An Empirically Based, Recovery-Orientated Framework for Safety Planning Interventions for Suicide Prevention: An Integrative Literature Review and Critical Meta-Autoethnographic Synthesis.

INTRODUCTION: Safety planning interventions are increasingly used in suicide prevention, yet their design and delivery often lack alignment with personal recovery principles. AIM: To explore with lived experience, empirical literature on safety planning for suicide prevention and examine the relationship between change mechanisms and personal recovery concepts. METHOD: An integrative literature review was conducted combined with critical meta-autoethnographic synthesis. Data were analysed using the Donabedian Model of Healthcare, the Conceptual Framework for Personal Recovery, lived experience and translated using reciprocal and refutational synthesis. RESULTS: Fifteen studies were included. An empirically based recovery-orientated framework was developed comprising three phases of personal development-Inspiring, Discovering and Embodying-and three mechanisms of change-Learning, Introspection and Self-reflection. The framework reconceptualises the clinicians' role as 'facilitator' highlighting the importance of relational, personalised approaches. DISCUSSION: The findings challenge dominant biomedical approaches, offering a more personalised, recovery-focused understanding of safety planning interventions. IMPLICATIONS FOR PRACTICE: The framework supports delivery of person-centred care, policy implementation, service redesign and workforce training aligned with NHS and WHO guidance. RECOMMENDATIONS: Future research should evaluate the framework's effectiveness and explore its application in diverse populations and settings.