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Article Structure

The Safety Plan form is a vital tool designed to assist individuals in identifying and managing potential crises. It is structured in six key steps, each encouraging proactive strategies to promote well-being. The first step focuses on recognizing warning signs that indicate when a crisis may be developing, such as specific thoughts or situations. Following this, the form prompts individuals to list internal coping strategies that can provide relief without relying on others. The third step emphasizes the importance of social connections by identifying people and places that help distract from distress. Additionally, the fourth step lists individuals who can be contacted in times of need for support. The fifth step details professionals or agencies available for assistance during a crisis, including emergency contacts and local services. Finally, the sixth step addresses creating a safer environment by identifying potential hazards and making necessary changes. The form concludes by encouraging individuals to reflect on what matters most to them, underscoring the importance of personal values in times of challenge.

Safety Plan Example

Patient Safety Plan Template

Step 1: Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be developing:

1._____________________________________________________________________________________________

2._____________________________________________________________________________________________

3._____________________________________________________________________________________________

Step 2: Internal coping strategies – Things I can do to take my mind off my problems without contacting another person (relaxation technique, physical activity):

1._____________________________________________________________________________________________

2._____________________________________________________________________________________________

3._____________________________________________________________________________________________

Step 3: People and social settings that provide distraction:

1.Name____________________________________________________ Phone______________________________

2.Name____________________________________________________ Phone______________________________

3.Place__________________________________________ 4. Place______________________________________

Step 4: People whom I can ask for help:

1.Name____________________________________________________ Phone______________________________

2.Name____________________________________________________ Phone______________________________

3.Name____________________________________________________ Phone______________________________

Step 5: Professionals or agencies I can contact during a crisis:

1.Clinician Name____________________________________________ Phone______________________________

Clinician Pager or Emergency Contact # _________________________________________________________

2.Clinician Name____________________________________________ Phone______________________________

Clinician Pager or Emergency Contact # _________________________________________________________

3.Local Urgent Care Services______________________________________________________________________

Urgent Care Services Address___________________________________________________________________

Urgent Care Services Phone_____________________________________________________________________

4.Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255)

Step 6: Making the environment safe:

1._____________________________________________________________________________________________

2._____________________________________________________________________________________________

Safety Plan Template ©2008 Barbara Stanley and Gregory K. Brown, is reprinted with the express permission of the authors. No portion of the Safety Plan Template may be reproduced

without their express, written permission. You can contact the authors at bhs2@columbia.edu or gregbrow@mail.med.upenn.edu.

The one thing that is most important to me and worth living for is:

________________________________________________________________

Form Characteristics

Fact Name Details
Purpose The Safety Plan form is designed to help individuals identify strategies and resources for managing crises and promoting safety.
Warning Signs The first step in the Safety Plan involves recognizing personal warning signs that indicate a crisis may be approaching. This can include specific thoughts, images, or situations.
Coping Strategies Individuals are encouraged to list internal coping strategies, which are personal actions one can take to divert their mind from problems, emphasizing self-reliance.
Support Network Step 3 focuses on identifying people and social settings that provide distraction and support during difficult times. This could include friends, family, or even safe places.
Emergency Contacts The form includes sections for listing professionals or agencies that can be contacted during a crisis, highlighting the importance of having accessible help.

Guidelines on Utilizing Safety Plan

Completing the Safety Plan form is an important step toward managing your personal safety and well-being. This plan helps identify triggers and offers resources for support. Follow these steps to fill out the form effectively.

  1. In the first section, outline your warning signs. Write down specific thoughts, images, moods, situations, or behaviors that indicate a crisis might be developing.
  2. Next, detail your internal coping strategies. List things you can do to distract yourself from problems without reaching out to someone else. Think of relaxation techniques or physical activities that are effective for you.
  3. In the third section, identify people and social settings that provide you with distractions. Fill in names and phone numbers, along with places where you feel comfortable and safe.
  4. List individuals in the fourth section whom you can ask for help. Make sure to include their names and phone numbers for easy contact during times of need.
  5. In the fifth section, add information about professionals or agencies you can reach out to during a crisis. This includes clinician names, their phone numbers, and any relevant emergency contact numbers. Don't forget to include local urgent care services and the Suicide Prevention Lifeline number.
  6. Finally, think about how to make your environment safe. Identify concerns and solutions that can help protect your well-being.
  7. At the end of the form, reflect on what matters most to you. Write down the one thing that you value and want to live for.

What You Should Know About This Form

What is a Safety Plan form?

A Safety Plan form is a structured tool designed to help individuals manage crises and reduce the risk of self-harm or suicide. It outlines specific warning signs and strategies that a person can use when they feel overwhelmed. This form encourages users to identify their coping mechanisms, supportive people, and professional resources they can contact in a time of need.

Why is it important to create a Safety Plan?

Creating a Safety Plan is important because it prepares individuals for potential crisis situations. It provides a proactive approach to mental health care, allowing a person to recognize early warning signs of a crisis and implement coping strategies. By having a plan in place, individuals can feel more empowered and supported during tough times.

What should I include in the warning signs section?

In the warning signs section, you should list specific thoughts, feelings, behaviors, and situations that signal that you may be entering a crisis. This might include emotional changes, behavioral shifts, or particular circumstances that have triggered distress in the past. Personalization is key, as recognizing these signs can help you take early action.

How do I determine my internal coping strategies?

Identifying internal coping strategies involves reflecting on activities that provide a mental break or a sense of calm without needing to reach out to others. These could be relaxation techniques, physical activities, hobbies, or anything that helps to refocus your thoughts. It's essential to explore different strategies to find what works best for you.

What are effective distractions to include in my plan?

Effective distractions might include people or enjoyable places that help shift your focus away from distressing thoughts. Listing friends or family members along with their contact information can provide quick access to support. Additionally, including places where you feel safe or happy serves as a reminder of positive environments during a crisis.

Who should I consider asking for help?

When considering whom to ask for help, think of individuals you trust who can provide support, understanding, or a listening ear. This may include friends, family members, or mentors. Be sure to have their contact details readily available, as this makes reaching out easier when feeling overwhelmed.

What resources should I include for professional help?

For the professional help section, include names and contact information for any clinicians, therapists, or counselors you have worked with. It’s also beneficial to list local urgent care services or mental health hotlines, such as the Suicide Prevention Lifeline at 1-800-273-TALK (8255). These resources are vital for immediate assistance during crises.

How can I ensure my environment is safe?

Making your environment safe involves assessing your surroundings and removing any items that could pose a risk to your safety. Consider factors such as access to medications, sharp objects, or anything harmful. You can also identify safe spaces in your home where you feel comfortable and protected, further contributing to your sense of security.

What is the most important thing to me worth living for?

This section encourages reflection on personal values or relationships that provide motivation and purpose. Identifying what matters most can serve as a powerful reminder during difficult times, reinforcing the reasons for seeking help and maintaining personal safety.

Common mistakes

Completing the Safety Plan form is a crucial step towards ensuring personal well-being, yet many individuals make notable mistakes during this process. It’s essential to avoid common pitfalls to create a document that truly serves its purpose. Mistake number one often occurs in Step 1, where individuals fail to identify clear warning signs. These signs are important indicators that a crisis may be developing. Leaving this section blank or writing vague descriptions can hinder the effectiveness of the plan.

Another frequent error lies in Step 2, where internal coping strategies are listed. People sometimes overlook the importance of selecting specific strategies that work for them. Instead of general activities like "exercise," it’s more beneficial to identify specific exercises they enjoy. By detailing these coping strategies, individuals can foster a stronger sense of agency during a difficult time.

A third mistake appears in Step 3, where individuals list people and social settings that provide distraction. Often, names and phone numbers are incomplete or missing altogether. This oversight can make it difficult to reach out during a crisis. Ensuring that the contact details are accurate and up to date will enhance opportunities for support.

While filling out Step 4, which focuses on individuals whom one can ask for help, some may include acquaintances instead of trusted individuals. Relying on less established relationships for support can backfire when immediate help is needed. Selecting those who are reliable and understanding is vital in crafting an effective Safety Plan.

Moving on to Step 5, a critical mistake involves identifying professionals or agencies one can contact during a crisis. Often, individuals neglect to include all necessary information, such as the clinician's pager or emergency contact number. This may lead to confusion in urgent situations when quick access to help is necessary.

In Step 6, when making the environment safe, many people fail to consider practical measures they can take in their immediate surroundings. This section should prompt individuals to think critically about their environments. Vague entries such as "make things safe" don’t provide actionable steps toward creating a secure space.

Finally, the last part of the form, which encourages reflection on personal values, is frequently left incomplete. Failing to articulate what is worth living for can undermine the overall purpose of the Safety Plan. This reflective process is essential for mental health and self-awareness. Taking time to fill it out thoughtfully can contribute to a more effective plan.

Documents used along the form

The Safety Plan form is a valuable tool designed to identify warning signs of potential crises, coping strategies, and resources for support. It serves as a proactive measure to help individuals manage their mental health effectively. Several other forms and documents accompany this plan to further enhance its effectiveness and provide comprehensive support.

  • Emergency Contact Form: This document lists important contacts to reach out to in times of crisis. It typically includes names, relationship to the person, and phone numbers, ensuring that help is just a call away.
  • Daily Mood Log: This form helps individuals track their daily emotions and thoughts. By maintaining a record, patterns may become clear, which can inform future discussions with mental health professionals.
  • Wellness Recovery Action Plan (WRAP): This plan outlines strategies and personal goals for maintaining wellness. It includes a self-care toolkit and a plan for triggering situations, promoting a proactive approach to mental health management.
  • Behavioral Safety Assessment: This evaluation form identifies specific behaviors of concern and suggests interventions. It aids caregivers or clinicians in monitoring changes in behavior over time.
  • Medication Management Plan: This document outlines prescribed medications, dosages, and schedules. Ensuring clarity on medication usage can enhance adherence and reduce stress surrounding treatment.

Utilizing these forms alongside the Safety Plan can create a comprehensive approach to mental health care. Together, they empower individuals to take charge of their well-being and foster a supportive environment.

Similar forms

The Safety Plan form serves a vital role in supporting individuals during times of crisis. It helps them identify warning signs, coping strategies, and resources for assistance. Several other documents share similar elements and purposes. Below is a list detailing these documents and how they relate to the Safety Plan form.

  • Wellness Action Plan: This document focuses on identifying triggers and developing coping strategies. Like the Safety Plan, it offers a structured approach for individuals to manage their mental health proactively.
  • Emergency Contact List: This list provides essential contact information for friends, family, or professionals. Similar to the Safety Plan, it emphasizes the importance of support networks during emergencies.
  • Crisis Intervention Plan: This plan outlines specific steps to take when facing a crisis, similar to the Safety Plan's steps for recognizing warning signs and reaching out for help.
  • Behavioral Health Advance Directive: Like the Safety Plan, this document allows individuals to outline their preferences for treatment in a crisis. It specifies how they would like to be cared for when they can’t make decisions.
  • Self-Care Plan: This plan details personal self-care activities to enhance well-being. It mirrors the coping strategies section of the Safety Plan by emphasizing proactive steps individuals can take for their mental health.
  • Support Network Map: Similar to the Safety Plan's section on people to contact, this visual representation helps individuals identify supportive relationships and environments that foster well-being.
  • Relapse Prevention Plan: This document outlines triggers and coping mechanisms. Like the Safety Plan, it aids individuals in recognizing early warning signs to prevent escalation.
  • Personal Strengths Inventory: The inventory encourages individuals to identify their strengths, akin to the Safety Plan's focus on recognizing what is important in life as motivation during difficulties.
  • Medication Management Plan: This plan helps individuals manage their medications and understand how they relate to their mental health, similar to how the Safety Plan facilitates understanding and connecting with professionals or agencies.
  • Post-Crisis Recovery Plan: This document guides individuals in the aftermath of a crisis, providing a roadmap for recovery, akin to the Safety Plan's focus on reinforcing coping strategies and support systems.

Dos and Don'ts

When filling out the Safety Plan form, there are certain best practices to follow and some things to avoid. Here’s a helpful list:

  • Do read each step carefully before writing anything.
  • Don't rush through the form. Take your time to think about each section.
  • Do write down specific warning signs that are personal to you.
  • Don't use vague descriptions. Be as clear and detailed as possible.
  • Do include names and contact information for people you trust.
  • Don't leave any sections blank if you can avoid it. Every part is important.
  • Do consider all your coping strategies, even the small ones.
  • Don't hesitate to ask for help if you need assistance filling out the form.
  • Do keep your completed form in a safe and accessible place.

Misconceptions

Misconceptions surrounding the Safety Plan form can lead to misunderstandings about its purpose and effectiveness. Below are some common misconceptions clarified for better understanding:

  • The Safety Plan is only for individuals with severe mental health issues. Many believe that only those in crisis should use the Safety Plan. In reality, it serves as a preventative tool for anyone feeling overwhelmed or at risk of emotional distress.
  • The Safety Plan is the same as a treatment plan. While both documents are important, a Safety Plan focuses on immediate coping strategies and support systems during a crisis. A treatment plan is usually more comprehensive and longer-term, detailing therapeutic objectives and methods.
  • This is untrue. The form provides proactive strategies that empower individuals. By identifying warning signs early, one can take steps to avoid or mitigate a crisis.
  • Privacy is essential. Individuals can choose who to share their Safety Plan with. It is meant to serve the individual and should be kept confidential unless sharing enhances support.
  • Some believe that once it’s created, it stays the same. In fact, the Safety Plan should be regularly reviewed and updated as circumstances change and new strategies are discovered.
  • It's important to remember that the Safety Plan is a guideline. While it should be informative, it doesn't need to be flawless. Each person's plan can evolve based on their experiences.
  • Change is encouraged. As coping strategies develop or different situations arise, the Safety Plan can and should be adapted to better meet the individual's needs.
  • On the contrary, many may appreciate the effort. A Safety Plan can foster open communication and show loved ones how they can best support you during tough times.

Key takeaways

Here are key takeaways about using the Safety Plan form effectively:

  • Clearly identify warning signs. Recognizing thoughts, feelings, or situations that signal a crisis is crucial.
  • Develop internal coping strategies. Think about activities that can help divert your mind without needing to reach out to someone else.
  • List distraction sources. Include names of people and places that offer a supportive distraction when needed.
  • Identify trusted individuals. Know who you can turn to for help when you feel overwhelmed. Include their contact information for quick reference.
  • Compile a list of professional resources. Include names and contact numbers of clinicians and agencies that can provide immediate assistance.
  • Assess and create a safe environment. Determine specific actions to reduce potential risks at home.
  • Connect with the Suicide Prevention Lifeline. Remember, this resource is available 24/7 for immediate support.

Completing this form is a proactive step towards ensuring your safety and well-being. Be thorough and honest, as it will enhance the effectiveness of your safety plan.