Components of a Safety Plan for Suicide Prevention
A safety plan is a structured, personalized document that includes coping strategies and sources of support to help individuals manage suicidal thoughts and prevent suicidal behavior. 1
Core Components of a Safety Plan
1. Recognition of Warning Signs
- Identification of personal thoughts, feelings, behaviors, or situations that may precede suicidal thoughts
- Documentation of specific internal cues (mood changes, thought patterns) and external triggers
2. Internal Coping Strategies
- List of activities the person can do on their own to distract from suicidal thoughts
- Personalized coping skills that have worked in the past
- Specific techniques for emotional regulation and distress tolerance
3. Social Contacts for Distraction
- Names and contact information of friends or family members who can provide distraction
- People who can help take the person's mind off suicidal thoughts without necessarily discussing the crisis
4. Social Contacts for Support
- List of trusted people who can provide emotional support during a crisis
- Names, phone numbers, and availability of these contacts
- Alternative contacts if primary supports are unavailable
5. Professional and Agency Contacts
- Mental health providers' names and contact information
- Local crisis resources with phone numbers
- National crisis hotlines and text lines
- Local emergency department information
- Instructions for accessing 988 Suicide & Crisis Lifeline
6. Means Restriction
- Steps to limit access to lethal means, particularly firearms
- The American Academy of Pediatrics emphasizes that the safest home is one without firearms, especially for patients with suicidal ideation 2
- Specific plans for securing medications, both prescription and over-the-counter
- Removal or securing of other potential means of self-harm
7. Reasons for Living
- Personal motivations to stay alive
- Future goals, relationships, or experiences worth living for
- Reminders of what matters to the individual
Implementation Considerations
Creating the Safety Plan
- Should be developed collaboratively between the patient and clinician
- Written in the patient's own words
- Kept accessible during times of crisis (wallet card, smartphone, etc.)
- Reviewed and updated regularly as circumstances change
Effectiveness
- Safety planning interventions reduce the risk of suicidal behavior by approximately 43% 1
- The number needed to treat is 16, meaning one suicide attempt is prevented for every 16 patients who receive a safety planning intervention 1
- Safety plans can reduce hospitalizations and increase appropriate use of crisis services 3
Special Considerations for Children and Adolescents
- Safety plans should include developmentally appropriate language and strategies
- Parents/guardians should be involved in creating and implementing the plan
- Schools may need to be included in the planning process
- Plans should address "grief triggers" that might occur in school settings 1
- A clear protocol should be established for when a child can leave a classroom if feeling overwhelmed 1
Common Pitfalls to Avoid
Creating generic plans: Safety plans must be personalized to the individual's specific circumstances, triggers, and resources.
Developing plans without adequate follow-up: Safety planning is most effective when combined with telephone follow-up and ongoing care 4.
Focusing only on crisis resources: Effective plans include multiple levels of strategies, starting with self-management techniques before escalating to emergency services.
Neglecting means restriction: Removing access to lethal means, especially firearms, is one of the most empirically supported strategies for suicide prevention 2.
Assuming the plan will be remembered during a crisis: The plan should be easily accessible and reviewed regularly so it can be utilized when cognitive functioning is compromised during a crisis.
Relying solely on the safety plan: While effective at reducing suicidal behavior, safety plans may not significantly impact suicidal ideation, which may require additional interventions 1.
The evidence strongly supports the use of safety planning interventions as an effective component of suicide prevention efforts, particularly when implemented thoroughly and combined with appropriate follow-up care.