Safety Planning 101

What is a Safety Plan ?

A safety plan is a written list of coping strategies and sources of support that can be used by people who have been deemed a high risk for suicide. These strategies are meant to be used before or during a suicidal crisis 1.

Note: The goal should be to create a safety plan with strategies that a person will actually use. The plan should be brief, in the person’s own words, and easy to read.

Safety Planning Steps

Get educated on the warning signs of suicide. These signs may include thoughts, images, thinking processes, moods, and/or behaviors.

Identifying the signs that someone may be in a suicidal crisis can help the individual know when they should use their coping strategies or reach out for support. Help the individual identify their warning signs and write them down on your safety plan.

Consider these questions:
  • How will they know when the safety plan should be used?
  • What do they experience when they start to think about suicide or feel extremely depressed?

  • Coping strategies are things an individual can do in moments of suicidal crisis. Help the person identify coping strategies that work for them.

    Help them to identify potential roadblocks that may prevent them from using those coping strategies and work with them to come up with alternative coping strategies.

    For example, my safety plan lists meditation as a coping strategy I can use when I am in a suicidal crisis. However, I may experience a suicidal crisis at a time and place where meditation may be difficult to do. An effective safety plan would include additional coping strategies I could use in situations where meditation may not be possible.

    Consider these questions:
    • What can they do, on their own, if they become suicidal again, to help themselves not to act on their thoughts or urges?
    • How likely do they think they would be able to do this step during a time of crisis?
    • What might stand in the way of them thinking of these activities or doing them when they think of them?

    Important: If Step 2 does not resolve the crisis or lower the risk, use Step 3.

    Next, have them think of people and social settings that can provide a distraction from the crisis. Have them list people they can reach out to, and/or safe places they can go to be around other people.

    The goal is to provide a distraction from suicidal thoughts.

    Make sure to determine how likely the individual is to engage in this step. Help them identify potential obstacles and problem solve ahead of time should those obstacles arise.

    Consider these questions:

    • Who or what social settings help them take their mind off of their problems at least for a little while?
    • Who helps them feel better when they socialize with them?

    Important: If Step 3 does not resolve the crisis or lower the risk, use Step 4.

    Then, have the individual identify several people who are supportive that they can talk to when they’re under stress. It is important for them to identify multiple people, in case one contact is unreachable.

    Help them prioritize the list based on who they feel most comfortable reaching out to. You can help them role play and rehearse how they can go about asking for help. Additionally, try to discuss potential obstacles that might prevent the individual from reaching out and help them problem solve.

    This step is important because the individual reveals to others that they are in crisis, and increases the likelihood that they can get the help they need.

    Consider these questions:

    • Among their family or friends, who do they think they could contact for help during a crisis?
    • Who is supportive of them and who do they feel that they can talk with when they’re under stress?

    Important: If Step 4 does not resolve the crisis or lower the risk, use Step 5.

    Have the person list the names, numbers and/or locations of clinicians or local urgent care services. If the person is unable to contact the individuals in Step 4, you should encourage them to seek professional help.

    Help them identify the possible barriers that may prevent them from reaching out, both internal and external ones. Like in previous steps, role play and rehearsal can be useful, especially if the individual feels wary about asking for help.

    Consider these questions:

    • Who are the mental health professionals that should be identified on their safety plan?
    • Are there other health care providers who could be included?

    Finally, it is important to make sure that their environment is safe. Discuss their past experiences with suicidal crisis and try to identify which means of suicide they have or would consider during a suicidal crisis.

    The goal should be to ensure that whatever lethal means the individual has considered in the past is not accessible to them at the time of suicidal crisis. Work with them to collaboratively identify ways they can secure or limit access to those lethal means.

    Consider these questions:

    • Do they own a firearm, such as a gun or a rifle?
    • What other means do they have access to and may use to attempt to kill themselves?
    • How can we go about developing a plan to limit their access to these means?

    Resources

    FOR CLINICIANS
    Safety Planning Guide: Quick Guide for Clinicians
    Patient Safety Plan Template
    SAMHSA’s SAFE-T Pocket Card: Suicide Assessment Five-Step Evaluation and Triage for Clinicians
    Suicide Safe Mobile App – Based on SAMHSA’s Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) card
    988 Suicide & Crisis Lifeline Safety Plan Pads – The Safety Plan is a 5”x7” pad, similar to a prescription pad, with 50 sheets of pull off plans. The intended use is for counselors, therapists, clinicians, and others working with people in need of safety plans. It is modified from Stanley & Brown. Available for FREE in limited quantities!

    FOR EVERYONE
    My Safety Plan – A simple, easy-to-use online tool for safety planning
    Suicide Safety Plan App – Developed by the New York State Office of Mental Health, along with the New York State Psychiatric Institute, the Research Foundation for Mental Hygiene and the New York State Suicide Prevention Initiative.
    My3 Safety Plan App(CURRENTLY UNDER CONSTRUCTION – CHECK BACK SOON!) A free mobile safety planning app developed by the California Mental Health Services Authority and the Link2Health Solutions.
    References

    1. Suicide Prevention Resource Center. (2009). Safety planning guide. https://www.sprc.org/sites/default/files/SafetyPlanningGuide%20Quick%20Guide%20for%20Clinicians.pdf.