Photograph by Nick Fewings, Unsplash
None of us are immune to the suffering or difficulties that life can bring. We are not always prepared for change especially when it takes us by surprise and when we are experiencing high periods of mental distress for some people this can lead to suicidal feelings, urges or self-harm.
Through my time as a crisis worker, I found safety planning an important tool in helping individual’s to navigate through a crisis. It serves two purposes; one it details coping strategies which you know work for you and secondly it holds a list of contacts in order of importance . For example, you have been triggered in the day and started to feel deregulated. You tried working through your coping strategies but for some reason they are not quite helping today. You don’t quite feel you need medical attention yet so you don’t need to ring the GP but you do have your friend listed who is there to support you. So you give them a call instead, chat things through and you start to feel a little better. Your friend suggests you call your GP which you do in the morning (risk deescalates).
When we are in the middle of a crisis staying safe for 5-10 minutes can take a great deal of strength and it is hard to remember what has helped and who can help so the safety plan is there to do all this remembering for you. It can be as brief or as detailed as you want. You can print it out, keep a copy on your or keep it on your phone. There is also an amazing app, websites and helplines (see my need help now page) that are available 24/7 which I will mention at the end. For now I will talk you through how I go about constructing a safety plan with a client.
A note of caution: It is essential when putting together your safety plan that you do so on a good day when you are feeling regulated and in a rational headspace. You can do this on your own, with your therapist, support worker, friend or a family member.
The safety plan is not a plan for how to rid yourself of thoughts, but it looks at staying safe in the moment until you can access the support you need. Thoughts and feelings can change so let’s focus on what you can do now.
What do I need to do to reduce the risk of me acting on the suicidal thoughts/self-harm and to make my environment safer? Where can I put things that I could use to harm myself with, so they are harder to get to if I feel overwhelmed?
This question is really looking at your environment and what you can do to feel safer when you are feeling overwhelmed. Planning on a good day is important as it allows you to assess your current situation more clearly with risk in mind. It may be that you choose to not keep medication stockpiled or not keep blades in the house. I also encourage clients to use bullet points and colour so it’ easier to read as concentration can be impaired when we feel overwhelmed.
- Examples:
- Not stockpile medication (get weekly blister packs)
- Keep all my medication in the cupboard out of sight
What warning signs or triggers are there that make me feel out of control (deregulated)?
This question helps clients to consider their early warning signs and triggers. Have you experienced a similar overwhelm in the past and can you remember what triggered this? E.g. falling out with boss, song that came on the radio etc.
- Examples:
- Staying at home and being in own thoughts all day
- Anniversary
- Falling out with partner
If I have acted on these thoughts before, what makes it harder to stay safe and what may I need to consider in order to stay safe now?
It’s important if you have acted on thoughts in the past to consider what might make it harder for you stay safe. This may tie in to the first section and you would find it harder for example to stay safe if you stockpiled medication. So it’s about reflecting on previous situations to help you stay safe in the future. What would you need to think about in order to stay now?
What have I done in the past that helped? What strengths do I have as a person and how might this keep me safe?Do I have any positive statements or quotes I can use for inspiration? How can I use this in my plan to stay safe?
This is the section where you can draw on past experiences and your inner resources. It is where you can add any existing coping strategies which have helped in the past, any special quotes (I’ve shared one of my favourites which a friend shared with me) and even affirmations.
- Examples:
- Called “…….” and been honest with him/her
- Distractions – do the washing up, hoover etc
- Being with a friend
- Writing my feelings down
- Knowing there’s an alternative way to look at things
- I am creative so using my art to express my feelings
- “It’s dark because you are trying too hard. Lightly child, lightly. Learn to do everything lightly. Yes, feel lightly even though you’re feeling deeply. Just lightly let things happen and lightly cope with them – Aldous Huxley
What I will do to help calm and sooth myself:
When we become distressed we go outside of what clinical professor of psychiatry Dan Siegel called our ‘window of tolerance’. When we are inside the window (the green zone) we feel calm, soothed, safe and balanced. If we become too distressed and overwhelmed with racing thoughts, anxiety etc then we start to become deregulated and fall into the amber zone. This goes further when we feel shame, guilt, numb, dissociated or shut down falling into the red zone. What we are aiming for is to stay in the green zone which we can achieve through things like mindfulness, centering and grounding techniques, self compassion, self-care and distress tolerance skills. Watch this video for a more in depth discussion on the window of tolerance.
- Examples:
- Find your soothing breathing rhythm and say ‘mind slowing down’
- Sensory grounding – 5 things I can see around me (say out loud), 4 things I can touch (say aloud as touching e.g. “the duvet feels soft”), 3 things I can hear (say out loud, “e.g. I can hear the birds in the trees), 2 things I can smell (name them) and 1 thing I can taste.
- Go to your inner safe place (anchor)
- Listen to my favourite calming music
- Make a hot milky drink
- Tell myself “I’m doing the best ok and that’s good enough”
What will I tell myself, as alternatives to the dark thoughts?
This is a good section to put any small notes of encouragement from yourself when you’re in a good place or even quotes from others to act as a reminder.
- Examples:
- “I’ve gone through this before and got through it and I CAN get through now.”
- “These are thoughts are intrusive but they are just thoughts and I don’t have to act upon them“
- “This too shall pass!”
So all the above concentrates on your inner resources, coping skills etc and the last part of the plan is the plan of action for if things get too much and the above isn’t quite helping.
What could others do to help?
This is a good section to write what others involved in your life or care can do to help.
- Example:
- My support worker will remind me of my safety plan
- Ask Mum to come to the GP with me
Is there anywhere I can go to feel safe?
Is there anywhere you go like a friend or family members, community or support group to feel safe?
- Example:
- Go to…….as I feel safe there and it helps calm me down
Who can I call?
Who are you able to call and talk to if you are feeling overwhelmed ? This is a good place to list your contacts in order for example where can you go if the GP service is closed? Is there a local crisis cafe or crisis hotline/service?
- Example:
- Call ………. as he always listens and talks me through it
- Call my GP if within the open hours
- Call the Samaritans on 116 123 as they are open 24/7 and always listen If I don’t feel like calling
- I can text SHOUT on 85258 as they are always good to talk to
- Talk to the crisis service
If I still feel suicidal and things feel out of control?
If you have tried everything on your plan and nothing is working and you feel you at at imminent risk of serious harm or taking you life then it is time to either go to your local A&E department or call 999.
- I will go to the A&E department
- If I cannot get there safely, I will call 999
Just remember your safety plan isn’t a fixed document you can review it and update it as much as you need as long as it works for you.
Free Templates
There are some great templates out there for safety planning at these websites (or you can make your own).
Recommended App
The Stay Alive app is an amazing tool and suicide prevention resource for the UK, packed full of useful information to help you stay safe.
If you are experiencing distress please visit my need help now I need help now page.
Otherwise thank you for reading, stay safe and take care for now.