Behavioral Health Suicide/Self-Harm Safety Plan

Suicide/Self-Harm Safety Plan

Patient Name: [Patient name]

Date Created: [Date]

Clinician/Team: [Clinician/Team name and phone number] (Include after-hours or on-call instructions if available)

Next Review Date: [Date]

How to Use This Plan

Use this plan when you notice warning signs or urges. Start at Step 1 and move through each step until you feel safe. If you are in immediate danger, call 911 or go to the nearest Emergency Department.

Step 1: Warning Signs

"How will I know it's time to use this plan?"

• [Warning sign in patient's own words]
• [Warning sign in patient's own words]
• [Warning sign in patient's own words]

(Include 3-5 warning signs. If patient cannot identify warning signs, include clinician suggestions clearly labeled as such, e.g., "Clinician suggestion: [suggested warning sign]")

Step 2: Coping Strategies (On My Own)

"What can I do by myself to get through the next 10-30 minutes?"

• [Self-coping action in patient's own words]
• [Self-coping action in patient's own words]
• [Self-coping action in patient's own words]

(Include 3-5 concrete, low-effort actions the patient can do alone without contacting anyone)

Step 3: Distraction — People and Places

"Who or where helps me feel a little better without having to explain what's wrong?"

People:

• [Name] — [Phone or text number]

Places:

• [Safe location]

(Include people, places, or both. If patient has no people to list, places alone are acceptable)

Step 4: People I Can Ask for Help

"Who can I tell directly that I'm struggling and need help?"

• [Name] — [Relationship] — [Phone]

(Include 1-3 contacts)

Suggested script: "I'm having thoughts of hurting myself and I need help staying safe."

Step 5: Crisis Resources

• 988 Suicide & Crisis Lifeline: Call or text 988
• Emergency: Call 911 or go to the nearest Emergency Department
• My treatment provider: [Clinician or clinic name and phone, or main line with "ask for on-call"]
• Veterans Crisis Line: Call 988, then press 1 (Include only if applicable)
• Local crisis team: [Name and phone] (Include if known)

(This section must always be populated; never leave blank)

Step 6: Making My Environment Safer

"What can I do to reduce access to things I might use to hurt myself?"

• Item: [Item or means] — Action: [Specific safety action] — Who: [Responsible person] — By: [Date/time]

(Cover relevant categories: firearms, medications, sharps, alcohol/substances, other hazards. Use specific, concrete steps. If patient declines discussion, document: "Patient declined means safety discussion" and include plan to revisit at next review)

Follow-Up

Next appointment: [Date/time] — [Clinician] — [Location or modality]

Where I will keep this plan: [Location, e.g., wallet, phone, with supporter]

If things get worse before my appointment: [Specific instruction, e.g., call the clinic or move to Step 5]