Six Steps of Safety Planning
(1) Recognizing warning signs
(2) Employing internal coping strategies without needing to contact another person
(3) Socializing with others who may offer support as well as distraction from the crisis
(4) Contacting family members or friends who may help resolve a crisis
(5) Contacting mental health professionals or agencies
(6) Reducing the potential for use of lethal means
(1) Recognizing warning signs
GOALS: • Identify personal warning signs that marked the beginning or worsening of the crisis. • Understand how identifying warning signs and change in risk provides an opportunity to cope before acting on suicidal urges.
Inform individuals that the purpose of identifying warning signs is to help them to recognize when the crisis may escalate so that they know to refer to their plan and take action to reduce risk. • Ask, “What were the warning signs that you experienced during the crisis that you told me about? How will you know you are in crisis and that the safety plan should be used?” • If the warning signs are vague, say, “Let's try to be more specific." Explain that it is important to be specific so that they are more likely to recognize the beginning of the crisis. Use their words or images.
(2) Employing internal coping strategies without needing to contact another person
GOALS: • Explain that the purpose of internal coping strategies is to help take the individual’s mind off of one’s problems to prevent worsening of suicidal thoughts and prevent making a suicide attempt without contacting other people • Help the individual identify specific internal coping strategies – the best strategies are simple and easy to do • Obtain feedback from the individual about the likelihood of using strategies • Identify barriers and problem-solve ways to overcome them
Explain how distracting oneself from the suicidal thoughts helps to lower risk • Ask “What have you done in the past to take your mind off your suicidal thoughts without contacting another person? What activities could you do by yourself to help take your mind off of your problems even if it is for a brief period of time?” • Provide suggestions if individuals cannot think of any distracting activities
Ask “How likely do you think you would be able to do this during a time of crisis?” or “Is it feasible?” • If doubt about use is expressed, ask “What might stand in the way of you thinking of these activities or doing them if you think of them?” • Use a collaborative, problem solving approach to address potential roadblocks and identify alternative coping strategies that are more feasible.
(3) Socializing with others who may offer support as well as distraction from the crisis
GOALS: • Instruct the individual to use Step 3 if Step 2 does not resolve the crisis or lower risk. • Identify other people and social settings that provide distraction from the crisis • Obtain feedback from the individual about the likelihood of actually doing these activities • Identify barriers and problem-solve ways to overcome them
Explain that if Step 2 does not lower risk, then go to Step 3 • Ask “Who can you contact who helps you take your mind off your problems or helps you feel better? You don’t need to tell these people that you are feeling suicidal. We just want to identify people who can take your mind off your problems even for a brief time.”
Ask, “What public places, groups, or social events help you to take your mind off your problems or help feel better?” • “Sometimes when people are feeling really upset, they don’t want to talk to other people. However, sometimes just getting out and being in a place around other people can help. Can you think of places you could go where you wouldn’t have to be alone?”
For each response, ask, “How likely do you think you would be able to do talk with someone/go somewhere during a time of crisis?” “Is it feasible and safe?” • If doubt about use is expressed, ask, “What might stand in the way of you thinking of contacting someone or going to a social setting?” Identify ways to resolve roadblocks or identify alternatives.
(4) Contacting family members or friends who may help resolve a crisis
GOALS: • Instruct the individual to use Step 4 if Step 3 does not resolve the crisis or lower risk. • Explain that the next step on the Safety Plan involves contacting and telling a trusted family member or friend that they are in crisis and need support. • Help the individual to distinguish between persons who are distractors (Step 3) and persons who can help to resolve the crisis (step 4). • Obtain feedback from the individual about the likelihood of actually contacting others • Identify barriers and problem-solve ways to overcome them
Explain that if Step 3 does not lower risk, then go to Step 4. • Ask “Among your family or friends, who do you think you could contact for help during a crisis?” or “Who is supportive of you and who do you feel that you can talk with when you’re under stress or feeling suicidal?” • Ask, “How likely do you think you would be able to reach out to each person?” • If doubt is expressed about contacting others, ask, “What might get in the way of reaching out to this person? Resolve roadblocks or brainstorm others to contact.
(5) Contacting mental health professionals or agencies
GOALS: • Instruct the individual to use Step 5 if Step 4 does not resolve the crisis or lower risk. • Explain that Step 5 consists of professionals or agencies who can provide assistance to the individual during a crisis. • Assess the likelihood that the individual will contact each professional or professional service listed on the plan.
Explain that if Step 4 does not lower risk, then go to Step 5. • Ask “Who are the professionals and community workers that we should identify to be on your safety plan? • Ask, “What is the likelihood that you would contact these professionals or agencies?” • Identify potential obstacles and problem solve.
(6) Reducing the potential for use of lethal means
GOALS: • Individuals may have already disclosed a method or plan during the suicide risk screen. If not, assess whether the individual has thought about a method or developed a specific suicide plan. • Explain that having easy access to lethal means places the individual at greater risk for suicide and does not allow enough time to use the coping strategies or sources of support listed on the Safety Plan. • For each method that is identified, determine the individual’s access to the lethal means and collaborate to find voluntary options that reduce access to the lethal method and make the environment safer.
Express concern about the patient’s safety. • Explain that making the environment safer will help to lower risk of acting on suicidal feelings (delays urge to act on suicidal thoughts) • For some patients who attempt suicide, the interval between thinking about and acting on suicidal urges is usually a matter of minutes
For each lethal method, ask “What can we do to make the environment safer?” • Ask, “How likely are you to do this? What might get in the way? How can we address the obstacles?” • Be aware of the potential view that having access to a lethal mean to kill oneself may be a strategy used to cope with crises. • If doubt is expressed about limiting access, ask, “What are the pros of having access to this method and what are the cons? Is there an alternative way of limiting access so that it is safer?”
Involving Others in Making the Environment Safer
Assess the potential helpfulness of involving specific persons • Assess whether the person is capable of carrying out the plan • When possible, discuss plan with other persons and patient together • Follow-up with other person to ensure completion of plan
Make sure the action plan is written down (Step 6 of the Safety Plan) • Caregivers or other responsible adult should be in charge of implementing the action plan to keep the youth safe • Clinicians should make a plan to follow up with caregivers at a specified time to confirm the agreed upon means safety measures were implemented.