01 MH112139.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the University of Pennsylvania IRB with the data use agreement and transfer from Columbia University.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are only available upon reasonable request to the authors.

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