Creating a Safety Plan

A Safety Plan can be a useful tool when a young person is ambivalent about living or dying, whether these thoughts are vague or intense in nature. It can help to manage distress and reduce the immediate risk of suicidal behaviour. 

It involves the young person identifying coping and help-seeking strategies that are tailored to their needs, situation and personal relationships. 

The plan prompts the young person to work through these steps until they feel safe. This may include strategies they can do themselves, such as relaxation exercises or participating in enjoyable activities, and identifying who they can contact for support.

Safety planning should be undertaken by staff who are skilled and experienced in this process, such as a mental health professional, school psychologist or counsellor.

The Safety Plan should be completed as part of a broader conversation with the student about their mental health, suicide risks and need for further support. It’s important to reinforce to the young person that if they feel at imminent risk and are unable to remain safe — even for a short period of time — they should seek immediate support from family, friends or emergency services.

Safety planning

Beyond Now is a suicide safety planning app that supports people to develop a list of warning signs, coping strategies, reasons for living and ways to stay safe in a free and confidential way.  It can be easily accessed during times of distress and crisis. It can also be used with health professionals or shared with family and close friends.

Beyond Now was developed by Beyond Blue and has been transferred to Lifeline to as part of a partnership to make it easier for everyone in Australia to access the support they need, when they need it.

The Safety Plan

1. Recognising warning signs and personal triggering events
2. Creating a safe environment
3. Identifying reasons to live
4. Identifying things I can do by myself
5. Connecting with people and places
6. Reaching out to trusted family and friends in a crisis
7. Seeking professional support.

Some young people may not wish to complete a step, or steps, in the Safety Plan.

Their plan is unique to them and is all about keeping safe. If certain steps aren't helpful or create an additional source of burden, stress or conflict, these can be left out. A Safety Plan should be modified over time to ensure it is effective. The young person might review their Safety Plan with the wellbeing team, their health professional or another significant support person.
 
Key steps of the Safety Plan

When you're supporting a young person to create their Safety Plan, asking questions can help them think about what might work for their situation and ensure the strategies you identify meet their individual needs.
 
Here are some questions you can use to help a young person develop a Safety Plan. The Beyond Now app and the associated information on the Lifeline website also list these prompts.

1. Recognising warning signs and personal triggering events
Being aware of changes in thoughts, moods and behaviour that may signal a developing crisis allows the young person to act earlier, helping to reduce further risk.

Questions to ask might include:

• When do you think you could use your Safety Plan?
• What are some of the difficult thoughts, feelings or behaviours that you experience leading up to a crisis?

Warning signs might include:

• moods such as sadness, anxiety or irritability
• thoughts involving hopelessness, helplessness or self-criticism
• behaviours such as alcohol or drug use, avoiding social situations or arguing more often with friends or loved ones.

2. Creating a safe environment
Identify ways to keep the young person’s immediate environment safe. This can be achieved by reducing or eliminating their access to potentially lethal means. This can also include being aware of and avoiding stressful or upsetting situations.

Questions to ask might include:

• Are there any specific situations or people that you find stressful or triggering, or that contribute to your suicidal thoughts?
• What things do you have access to that are likely to be used in a suicide attempt?
• How can we develop a plan to limit your access to these means and avoid these situations?

Restricting access to lethal means might include:

• asking someone else to manage access to medication
• reducing access to firearms or improving safety procedures (this step should always involve having a support person remove any firearms)
• getting rid of glass or blades that might be used to cause harm.

3. Identifying reasons to live
Develop a list of positive things in life that bring joy and meaning can help change the young person’s focus. The list may include things the young person can look forward to in the future. 

Questions to ask might include:

• What’s the best thing about living?
• What’s the most important thing in your life?
• What things in your future do you look forward to?

Reasons to live might include:

• family, friends or pets
• spiritual or religious beliefs
• everyday pleasures such as walking on the beach or enjoying nature
• life experiences such as having children or travelling.

4. Things I can do by myself
Identify activities and internal coping strategies a young person can do without contacting anyone else. This can help to regulate emotions, reduce distress, change the focus of thinking and distract from suicidal ideation, potentially preventing a further escalation into crisis.

Questions to ask might include:

• What can you do on your own if you have suicidal thoughts in the future to avoid acting on those thoughts?
• What can you do to help take your mind off your problems, even for a short period of time?

Internal coping strategies might include:

• breathing or relaxation exercises
• going for a walk, doing yoga or other exercise
• watching a favourite movie or listening to a favourite band
• playing or cuddling with a pet.

5. Connecting with people and places
Just being around other people can provide a distraction from suicidal thoughts. This can include spending time with family and friends or going to a busy park or shopping centre. 

Questions to ask might include:

• Who helps you feel good when you socialise with them?
• Where can you go and be around other people in a safe environment?

Socialisation strategies might include:

• spending time with friends and family, remembering that socialising can include activities that don’t require much talking or engagement, such as watching TV
• going to a coffee shop, park, place of worship or meeting group.

6. Reaching out to trusted family and friends in a crisis
The young person should think carefully about who would be helpful in a crisis. Avoid listing people who could possibly exacerbate the situation.

Questions to ask might include:

• Among your friends and family, who do you feel you could talk to when you’re having suicidal thoughts?
• Who do you feel you could contact to support you during a suicidal crisis?

7. Seeking professional support
Health professional or support services that can be contacted during a suicidal crisis. 

Questions to ask might include:

• Which services could you turn to for support?
• Which health professionals can you involve in your treatment plan?

Reviewing the Safety Plan

A Safety Plan should be modified over time to ensure it continues to be effective.

As part of monitoring a young person identified as at risk of suicide, the wellbeing team or identified health professional should regularly check in with the young person about their use of the Safety Plan.

These questions can be helpful in these discussions:

• How often has the young person needed to use the Safety Plan?
• What was the most useful aspect of the Safety Plan?
• Are there any barriers to using it?
• How will the young person continue to use the Safety Plan?

Monitoring a young person 

Wellbeing staff can also use their knowledge 
of risk factors and warning signs to assist with monitoring a young person’s level of risk and their mental health. 

Where issues of concern are raised, the wellbeing team can facilitate a risk assessment. This can review the level of risk more thoroughly and guide what supports the young person may need to remain safe and supported. 

Changes in mood, levels of participation and thinking patterns may indicate that a young person needs extra support, and that their Safety Plan might need some changes. 

Changes in mood may include:

• being irritable or angry with friends or family for no apparent reason
• feeling tense, restless, stressed or worried
• crying for no apparent reason or feeling sad or down for long periods of time.

Changes in levels of participation may include:

• not enjoying or not wanting to be involved in things they would normally enjoy
• being involved in risky behaviour they’d normally avoid
• unusual sleeping or eating habits.

Changes in thinking patterns may include:

• having a lot of negative thoughts
• expressing distorted thoughts about themselves and the world (for example, everything seems bad and pointless).

If staff become aware of changes in a young person, it’s important to act. They might be  able to have a conversation with the young  person or they might refer their concerns to  the wellbeing team.

It’s important to:

• recognise the young person’s distress or concerning behaviour
• ask them about it (for example, “I’ve noticed you seem to be sad a lot at the moment”) 
• acknowledge their feelings (for example, “That seems like a really hard place to be in. I can understand why you’re upset about that”) 
• get appropriate support and encourage healthy coping strategies (for example, “Do you need some help to handle this?”) 
• check in a short time afterwards to see how the young person is feeling.

Creating a Safety Plan is a practical and accessible activity that young people can be encouraged to use to help them develop coping skills and identify what to do in times of crisis.