A Suicide Safety Plan Is More Than a Piece of Paper

How to actually use one when suicidal thoughts become intense

Need help right now? Call or text 988. If there is an immediate medical or life-threatening emergency, call 911 or go to the nearest emergency department.

If you have experienced suicidal thoughts, there is a good chance someone has asked you to complete a safety plan.

And there is also a chance you did not think much of it.

Safety plans can feel like paperwork. Sometimes they are treated like one more box to check before leaving an emergency department or crisis center. For someone who has been through the mental health system repeatedly, it can be easy to become skeptical of them altogether.

But a good suicide safety plan is not supposed to be paperwork.

It is a map.

You create that map before or between crises so that when suicidal thoughts become intense, you do not have to figure out from scratch what to do next. Instead, you have a series of steps to follow.

And importantly, you do not have to make every step work.

You just have to keep moving down the list until you are safe.

What Is a Suicide Safety Plan?

A suicide safety plan is a personalized, step-by-step plan for what to do when suicidal thoughts or urges become difficult to manage.

One widely used approach is the Stanley-Brown Safety Planning Intervention. It includes recognizing warning signs, using your own coping strategies, finding people or places that can provide distraction, reaching out to trusted people for help, contacting professional crisis resources, and making your environment safer by reducing access to lethal means. Identifying reasons for living can also be incorporated into the plan.

That sounds fairly simple when you are sitting in a therapist's office.

It may not feel simple at all when you are suicidal.

That is why the plan is created ahead of time. Instead of requiring yourself to solve an enormous problem while overwhelmed, you can ask a much smaller question:

What is the next thing on my plan?

Start With Your Reasons for Living

I like to spend time identifying reasons for living.

These do not have to be profound or inspirational. Your reasons are yours.

They might include your children, spouse, parents, friends, pets, future experiences, responsibilities, goals, beliefs, curiosity about what happens next in your life, or something seemingly small that still matters to you.

And if you genuinely cannot think of a reason to live?

That is important information, too.

It may be something worth exploring with your therapist rather than something you are expected to immediately fix.

The purpose is not to force yourself to feel optimistic. It is to identify the things that can help orient you toward staying alive when your mind is telling you something different.

Step 1: What Can I Do on My Own?

Your plan should contain coping strategies you can use without needing another person.

Maybe that is taking a walk, playing a game, watching something familiar, spending time with a pet, exercising, listening to music, grounding yourself, doing something creative, or using a coping skill you have practiced in therapy.

The specific activity matters less than whether it actually works for you.

This is also one reason safety planning can be useful outside of a crisis. If you look at the coping section of your safety plan and realize, 'I honestly have no idea what helps me when I feel this way,' that is something you can work on with your therapist.

But here is an important part:

If your coping strategies do not work during a crisis, you have not failed. Move to the next step.

Step 2: Who Can Help Me Get Out of My Head for a While?

This part of a safety plan is sometimes misunderstood.

There are people you can spend time with because they help you feel connected, distracted, or simply less alone. They do not necessarily need to know everything happening inside your head at that moment.

Maybe you call a friend and go get coffee. Maybe you sit with your sibling and watch television. Maybe you go somewhere safe where other people are around.

Sometimes distraction is exactly what you need.

If your emotional intensity feels like a 10 out of 10, you may not be able to use many of your coping skills effectively. But spending time with someone might bring that intensity from a 10 to a 6.

The problem has not disappeared. But a problem you could not cope with at a 10 may become something you can cope with at a 6.

Step 3: Who Can I Actually Tell That I Am Suicidal?

This is a different category of person.

These are the people you can tell: 'I am having suicidal thoughts, and I need help staying safe.'

Talking openly about suicidal thoughts can be difficult for everyone involved. That is why I recommend being thoughtful about who goes in this part of the plan.

This person should be an adult, including when the person creating the safety plan is a minor. A child or teenager should not be responsible for managing another person's suicidal crisis.

The people you list should also know that they are on your safety plan.

You can certainly identify someone first and talk to them afterward, but eventually they need the opportunity to understand what you are asking of them and agree to that role.

One reliable person who understands, cares, and has agreed to help can be more useful than three people who do not know they are listed.

Step 4: Know Your Professional Crisis Resources

Your safety plan should also include professional resources you can actually access during a crisis.

Your outpatient therapist may absolutely be an important part of your support system. But unless your therapist has specifically established that they provide crisis availability, your emergency plan should not depend on being able to reach them immediately.

You need resources designed to respond when the crisis is happening.

For Utah residents, several options are worth knowing:

• 988 Suicide & Crisis Lifeline: Call, text, or chat 988 for confidential crisis support 24 hours a day. In Utah, 988 is staffed by crisis workers through Huntsman Mental Health Institute.

• SafeUT: Utahns can access crisis support through SafeUT, including through the SafeUT app.

• HMHI Crisis Care Center: Adults 18 and older can walk in 24/7 without an appointment at 955 West 3300 South in South Salt Lake for immediate mental health crisis assessment and stabilization.

• HMHI Youth Crisis Care: Children and teens ages 5-17, as well as some 18-year-olds still in high school, can receive 24/7 walk-in crisis care at 501 Chipeta Way in Salt Lake City. No appointment is necessary.

• Intermountain Behavioral Health Access Centers: Behavioral Health Access Centers offer urgent behavioral health evaluation and support at select Intermountain hospitals, including Alta View, LDS, McKay-Dee, and St. George Regional.

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These types of centers are useful to think of almost like an InstaCare for mental health: somewhere you can go when you need help now rather than waiting for your next regularly scheduled therapy appointment.

Put the resources that make sense for you on your safety plan before you need them.

Step 5: Make Your Environment Safer

An important part of safety planning is reducing access to things you could use to seriously hurt or kill yourself.

This is not an admission that you are inevitably going to act on suicidal thoughts.

It is about creating time and distance between an intense suicidal impulse and the ability to act on it.

The Stanley-Brown Safety Planning Intervention includes making the environment safer by limiting or eliminating access to potentially lethal means, even when someone has not identified a specific suicide plan.

This is something worth discussing directly with your therapist, crisis provider, or trusted support person so you can develop a plan appropriate to your circumstances.

Step 6: If You Are Still Not Safe, Go to the Hospital

This is one of the biggest things I wish we could change about how people think about psychiatric hospitalization.

Going to the hospital does not mean your safety plan failed.

Sometimes people see hospitalization as the worst possible outcome. They tried their coping skills. They called someone. They used crisis resources. And if they still end up in an emergency department or hospital, they feel like everything before it failed.

I see it differently.

If you were at risk of ending your life and your safety plan ultimately got you somewhere that could keep you alive, the safety plan worked.

The goal of a safety plan is not to guarantee that you will never need a hospital. The goal is to keep you alive.

Think of Your Safety Plan as a Checklist

When suicidal thoughts become intense, try not to evaluate yourself after every step. Follow the map.

• I tried coping on my own. I am still not safe. Next step.

• I tried finding someone to spend time with. No one is available. Next step.

• I called the person I trust and told them what is happening. I am still not safe. Next step.

• I contacted a crisis resource. I still cannot stay safe. Next step.

And if the next step is the hospital, go to the hospital.

You do not have to prove that the earlier steps worked. You do not have to feel ashamed that you reached the bottom of the list.

You kept going until you got somewhere safe. That is the point.

A Safety Plan Helps With the Crisis. Therapy Can Help With What Is Underneath It.

A safety plan is primarily about getting through dangerous moments.

Once the immediate crisis has passed, there is another important question:

What keeps bringing me here?

That is where ongoing mental health treatment can be particularly important.

At Gentle Guardians Counseling Center, our therapists have experience working with suicidal ideation and helping clients explore the experiences, emotions, relationships, trauma, mental health concerns, and other factors that may contribute to overwhelming distress.

The goal is not simply to hand you a safety plan and send you home.

It is to help you stay safe when a crisis happens while also doing the longer-term therapeutic work that may help life become more manageable.

If you or someone you know is experiencing suicidal thoughts or a mental health crisis right now, call or text 988. If there is an immediate medical or life-threatening emergency, call 911 or go to the nearest emergency department.