Suicide Safety Planning

What a Safety Plan Is

A Written, Personal, Ordered Plan

A safety plan is a brief written document — typically one to two pages — that a person can refer to when they are starting to feel suicidal. It is personal: the warning signs are their warning signs, the strategies are their strategies, the contacts are their contacts. It is ordered: lower-effort, lower-stakes steps come first, with higher-intensity professional and emergency contacts later. And it is concrete: vague comforts ("be positive") are replaced by specific actions ("take a walk to the park on 5th and Main").

Why a Written Plan

In a suicidal crisis, cognitive functioning narrows. Memory, planning, and decision-making are impaired. Asking a person in that state to remember coping skills is asking a lot. A written plan externalizes the strategy so that the person does not have to generate it from scratch when they are least able to do so. Knowing what comes next reduces the paralysis of the moment.

When the Plan Is Used

The plan is used at the earliest sign of a developing crisis — not only when the urge to act has already peaked. Catching the warning signs early gives more time for the steps to work and reduces the chance that the person reaches a point of severe agitation, intoxication, or hopelessness without resources at hand.

Who Builds the Plan

Ideally, the plan is built in conversation with a trained clinician, crisis counselor, or peer specialist. Self-built plans can be useful as a bridge, but a good plan benefits from a second perspective — particularly to make sure the steps are realistic, the warning signs are well chosen, and the means-restriction step is taken seriously.

Evidence Base

The Stanley-Brown Trial

The most influential evidence for the Stanley-Brown Safety Planning Intervention came from a large cohort comparison conducted across nine Veterans Health Administration emergency departments. Patients who received a safety plan plus brief structured follow-up had about a 45 percent reduction in suicidal behavior over the next six months, and roughly twice the rate of outpatient mental-health follow-up, compared with patients who received usual care. The study has been broadly influential in shaping current ED practice.

Why It Works

Researchers think several mechanisms contribute: the plan slows down the crisis, externalizes coping skills, builds connection by naming specific people and professionals, and — through the means-restriction step — physically reduces the chance that an impulsive moment becomes a fatal act. The brief follow-up calls that accompany the plan in many programs also matter; the "caring contact" itself has independent evidence of benefit.

Settings Where It Has Been Tested

• Emergency departments
• Inpatient psychiatric discharges
• Outpatient mental-health clinics
• Veterans Affairs and military behavioral health settings
• College counseling centers
• Crisis lines and mobile crisis teams

What the Evidence Does Not Yet Show

Most trials look at the safety plan combined with brief follow-up, not the plan alone. The plan is best understood as one component within a system of care that also includes outpatient treatment, lethal means counseling, and ongoing contact. It is not yet clear how the plan performs in isolation, and the field consensus is to deliver it alongside other supports.

Step 1: Warning Signs

The Person's Own Warning Signs

The first step asks the person to identify the personal warning signs — thoughts, feelings, situations, images, and behaviors — that tell them a suicidal crisis may be developing. These are individual, not generic. One person's warning sign may be the sound of certain music. Another's may be a flash of a specific intrusive image, a particular argument with a partner, a sleepless night past a certain hour, or a feeling of numbness that often precedes the urge to act.

Why Personal Specificity Matters

Generic checklists ("hopelessness," "withdrawal") are useful for educating the public but less useful as triggers for a personal plan. The point of step one is to give the person something concrete enough that they can recognize it early — earlier than they have in the past. The more specific the warning sign, the more useful it is as a cue to move to step two.

How to Identify Warning Signs Together

A clinician often asks the person to walk through the lead-up to a recent suicidal crisis hour by hour, or even minute by minute when possible. What was happening before things got bad? What thoughts appeared first? What body sensations? Out of that walkthrough come three to five concrete warning signs that go on the plan.

Examples

• "When I start replaying the conversation with my brother on a loop"
• "When I find myself looking at the medication cabinet"
• "When I haven't slept more than three hours and the sky starts getting light"
• "When I start writing the goodbye text I never send"
• "When I feel completely numb and far away from everyone"

Step 2: Internal Coping Strategies

What This Step Is For

The second step is a short list of things the person can do on their own, without contacting anyone else, that have helped before — or that they are willing to try — when warning signs appear. These are activities that take their mind off the suicidal thoughts, reduce the intensity, or shift their physical state.

Why Internal Strategies Come Early

Strategies that the person can do alone are listed before strategies that involve other people because they are immediately available. Even in the middle of the night, in an empty apartment, the person can put on music, take a shower, step outside, or do a brief breathing exercise. These steps buy time and can sometimes shift the state enough that the crisis passes without further escalation.

Examples

• Going for a walk around the block
• Taking a hot or cold shower
• Listening to a specific playlist that has helped before
• Doing a paced breathing exercise (4-in, 7-hold, 8-out)
• Watching a familiar comforting show or movie
• Holding ice or splashing cold water on the face (a DBT TIP skill)
• Doing a brief physical activity — push-ups, stretching, dancing
• Writing in a journal or to a "future self"
• Caring for a pet

Realistic, Not Aspirational

The plan should list strategies the person has actually used or is willing to use, not generic wellness advice. "Meditate for 30 minutes" is not a useful crisis strategy for someone who has never meditated; "step into the bathroom, run cold water over my wrists for one minute" might be.

Step 3: Social Contacts and Settings That Distract

People and Places — for Distraction, Not Help

Step three is important and easy to misunderstand. The contacts and settings listed here are not chosen because the person plans to talk about the crisis with them. They are chosen because being around them — being in a coffee shop, going to a friend's apartment, sitting at a public library, going to a religious service — reduces the intensity of the suicidal state by providing distraction, social presence, and a different physical environment.

Why Separate from "People to Ask for Help"

Asking someone for help is a vulnerable, energy-intensive act. In a developing crisis, the person may not be ready for that conversation yet. But going to a friend's place and watching a game, or sitting at a coffee shop with a laptop, may be possible. These lighter contacts can interrupt the crisis without requiring disclosure.

Examples

• A specific coffee shop where the person feels comfortable
• A friend's home that has an open-door understanding ("you can always come over")
• A gym, library, place of worship, community center, or park
• A family member's house where the person can be present without explaining
• A volunteer setting, group meeting, or class

What to Avoid

The plan should also note settings to avoid during a crisis — places associated with prior attempts, environments where lethal means are available, or contexts where alcohol or substance use is likely to increase. Naming these settings explicitly is part of safety, not stigma.

Step 4: People to Ask for Help

The Disclosure Step

Step four is where the plan moves from distraction to disclosure. It lists specific people — by name and phone number — that the person can call or text when they need to actually tell someone what is going on. These people have been asked in advance whether they are willing to be on the list and, ideally, have some basic understanding of what to do.

Choosing the Right People

The list should include people who:

• Are reasonably reliably reachable
• Can stay relatively calm in the conversation
• Are not the primary source of the person's pain
• Know that being on the list is voluntary and can say no without consequence

Coaching the Supports

When possible, the people on the list should have a brief conversation in advance about what helps the person and what does not — a topic that may be too overwhelming for the person to communicate during a crisis. Some clinicians invite supports to a session to set this up directly. (See our guide on talking to a loved one in crisis for what supports should know.)

Multiple Names, in Order

The plan should list more than one person, ranked in the order the person would prefer to reach out. This handles the realistic possibility that the first person does not answer. Knowing there is a "next" name reduces the risk that one unsuccessful call ends the attempt to connect.

Step 5: Professionals and Agencies

The Clinical Network

Step five lists the professionals and agencies the person can contact when steps one through four have not been enough — or when the crisis is severe from the start. This typically includes:

• The person's individual therapist (name and number)
• The person's psychiatrist or prescribing clinician (name and number)
• The local mental-health clinic or after-hours line
• The 988 Suicide & Crisis Lifeline (call or text)
• Crisis Text Line (text HOME to 741741)
• The nearest psychiatric emergency department or crisis stabilization unit
• A mobile crisis team where available

Why This Belongs on the Plan

People in crisis often cannot remember or find these numbers, especially after hours. Putting them on a single page — and writing them in a format that is easy to read and dial — removes friction at the moment when friction matters most.

When to Use This Step

Earlier rather than later is usually better. People sometimes treat the professional step as a last resort and then are too overwhelmed to use it when they actually need to. The plan should encourage use of this step whenever the person is unsure, not only when they are in obvious extremity.

The 911 Question

The plan may include 911 as a final option, but the field increasingly recognizes that police involvement in mental-health crises has risks — particularly for Black, Indigenous, and other people of color, and for people with serious mental illness. Where mobile crisis teams or co-responder programs exist, the plan should list them in preference to 911. (See talking to a loved one in crisis for more on this.)

Step 6: Means Restriction

Why This Step Is Critical

Step six addresses the single strongest predictor of whether a suicidal moment becomes a fatal act: access to lethal means. The Harvard Means Matter campaign has summarized decades of research showing that suicidal crises are often short-lived, that people who survive an attempt are far more likely to die from another cause than from later suicide, and that the lethality of the method used in a moment of acute risk is the dominant factor in whether the person survives. Reducing access to highly lethal means — particularly firearms — saves lives.

The Counseling Conversation

Lethal means counseling is a brief, non-confrontational conversation about what lethal means are present in the person's environment and how to reduce or temporarily eliminate access. It is not about confiscation or judgment. It is about helping the person and family put time and distance between an impulsive moment and a fatal outcome.

Firearms

Where firearms are present, the safest option during elevated risk is to store them outside the home — with a trusted family member, friend, gun shop, range, or law-enforcement agency that offers temporary storage. Where that is not possible, options include locking the firearm in a safe with the key held by someone else, separating ammunition from the firearm, and using a cable lock. Many gun-owning communities have embraced this conversation as a matter of responsible ownership.

Medication

Stockpiles of medication — particularly opioids, sedatives, tricyclics, acetaminophen, and certain blood-pressure agents — are another major lethal means. Reducing on-hand supply (by filling prescriptions weekly rather than in 90-day quantities), using lock boxes, and dispensing through a trusted family member can each reduce risk.

Other Means

Other lethal means to consider include knives where they are part of a personal plan, ropes or cords in specific contexts, and access to bridges, train lines, or other location-based methods. Means restriction is highly personal and follows from the warning-sign work in step one.

Time Limits

Means restriction does not have to be permanent. Many families set it up as a time-limited arrangement ("for the next three months while we get treatment stabilized") that is revisited together later. Framing it this way often increases willingness.

The Collaborative Process and Modern Tools

How a Clinician Builds It

The Stanley-Brown protocol involves the clinician and patient sitting side by side, often literally — sometimes with the document on a tablet or printed sheet between them. The clinician asks open questions, the patient does the bulk of the talking and choosing, and the plan is written in the patient's own words. The session typically takes 20 to 45 minutes, often as part of a larger evaluation or discharge process.

The Patient Keeps a Copy

The patient leaves with a copy in a format they will actually use: a folded sheet in a wallet, a photo on their phone, an entry in a notes app, or a dedicated safety-plan app. The clinician keeps a copy in the medical record. Some programs also share a copy (with consent) with a key family member.

App-Based Versions

Several apps now implement digital safety plans, including the Stanley-Brown Safety Plan app, BraveLife (developed with veteran communities), and Virtual Hope Box. These can be helpful for people who reach for their phone in a crisis more readily than a piece of paper. App-based plans should still be built with a clinician where possible, not assembled solo from a download.

Updating the Plan

A safety plan is a living document. Warning signs change, supports change, and what works at one stage of recovery may not work at another. Plans should be reviewed regularly — at the start of each therapy session in some programs, or at minimum every few months — and after any significant event (a major loss, a discharge, a near-attempt).

The Family Role

With the patient's consent, family members can be brought into a session to learn the plan, ask questions, and clarify their role. Family involvement is especially important for means restriction, where another household member's cooperation may be essential.

Cultural Adaptation

Effective safety plans reflect the person's cultural context, language, and resources. A plan that lists "your therapist" is not useful for someone who does not have one; a plan that lists "your priest" is not useful for someone of a different faith. Good clinicians flex the structure to fit the person.

Limits, Contracts, and the Bigger Picture

Safety Plans Are Not No-Suicide Contracts

"No-suicide contracts," also called "no-harm contracts" or "contracts for safety," were once common in clinical practice. In these documents, the patient signed an agreement promising not to attempt suicide before the next session. Research has found no evidence that these contracts reduce suicide risk, and there is reason to think they may cause harm by shifting clinical responsibility onto the patient, discouraging honest disclosure, and giving clinicians a false sense of reassurance. The field has largely abandoned them in favor of safety planning.

The Difference

A safety plan does not ask the patient to promise anything. It asks: "What are the warning signs? What can you try? Who can you call? How do we make your environment safer?" The plan is a resource, not a contract. It treats the patient as a collaborator, not as someone to be managed.

What Safety Planning Cannot Do Alone

Safety planning is one tool, not a complete treatment. It does not treat depression, PTSD, substance use disorder, chronic pain, or any of the underlying conditions that often drive suicidal crises. It works best as part of a broader plan that may include:

• Evidence-based psychotherapy (CBT-SP, DBT, CAMS — see our suicidal ideation guide)
• Medication where appropriate
• Treatment of co-occurring conditions
• Brief follow-up contacts after high-risk transitions
• Family or peer support
• Address of social drivers (housing, financial stress, isolation)

Realistic Expectations

A safety plan is not a guarantee. People in deep crisis sometimes do not reach for it. Some die by suicide despite having a thoughtful plan. Acknowledging this is not pessimism — it is part of why the plan is one component of layered prevention rather than a stand-alone fix. The goal is not perfection but a system that, on average and across many people, reduces deaths.

Hope

For most people, suicidal crises are time-limited. A safety plan is a way of carrying tools through a hard hour or week so the person can reach the other side. Many people who have used safety plans describe them not as a permanent crutch but as a bridge — a way of holding on long enough for treatment, time, and connection to do their slower work.