This form is to help you plan for times when you have strong thoughts, feelings or urges to end your life.
There is also space for you to provide information about how people can best support you when you feel this way.
Follow the steps below until you feel safe.
This form can be completed by the person experiencing suicidal feelings, or with support from a trusted friend or family member, health care professional, or support worker.
The SPI (Safety Planning Intervention) has 6 key steps: (1) identify personalized warning signs for an impending suicide crisis; (2) determine internal coping strategies that distract from suicidal thoughts and urges; (3) identify family and friends who are able to distract from suicidal thoughts and urges and social places that provide the opportunity for interaction; (4) identify individuals who can help provide support during a suicidal crisis; (5) list mental health professionals and urgent care services to contact during a suicidal crisis; and (6) lethal means counseling for making the environment safer (http://www.suicidesafetyplan.com).
Autism adapted SPIs add a seventh step: identify support and communication preferences. This is important to supporting neurodivergent people.
This form is based on “Stanley-Brown Safety Planning Intervention“, “MHAutism Safety Plan“, and “Feasibility and acceptability of autism adapted safety plans: an external pilot randomised controlled trial“.
Table of Contents
- My Safety Plan
- Step 1: Recognize warning signs of an impending suicidal crisis.
- Step 2: Employ internal coping strategies.
- Step 3: Utilize social contacts as a means of distraction from suicidal thoughts.
- Step 4: Contact family members or friends who may help to resolve the crisis.
- Step 5: Contact mental health professionals or agencies.
- Step 6: Make the environment safer by reducing the potential use of lethal means.
- Step 7: Identify how other people can offer support.
My Safety Plan
Name:
Date(s) of crisis:
What is important to me:
(Please use this space to write a message to yourself for when you feel suicidal. You may also like to attach a photo to this form and/or something meaningful to you that you can focus on when you feel suicidal.)
Step 1: Recognize warning signs of an impending suicidal crisis.
Recognize warning signs of an impending suicidal crisis.
One of the most effective ways of averting a suicidal crisis is to address the problem before it fully emerges. These warning signs include personal situations, thoughts, moods, or behaviors and serve as a reminder to retrieve and follow the Safety Plan.
Step 1: What are the warning signs that I/the person I support may start to have strong thoughts, feelings or urges to end life? (e.g. reduced enjoyment from a special interest, change in routine, change in patterns of sleep, eating, mood).
Step 2: Employ internal coping strategies.
Employ internal coping strategies.
In this step, patients are asked to identify what they can do, without the assistance of another person, should they become suicidal again. Such activities function as a way for patients to distract themselves from the crisis and allow time for the suicidal thoughts to subside.
Step 2: What I can do to help distract myself/the person I support (e.g. engage in a particular activity or interest, a relaxation technique, or physical activity):
Step 3: Utilize social contacts as a means of distraction from suicidal thoughts.
Utilize social contacts as a means of distraction from suicidal thoughts.
Patients can utilize socialization strategies of two types: socializing with other people in their natural social environment or healthy social settings that may help to distract themselves from their suicidal thoughts.
Step 3: People I can socialize with (e.g. family, friends, mentor, support worker):
Step 4: Contact family members or friends who may help to resolve the crisis.
Contact family members or friends who may help to resolve the crisis.
This step is distinguished from the previous one in that patients explicitly reveal to others that they are in crisis and need support and assistance in coping with the crisis.
Step 4: People I can contact to ask for help (e.g. family, friends, mentor, support worker):
Step 5: Contact mental health professionals or agencies.
Contact mental health professionals or agencies.
Patients are instructed to contact a professional or agency who are trained to provide or get help during a suicidal crisis.
Step 5: Professionals or agencies I can contact during a crisis (e.g. ER, A&E, Psychiatric Services, Samaritans, Mind):
Step 6: Make the environment safer by reducing the potential use of lethal means.
Make the environment safer by reducing the potential use of lethal means.
Even if no specific plan is identified by patients, a key component of the Safety Plan Intervention involves eliminating or limiting access to any potential lethal means in the environment to allow time to pass so that the suicide risk subsides.
Step 6: Making the environment safe (throw away things that could be used to harm yourself/the person you support):
Step 7: Identify how other people can offer support.
Step 7: How can other people help support me? (There are suggestions below, please adapt these or add your own if you wish):
How I communicate distress (e.g. I shut down, I have a meltdown):
What stresses me/makes me unhappy (e.g. loud noises, being touched, change of plan, too much information):
What can help calm me? (e.g. a special interest, a fidget, a quiet safe place to calm down, just sitting with me, giving me my own space):
How I would like you to communicate with me (e.g. don’t ask me to look you in the eye, speak softly, use visual supports, use plain English, keep in mind that I may take what you say literally):
Who I would like you to contact:
