When a person who is struggling with suicidal thoughts, urges, or behaviors presents for an intake session at a dialectical behavior therapy clinic, the mental health therapist will conduct a thorough assessment of suicidality to really understand the suicidality in more depth. Often, individuals appreciate knowing more details about what they can expect from this assessment process and what interventions are offered directly for suicidality. This blog post provides details about a specific evidence-based intervention for suicidality that is routinely used in mental health clinics: the safety plan. The specific safety plan reviewed in this blog post is recommended by the Suicide Prevention Resource Center (Moscardini et al., 2020), and used at Cincinnati Center for DBT, alongside other evidence-based clinics.
When creating a safety plan, the therapist and the client identify specific action steps that the client can take when the client experiences suicidal thoughts or urges. The safety plan is arranged with actions to take as the situation becomes more intense. Thus, clients first try the actions at the beginning of the safety plan and then proceed down the list. The first section of the safety plan includes warning signs. This section includes thoughts, images, moods, situations, and behaviors that indicate that a crisis might be developing. Awareness of one’s warning signs is a powerful step toward decreasing the likelihood that the warning signs will escalate to crisis episodes. Some individuals might list physical sensations (e.g., crying extensively), and other individuals might list social circumstances (e.g., conflict with a partner).
After recording warning signs, the client is directed to record internal coping strategies that can be used without another person intervening. These internal coping strategies are skills that can be implemented to take one’s mind off of the crisis, preferably with no additional person or physical materials needed. Examples might include paced breathing and intense exercise. It is also reasonable to record other coping strategies that involve physical materials if these resources are readily available. For example, someone could record the tipping the temperature coping strategy if they are able to carry instant cold packs in their backpack or purse.
Following the internal coping strategies, there are three sets of people that are recorded on the safety plan–to seek further assistance during a suicidal crisis. The first category includes three individuals who provide distraction. This list can include friends, siblings, or acquaintances that provide camaraderie, without necessarily providing support for the suicidal crisis. Next, the second category includes three individuals who can provide support who are not professionals. This list could include a person’s parents, other mentors, and mature acquaintances who agree to take on this specific role. Finally, the third category includes three professionals or organizations to contact. This list could range from listing a person’s individual therapist to crisis hotlines to the local emergency service numbers. By listing these individuals and their contact information (e.g., phone numbers) on the safety plan, the person at risk has a specific, hierarchical plan to reach out for assistance.
In the final step of the safety plan, individuals describe several characteristics that would make their environment safe. These details could range from removal of objects that could be used for self-harm or suicidal behavior, to the addition of objects that provide assistance (e.g., phone access). Finally, we also recommend that the individual record several of the things that make life worth living for the individual. These details could range from specific family members, to long-term career goals, to anticipated experiences. It is important that this section provide a range of unique and accurate details, thereby instilling hope, rather than pessimism if one particular reason to live is no longer salient or available. After completing the safety plan, clients receive a paper and/or electronic copy of the safety plan. Clients are encouraged to make the safety plan as accessible as possible by putting it on their backpacks/purses, bedside tables, and smartphones. All in all, the suicide safety plan is an essential tool in suicide prevention efforts, and evidence-based clinics make comprehensive and accessible safety plans to save lives.
Moscardini, E. H., Hill, R. M., Dodd, C. G., Do, C., Kaplow, J. B., & Tucker, R. P. (2020). Suicide safety planning: Clinician training, comfort, and safety plan utilization. International Journal of Environmental Research and Public Health, 17(18), 6444.
About the Author
Samuel Eshleman Latimer (he/his), Psy.D., is a clinical psychology postdoctoral fellow that specializes in effective conflict management and dialectical behavior therapy. Samuel also works to help individuals, couples, and families decrease interpersonal difficulties and manage challenges associated with borderline personality disorder. Samuel believes that people do not need to choose between learning effective techniques that are based on science and developing warm, genuine relationships, as both of these styles complement each other. Click Here to learn more about Samuel’s experience and therapeutic style.