Creating a Safety Plan for Times of Suicidal Crisis: Gina Capobianco

I have lived with depression for decades. Suicidal thoughts have accompanied the depression most of my life. While facing a difficult time a couple years ago, the psychiatric nurse practitioner (PMHNP) I was seeing brought up the idea of a safety plan. I had never heard of this type of plan but was willing to try it.

Like many people with suicidal thoughts, when the depression is not bearing down on me, I don’t want to die. It is just when the thoughts get going and the depression turns everything dark that dying seems like my only escape. I needed a plan for dealing with the suicidal thoughts.

My PMHNP explained what a safety plan is and how it works. A safety plan is an intervention that helps a person survive a suicidal crisis by providing them with a set of steps, which they have helped create, to follow during the crisis that will decrease the chances they will engage in the suicidal behavior.  My PMHNP described the plan as my action steps for when I feel that the suicidal thoughts are becoming overwhelming. Together we laid out the plan. It has been necessary for me to use the safety plan a couple of times, and it has been effective each time.

Let’s go through the steps my PMHNP and I used when creating my safety plan.

Purpose of a Safety Plan

First, we identified the purpose of the safety plan. The main purpose of a safety plan is to prevent suicide. The plan provides a way to cope with the crisis of suicidal thoughts using a guide to get help in a way that is comfortable and not overwhelming. The plan allows an individual to reach out to family or friends, who will serve as a support person, as well as provides connections to mental health professionals. The plan lets the support person know how to help you in a crisis.  

It is helpful if the plan is written in the individual’s own words. This ensures the person understands the steps and can enact the plan in a crisis. The words should be simple and easy to follow. The person should keep it in a place that is easily accessible. The people involved in enacting the safety plan should also have a copy. 

Components of a Safety Plan

Identifies When It Will Be Used

The safety plan should spell out when it will be enacted. I discussed this with my PMHNP.  Discussing this with your mental health professional can ensure that you are aware of when to utilize it.  When the plan is used differs for each individual. So, the plan should include when to enact it in language that can be comprehended in a crisis. My plan is enacted when I recognize my thoughts becoming overwhelming and I start thinking about acting on my suicidal thoughts.

Provides Coping Strategies 

Coping strategies are going to vary from person to person. These may include breathing exercises, meditation practice, distractions, or anything that helps the person cope with suicidal thoughts. The plan should include how to know if the strategies are working. If the coping strategies are not working or the person recognizes they are beyond the use of coping strategies, it is time to reach out for support. My coping strategies include journaling and listening to music. When these are not working it means it is time to reach out for help.

Identifies Individual(s) Who Will Support You

When you are in a suicidal crisis, you need to be able to reach out to others for support. When developing your plan, identify a friend or family member who you can reach out to. The individuals on the safety plan need to be willingly involved and consent to being a part of the plan. It is not enough to just be willing to be part of the plan. The individuals need to be able to be an active part of the plan. You need to be able to reach them in a crisis. Share your plan with them and make sure they understand the plan. Your plan should also include who your mental health professionals are and their contact information. In addition, the 988 number, the Suicide and Crisis Lifeline, should be a part of your plan. 

Provides the Questions Your Support Person Will Ask You

Your support person refers to the safety plan when you contact them. My support person has the safety plan on her phone, so she does not have to look for it.  The first question the support person should ask is if you are safe. If you are not safe, they may need to call for emergency support. My plan is set up so that I am asked if I need comfort or support once it is established that I am safe. This gives the person an idea of how severe my suicidal thoughts are at that moment. 

If I respond that I need comfort, my support person will ask me if I need to be listened to or distracted? She then responds accordingly. If I respond that I need support, she will ask me if I need her to help connect me to my mental health professional or if I need her to do it for me.  If I respond that I need help, she reminds me of who to call and may need to provide the number. As I make the call, she stays in contact with me through texting. 

Provides Steps to Be Taken to Get Professional Help

If I need her to make the contact for me, she asks me for my location and what I am thinking. She will relay this information to my mental health professional when she contacts them. 

The 988 Hotline can be called if it seems like I need professional support, and it is at a time when my mental health professionals would not be able to be reached. Some people may not have mental health professionals that can be contacted. In this situation, if the person is not in imminent danger 988 can be contacted. The person can make the call themselves or the support person can call for them. 

If I say or indicate that I am not safe, my support person may need to call 911. While waiting for emergency help to arrive, my support person needs to stay in contact with me. It is important not to leave a person who is in crisis alone. The responders on the 988 hotline and at 911 have the ability to transfer a caller to the other line depending on the need and the level of safety concern.

Plan for Follow-Up

Once intervention has taken place the support person should follow-up with the individual. When my support person does this, it lets me know that I am not alone.  The support person should check in to see how the individual is doing and to ensure that the care provided was helpful. My support person calls me to just talk.

Conclusion

Having a safety plan has made a difference in how I cope with suicidal thoughts. It ensures that I am safe even in my darkest moments. Being a part of a safety plan requires a commitment on the part of the support person. I am grateful that I have a friend who is willing to fill this role. If you deal with suicidal thoughts, talk to your mental health professional about creating a safety plan. Your plan may look different than mine. That is okay. We each have our own needs and cope with our suicidal thoughts in our individual ways. Despite the differences, a safety plan can prevent a suicide attempt and save a life.