Safety plans to
prevent suicide
A SUICIDE PREVENTION
TOOLKIT
IN THIS TOOLKIT
What is a safety plan?
When is a safety
plan written?
Why does it work?
Suicide safety plan
How to co-develop
a Safety Plan
How to implement
a Safety Plan
Is a safety plan the
same as a no-suicide
contract?
References
While some people who consider suicide do so
fleetingly or only once in their lives, others experience
these thoughts ongoing or o and on over time.
Suicidal thoughts can burden people and hold them
hostage. Experiencing these thoughts is to experience
“absolute darkness, hopelessness, pain,” and nothing
matters but stopping that pain.
As friends and caregivers, wemay feel at a loss to help
or support people with these thoughts; we may feel
that taking our loved one to the emergency room is our
only option, that crisis medical support is necessary.
If the person at risk of suicide is in immediate crisis,
the emergency room is an appropriate level of care.
Otherwise, co-developing a safety plan is the best
way forward.
This toolkit will show you what a safety plan is and
how to create one together with an individual who
may be at risk. It will illustrate how safety plans work
and why they are one of the best tools to help mitigate
future suicidal behaviours.
This toolkit is for people wishing to help someone they know who is
struggling with thoughts of suicide. If you’re struggling with thoughts of
suicide yourself, contact your local crisis centre for support.
A safety plan can also be used to support and guide a person who is self-
harming, however, in this toolkit we focus on people with thoughts of suicide.
A safety plan is a document
that supports and guides
someone when they are
experiencing thoughts
ofsuicide, to help them
avoida state of intense
suicidal crisis.
Anyone in a trusting relationship with
the person at risk can help dra the
plan; they do not need to be a
professional.
When developing the plan, the
personexperiencing thoughts of
suicide identifies:
•
their personal warning signs,
•
coping strategies that have worked
for them in the past, and/or
strategies they think may work in
thefuture,
•
people who are sources of support in
their lives (friends, family,
professionals, crisis supports),
•
how means of suicide can be removed
from their environment, and
•
their personal reasons for living,
orwhat has helped them stay alive.
When is a
safety plan
written?
A safety plan is written when a person
is not experiencing intense suicidal
thoughts. It may be written aer a
suicidal crisis, but not during, as at this
time an individual can become
overwhelmed with suicidal thoughts
and confusion, and may not be able to
think clearly. A safety plan is written
when a person has hope for life, or
even can consider the possibility of
What is a safety plan?
A suicidal crisis refers to “a suicide
attempt or an incident in which
an emotionally distraught person
seriously considers or plans to
imminently attempt to take his or
her own life” (Suicide Prevention
Resource Center, n.d.).
life, so that they can identify their
reasons for living, and positive actions
they can take to prevent their thoughts
from becoming intense and
overwhelming.
A safety plan can be developed in
one sitting by the person with thoughts
of suicide together with you, their
caregiver or friend, or over time. The
plan can change as the circumstances
for the individual change, and can be
revised accordingly.
Why does
it work?
A safety plan is an assets-based
approach designed to focus on a
person’s strengths. Their unique
abilities are identified and emphasized
so they can draw on them when their
suicidal thoughts become intense. The
goal is to draw upon their strengths
during subsequent recovery and
healing processes (Xie, ). Personal
resources are another integral safety
plan component. Drawing on strengths
is the entry-level activity; reaching out
for help may also become necessary
(Xie, ; Bergmans, personal
communication, ).
The safety plan is organized in
stages. It starts with strategies
the individual can implement by
themselves at home and ends with 24/7
emergency contact numbers that can
be used when there is imminent danger
or crisis.
The person with thoughts of
suicide can verify, along with their
caregiver or friend, whether coping
skills are feasible, as well as whether
or not the chosen contact people
are appropriate. Alternative ideas
can be brought forward by either
party as needed (Bergmans, personal
communication, 2019).
When implemented, safety plans
become self-strengthening. For people
who experience recurring suicidal
thoughts or crises, one strength
becomes knowing they have weathered
the storm before and have navigated
their way out.
STEP 1: WARNING SIGNS (THOUGHTS, IMAGES, MOOD, SITUATION, BEHAVIOUR) THAT A CRISIS MAY BE DEVELOPING:
1.
2.
3.
STEP 2: INTERNAL COPING STRATEGIES – THINGS I CAN DO TO TAKE MY MIND OFF MY PROBLEMS WITHOUT CONTACTING ANOTHER PERSON
(RELAXATION TECHNIQUE, PHYSICAL ACTIVITY):
1.
2.
3.
STEP 3: PEOPLE AND SOCIAL SETTINGS THAT PROVIDE DISTRACTIONS:
1. NAME PHONE
2. NAME PHONE
3. PLACE 4. PLACE
STEP 4: PEOPLE WHOM I CAN ASK FOR HELP:
1. NAME PHONE
2. NAME PHONE
3. NAME PHONE
STEP 5: PROFESSIONALS OR AGENCIES I CAN CONTACT DURING A CRISIS:
1. CLINICIAN NAME PHONE
EMERGENCY CONTACT PHONE
2. CLINICIAN NAME PHONE
EMERGENCY CONTACT PHONE
3. LOCAL EMERGENCY SERVICE
EMERGENCY SERVICE ADDRESS
EMERGENCY SERVICE PHONE
4. CRISIS SERVICES CANADA PHONE: 1-833-456-4566
STEP 6: MAKING THE ENVIRONMENT SAFE:
1.
2.
The one thing that is most important to me and worth living for is:
Safety Plan Template ©2011 Barbara Stanley and Gregory K. Brown, is reprinted with the express permission of the authors. No portion of the Safety Plan Template may
be reproduced without their express, written permission. You can contact the authors at bhs2@columbia.edu or gregbro[email protected].
Suicide safety plan
To download a pdf of the template, visit bit.lylWnAJ
To download an app with the template, visit apple.comOQjh
(Stanley & Brown, 2012)
GUIDING QUESTION(S) FOR THE
PERSON THINKING ABOUT SUICIDE:
What (situations, thoughts, feelings,
body sensations, or behaviours) do you
experience that let you know you are
on your way to thinking about suicide,
or that let you know you are mentally
unwell generally? Think about some of
the more subtle cues.
EXAMPLES:
Situation: argument with a loved one
Thoughts: “I am so fed up with this and
Ican’t handle it anymore”
Body sensations: Urge to drink alcohol
Behaviours: Watch violent movies,
irregular eating schedule
WHEN TO IMPLEMENT?
At any time before a suicidal crisis.
HOW TO IMPLEMENT?
Being aware of one’s own warning
signs can alert the person to the fact
that they may be at high risk of
thinking about suicide when these
situationsthoughtsbody sensations
arise. They can put the plan in action
and move onto the next step: coping
strategies.
Being aware of personal warning
signs can help friends/caregivers
identify when that person may need
more support, even before they’ve
asked for it.
1
STEP ONE: List warning signs that
indicate a suicidal crisis may
bedeveloping.
GUIDING QUESTION(S) FOR THE
PERSON THINKING ABOUT SUICIDE:
Where can you go to feel grounded,
where your mind can be led away from
thoughts of suicide? Who helps take
your mind away from these thoughts?
EXAMPLES:
Places: Go to a movie, sit in a park
People: Text friend (name, phone), go for
coee with a co-worker (name, phone)
WHEN TO IMPLEMENT?
At any time before a suicidal crisis, or
when suicidal thoughts emerge but are
not intense.
HOW TO IMPLEMENT?
The person with thoughts of suicide
can go to these places or contact these
people to help distract them from their
thoughts of suicide and move them to
amore positive mental space.
GUIDING QUESTION(S) FOR THE
PERSON THINKING ABOUT SUICIDE:
What (distracting activity, relaxation
or soothing technique, physical
activity) helps take your mind away
from thought patterns that feel scary
or uncomfortable, or thoughts
ofsuicide?
EXAMPLES:
Distracting activity: Watch a
funny movie
Relaxation technique:
Deliberatebreathing
Physical activity: Go for a bike ride
WHEN TO IMPLEMENT?
At any time before a suicidal crisis, or
when suicidal thoughts emerge but are
not intense.
HOW TO IMPLEMENT?
The person with thoughts of suicide
can use these coping strategies to help
distract them from their thoughts
and move them to a more positive
mental space.
Friends/caregivers can suggest to
the person that they use one or more
of their coping strategies and support
them if needed.
2
3
STEP TWO: List the coping strategies
that can be used to divert thoughts,
including suicidal thoughts.
STEP ONE: List the places and people
that can be used as a distraction
fromthoughts ofsuicide.
GUIDING QUESTION(S) FOR THE
PERSON THINKING ABOUT SUICIDE:
Who among your friends, family, and
service providers can you call when
you need help (when your thoughts
become overwhelming or you’re
thinking about suicide)?
EXAMPLES:
Mom: work phone, cell phone
Spouse: work phone, cell phone
WHEN TO IMPLEMENT?
At any time before a suicidal crisis,
orwhen suicidal thoughts emerge
andare becoming intense.
HOW TO IMPLEMENT?
The person with thoughts of suicide
can call these people at any time, to
distract them from their thoughts or to
let them know when their thoughts are
becoming more intense, signaling that
they need support.
Friends and caregivers can respond
to the person by supporting them
through this dicult time: listening
to them, going to visit them, making
sure to check in oen, asking what
specifically they can do to help.
4
STEP FOUR: List all the people that
canbe contacted in a crisis, along
with their contact information.
(Stanley & Brown, 2012)
GUIDING QUESTION(S) FOR THE
PERSON THINKING ABOUT SUICIDE:
Who are the professionals you’ve
worked with who can be helpful to you
in a crisis? What other professionals or
organizations could you call?
EXAMPLES:
Therapist: work phone, cell phone,
hours available
Closest hospital: Regions Hospital,
 Jackson Street
Crisis Line: ---
WHEN TO IMPLEMENT?
When suicidal thoughts have become
very intense, and the person
experiencing the thoughts believes
they cannot cope on their own.
HOW TO IMPLEMENT?
The person with thoughts of suicide
should immediately call or visit these
crisis contacts.
5
STEP FIVE: List mental health providers
and the hours they can be reached,
as well as 24/7 emergency contact
numbers that can be accessed in
a crisis.
(Stanley & Brown, 2012)
GUIDING QUESTION(S) FOR THE
PERSON THINKING ABOUT SUICIDE:
What could be used to die by suicide in
your environment (home, work)? How
have you thought about dying by
suicide before, and how can you make
that method more dicult to access?
EXAMPLES:
Pills: Give to pharmacist or friend
for disposal
Guns (or rope): Remove from home
(give to a friend, etc.)
WHEN TO IMPLEMENT?
Before a suicidal crisis, preferably
immediately aer safety plan is
developed.
HOW TO IMPLEMENT?
The person with thoughts of suicide
can remove these items from their
environment themselves, giving them
to friends or caregivers. The person
working with them on their safety
plan should confirm that all means
have been removed from the home.
Friends/caregivers can oer to keep
or throw away these items. Keeping a
person safe from a method of suicide
can mean dierent things for each
person and method. Firearms in
particular should always be removed
from the home, regardless of whether
or not they have been noted as a means
of suicide.
6
STEP SIX: List the steps to be taken
to remove access to means of
suicide from the environment.
(Stanley & Brown, 2012)
GUIDING QUESTION(S) FOR THE
PERSON THINKING ABOUT SUICIDE:
When do you feel most at ease during
the day? Who do you love? What do
you enjoy doing? What did you used to
enjoy doing? What is important to you,
or used to be important to you? What
has kept you alive up until now?
Note: These reasons can become
apparent through conversation with
the person, and through the process of
a suicide intervention. You may need to
identify these for the person, based on
what they’ve told you.
EXAMPLES:
My dog is important enough to me that
I want to stay alive to take care of him.
WHEN TO IMPLEMENT?
At any time before or during a
suicidal crisis.
HOW TO IMPLEMENT?
A person with thoughts of suicide can
refer to these reasons for living at any
time, as oen as they want, to remind
them of the positive aspects of
theirlives.
Friends/caregivers can use these
reasons in organic conversation, to
help gently remind that person of their
reasons for living.
7
STEP SEVEN: List important reasons
to live, or how/why that person
is still alive.
(Stanley & Brown, 2012)
Co-developing a safety plan involves a
collaborative, in-depth conversation
between the person experiencing
thoughts of suicide and their caregiver
or friend.
Go over each step together,
thoroughly and thoughtfully (Berk
& Clarke, 2019). There may be times
where, through organic or structured
conversation, you will identify
potential safety plan items for the
person - bring these into the plan!
For example, if someone mentions
that they need to get home to spend
time with their dog, that is a potential
reason to live. You can suggest adding
the positive things you hear coming
from that person at any point.
How to
co-develop
a safety plan
How to
implement
a safety plan
“You talked about how excited your
dog is to see you when you get home
earlier. Can you tell me a bit more
about him?” Then, “It sounds like he’s
really important to you. Do you think
we could add him onto your safety
plan as a reason for living, or as a
reason that you’re still alive?”
Once complete, you and the person
who has had thoughts of suicide should
keep copies of the safety plan in an
accessible place. The safety plan needs
to be handy so that the person can
always find it when they are
experiencing intense thoughts of
suicide. Some people choose to always
keep their plan with them, e.g. on their
phone or in their wallet.
Each step in the safety plan plays
a role in supporting the person with
thoughts of suicide, as well as yourself,
and other friends and caregivers. Refer
to the “Suicide safety plan” for how and
when to implement each step.
Keep in mind that the safety plan is
not written in stone: it can be revised
as oen as is needed. The plan can be
reviewed at any time, and especially
if the person experiencing thoughts
of suicide has found any portion of
it ineective in helping them cope
with their thoughts. For example, if
one contact person was found to be
dicult to get in touch with on several
occasions, or if a coping strategy is no
longer eective or accessible.
Is a safety plan the same as
a no-suicide contract?
A no-suicide contract is dierent from
a safety plan in that it is “an agreement,
usually written, between a mental
health service user and clinician,
whereby the service user pledges not
to harm himself or herself” (McMyler
& Prymachuk, , p.). It was
introduced in  by Robert Drye,
Robert Goulding and Mary Goulding.
Mental health service users are
expected to seek help when they feel
they can no longer honour their
commitment to the contract (Rudd,
Mandrusiak & Joiner, ).
The no-suicide contract has been
widely used by clinicians working
with patients at risk of suicide (Rudd,
Mandrusiak & Joiner, 2006). However,
there is a lack of evidence to support
contracts as clinically eective tools.
Both service users and clinicians
have voiced strong opposition to their
use. Moreover, important ethical
and conceptual issues in the use of
such contracts have been identified,
including the potential for coercion
from the clinician for their own
protection and the ethical implications
of restricting a service user’s choices
when they may be already struggling
for control. A strength-based approach
like a safety plan, on the contrary,
not only encourages the service
user’s input and agency, it is a true
partnership with the physician or
caregiver, bound by hope (McMyler
& Prymachuk, 2008; Rudd, Mandrusiak
& Joiner, 2006).
REFERENCES
Berk, M. & Clarke, S. (2019). Safety
planning and risk management.
In M. Berk (Ed.), Evidence-based
treatment approaches for suicidal
adolescents: Translating science into
practice (63-84). Washington, D.C.:
American Psychiatric Association
Publishing.
Drye, R., Gouling, R. & Goulding, M.
(1973). No-suicide decisions:
Patient monitoring of suicidal risk.
American Journal of Psychiatry,
130(2), 171-174.
McMyler, C. & Prymachuk, S.
(2008). Do “no-suicide’ contacts
work? Journal of Psychiatric and
Mental Health Nursing, 15(6),
512-522.
Rudd, M., Mandriusiak, M. &
Joiner, T. (2006). The case against
no-suicide contracts: the
commitment to treatment
statement as a practice alternative.
Journal of Clinical Psychology.
DOI:10.1002/jclp.20227
Stanley, B. & Brown, G. (2011).
Safety plan. Retrieved from http://
suicidesafetyplan.com/uploads/
SAFETY_PLAN_form_8.21.12.pdf
Stanley, B. & Brown, G. (2012).
Safety planning intervention:
A brief intervention to mitigate
suicide risk. Cognitive and
Behavioral Practice, 19(2), 256-264.
Suicide Prevention Resource
Center. (n.d.) Topics and terms.
Retrieved from https://www.sprc.
org/about-suicide/topics-terms
Xie, H. (2013). Strengths-based
approach for mental health
recovery. Iranian Journal of
Psychiatry and Behavioral Science,
7(2), 5-10. Retrieved from https://
www.ncbi.nlm.nih.gov/pmc/
articles/PMC3939995
Centre for Suicide Prevention
T 403 245 3900
csp@suicideinfo.ca
suicideinfo.ca
@cspyyc
We are the Centre for
Suicide Prevention, a branch
of the Canadian Mental
Health Association. For
35+ years we have been
equipping Canadians with
knowledge and skills to
respond to people at risk
of suicide.
We educate for life.