Safety plan

A written, prioritised list of coping strategies and supports the patient can use when a crisis builds.

Whenever suicidal ideation is present. Built collaboratively, in the patient’s own words, before they leave.17 fieldsLegally & ethically load-bearing

How this document is used well

Safety planning follows the structure developed by Stanley and Brown: a hierarchy of steps beginning with what the patient can do alone and escalating only as needed. It has randomised evidence of reduced suicidal behaviour and increased treatment engagement, and it takes twenty minutes.

1Warning signs — the person’s own early signals that a crisis is starting
2Internal coping strategies they can use alone, without contacting anyone
3People and social settings that provide distraction
4People they can ask for help
5Professionals and agencies to contact, with numbers
6Making the environment safe — means restriction

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Step 1 — Warning signs

How I know a crisis may be building — thoughts, feelings, images, behaviours*

Ask them to recall the hours before the last crisis and work backwards.

Step 2 — Things I can do on my own

Activities that take my mind off it, without contacting anyone*

Concrete and available: specific music, a walk to a specific place, a specific game.

Has the patient used these before with any success?

YesNo — consider testing them first

Step 3 — People and places that distract

People whose company helps, even without discussing the crisisPlaces I can go

Somewhere open late; somewhere with other people present.

Step 4 — People I can ask for help

Name and contact for each*

Do these people know they are on the plan?

YesNoPatient will ask them

A support who does not know they are a support may not answer at 3am.

What I could say to them

Rehearse an actual opening sentence. Many people cannot generate one in crisis.

Step 5 — Professionals and crisis services

My clinician and how to reach them (including out of hours)*Crisis line*Emergency department / emergency number*What might stop me using these, and what I will do about it

Prior bad experiences with emergency services are common and are a genuine barrier. Address them rather than ignoring them.

Step 6 — Making my environment safer

What will be removed or secured, by whom, by when*When we will review this

The one thing worth living for

The most important reason to keep going

Ask for one. Put it at the top of the copy they carry.

Copy provided as*

Photo on their phonePrinted cardNotes appCopy to a named support

How likely are you to use this plan?

Not at allCertain—

Anything under 7 means the plan needs reworking now, not next week.

8 required fields outstanding: How I know a crisis may be building — thoughts, feelings, images, behaviours; Activities that take my mind off it, without contacting anyone; Name and contact for each …

How this document is used well

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