Back in November, I introduced Suicide Safety Planning. I reviewed the research and tips for making a high quality plan. Namely, I explained that all elements on a safety plan should be specific, accessible, feasible, and safe. In this post, I’ll start going into the different sections in more detail starting with Warning Signs and Coping Strategies: Things You Can Do On Your Own.
Safety Plan Sections
- Warning Signs
- Coping Strategies: Things You Can Do On Your Own
- Coping Strategies: Community Connections
- Places To Go
- People You Can Call
- Providers and Emergency Services
- Keeping the environment safe
You may notice the section names are a bit different then what I presented in my first post, which was pulled from Stanley-Brown Safety Planning Intervention. As I discussed, and will in more detail in the next post, the standard safety plan model highly emphasizes the self, which has limitations, including lacking cultural attunement.
Warning Signs
Before going into what to include in a safety plan, we have to first identify when to use our plan. Thus the first section, warning signs. This section tells us what is going on when suicide is becoming an option. In most versions of safety plans, this section is left open ended. In my version, I break it down into categories to allow us to get as specific and personalized as possible. Not everyone experiences distress the same way – some of us feel it in our bodies, others notice changes in behaviors first, for others it’s our thoughts that give us the best information.
Remember, research shows that what is often missing in safety plans is a lack of specificity for indicating when to use a plan. Ideally, at the first indication of any identified warning sign, the client starts to use their plan, thereby catching their pain as soon as possible and preventing it from exacerbating into a crisis. Think of a set of dominos, we don’t want the whole set to fall, we want to stop it as soon, and as quickly, as possible.
The process of having this in-depth of a conversation also reinforces the importance of self-reflection, of tuning into the self to know what is being experienced and in turn what is needed.
The Categories
Listed below are the different categories, a description of them (which doubles as a way of how to ask your client to identify each), and examples. Of course the examples are far from exhaustive. There is no one way of experiencing suicidal ideations. So, it is essential to get these details in the clients own words based on their own experience.
- Thoughts: What we are saying to ourselves: I can’t do this anymore, my family will be better off without me, things are never going to get better, I just want peace, I just want this to be over.
- Feelings: The emotions we are experiencing: hopelessness, helplessness, loneliness, despair, full of fury, all nerved up and can’t sit still, agitated.
- Bodily Sensations: What we are experiencing in our bodies: pit in my stomach, heaviness in my chest, fullness in my head, body feels like it’s full of lead.
- Behaviors: Actions we are taking: not eating, sleeping all the time, researching lethality of different methods, fantasizing about death, staring into space for hours, arguing with my family, withdrawing from friends.
- Events/Triggers: Things that happen: fight with my spouse, get yelled at by boss, can’t pay the bills, chronic pain gets worse
Coping Strategies: Things You Can Do On Your Own
As we get into the actual items on a safety plan, I want to reiterate, safety plans will not eliminate the original causes of suicidal ideations. They are about buying time to stay safe. This is important for the expectations you set with your client about what the plan is for, how and why to use it, and what outcomes you are aiming for.
This first coping strategies section, details the skills you can use and the actions you can take on your own. Our support isn’t always available 24/7, and for many, knowing what you need to engage in effective distress tolerance and emotion regulation is essential. I realize this may sound contradictory to my espousing on the importance of community and connecting with others. This is one of those dialectics I keep harping about. It is a both/and situation. We need to have the skills to care for ourselves and we need each other.
What To Include
Items that can go in this section will depend on what the client knows already works for them, what resources they have, and where they are in therapy. If you are in the beginning of care, items may be more simple. For example, listening to music, taking a hot bath, coloring, watching a favorite TV show, working on a puzzle, doing 20 push-ups. Remember to be specific and plan ahead. Create a set playlist, have aromatherapy oils ready for the bath, know which shows you are going to watch, have a stash of puzzles. The goal is to distract, take the edge off, and engage in opposite action (e.g. laughing at your favorite comedy when you are feeling despair).
If the client has more therapeutic skills on board, you can include things like mindfulness, states of mind worksheet, 4-way pros and cons, thought records, or chain analysis. You can also include items that directly correlate to reasons for living. This may look like cuddling your pet, creating a hope kit, researching your next vacation, making a digital photo album, spending time on a work or school project.
It’s somewhat arbitrary, and I always aim to get at least five items in this section.
For Clinicians: I hope this gives you ideas on how to be more personalized and specific when creating safety plans with your clients.
For Those Seeking Healing: If you are in a position to need a safety plan, I hope this gives you inspiration for what to include. And please remember, these posts are not therapy or an emergency resource. If you are having thoughts of suicide call 9-8-8 or go to your local emergency room.
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