Safety Plan Template

Safety Plan Template

The Safety Plan form is a structured tool designed to help individuals identify warning signs of a potential crisis and outline coping strategies. It encourages proactive thinking by detailing internal strategies, support networks, and professional resources that can be accessed during difficult times. Taking the time to fill out this form can empower you to navigate challenges effectively—click the button below to get started.

Table of Contents

Creating a Safety Plan is an essential step for anyone who may face a crisis, providing a structured way to navigate difficult moments. This form is designed to help individuals identify their warning signs, such as specific thoughts, moods, or behaviors that signal a potential crisis. By recognizing these early indicators, individuals can take proactive measures to manage their emotions. The plan also encourages the development of internal coping strategies, which are personal techniques that can help divert attention from distressing thoughts without needing to reach out to others. Furthermore, it highlights the importance of social support by listing people and places that can provide distraction or comfort during tough times. Identifying trusted individuals who can offer help is another critical aspect of the plan, ensuring that support is readily available when needed. Additionally, the form includes contact information for professionals or agencies that can be reached during a crisis, emphasizing the importance of having resources at hand. Lastly, it prompts individuals to consider how to make their environment safer, reinforcing the idea that safety is a multi-faceted approach. Ultimately, the Safety Plan culminates in a personal reflection on what matters most, reminding individuals of their reasons for living and the hope that exists even in challenging times.

Safety Plan Sample

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:

________________________________________________________________

Document Attributes

Fact Name Description
Purpose The Safety Plan form is designed to help individuals identify warning signs of a crisis and outline steps to take to ensure their safety.
Structure The form consists of multiple steps, guiding users through identifying coping strategies, support systems, and emergency contacts.
Confidentiality All information provided in the Safety Plan form is confidential and should only be shared with trusted individuals or professionals.
Governing Laws In the state of California, the Safety Plan form is guided by the California Welfare and Institutions Code, Section 5150, which addresses mental health crisis interventions.

Safety Plan: Usage Instruction

Completing the Safety Plan form is an important step in preparing for potential crises. It allows individuals to identify warning signs, coping strategies, and support systems. Following the steps outlined below will help ensure that the form is filled out accurately and thoroughly.

  1. Begin with Step 1: Identify warning signs. Write down three specific thoughts, images, moods, situations, or behaviors that indicate a crisis may be developing.
  2. Proceed to Step 2: List internal coping strategies. Think of three activities you can do alone to distract yourself from problems, such as relaxation techniques or physical activities.
  3. Move to Step 3: Identify people and social settings that provide distraction. List three names along with their phone numbers, and include two places where you feel comfortable.
  4. Continue to Step 4: Write down people you can ask for help. Include three names and their phone numbers for individuals you trust and can reach out to during a crisis.
  5. Next, in Step 5: Identify professionals or agencies to contact during a crisis. List two clinicians with their names and phone numbers, along with their emergency contact information. Also, include local urgent care services and the Suicide Prevention Lifeline number (1-800-273-TALK (8255)).
  6. Finally, complete Step 6: Make your environment safe. Write down two specific actions you can take to create a safer environment for yourself.
  7. Conclude by identifying what is most important to you and worth living for. Write this down in the space provided at the end of the form.

Frequently Asked Questions

  1. What is a Safety Plan form?

    The Safety Plan form is a tool designed to help individuals identify warning signs that a crisis may be developing. It encourages people to think about coping strategies, supportive contacts, and resources available during difficult times. The goal is to create a personalized plan that can be referenced in moments of need.

  2. How do I fill out the Safety Plan form?

    To fill out the Safety Plan form, start by identifying your personal warning signs. These may include specific thoughts, moods, or behaviors that indicate you might be entering a crisis. Next, list internal coping strategies that can help distract you from your problems without needing to contact someone else. After that, think of people and places that provide you with distraction and support. Finally, include contacts for professionals or agencies you can reach out to during a crisis.

  3. Who should use the Safety Plan form?

    The Safety Plan form is suitable for anyone who may experience a mental health crisis. This includes individuals who have a history of mental health challenges or those who simply want to be prepared for difficult times. It can be beneficial for friends and family members who want to support someone in need as well.

  4. What should I do if I don't know my warning signs?

    If you are unsure about your warning signs, consider reflecting on past experiences when you felt overwhelmed or in crisis. Think about what thoughts, feelings, or situations contributed to those times. You may also find it helpful to talk to a trusted friend or mental health professional who can assist you in identifying these signs.

  5. Can I change my Safety Plan over time?

    Yes, your Safety Plan is a living document. As you grow and change, so may your coping strategies and support systems. It’s important to review and update your plan regularly to ensure it remains relevant to your current needs.

  6. What if I need help but I can't reach my contacts?

    If you cannot reach your contacts, it's important to have alternative resources available. This may include local urgent care services or hotlines, such as the Suicide Prevention Lifeline at 1-800-273-TALK (8255). These resources can provide immediate support and guidance during a crisis.

  7. How can I make my environment safer?

    Making your environment safer involves identifying potential hazards or triggers that could escalate a crisis. Consider removing or securing items that could be harmful. You can also create a calming space by adding comforting items or reducing noise and distractions. Think about what changes would help you feel more secure.

Common mistakes

Filling out the Safety Plan form can be a crucial step in ensuring personal safety during a crisis. However, there are common mistakes that people often make, which can undermine the effectiveness of the plan. Understanding these pitfalls can help individuals create a more useful and comprehensive Safety Plan.

One frequent mistake is leaving sections blank. Each part of the form is designed to capture important information. When individuals skip sections, they miss the opportunity to identify key warning signs or coping strategies. It’s essential to take the time to think through each step thoroughly.

Another common error is providing vague or generic responses. For example, writing “friends” instead of naming specific people can lead to confusion when the plan is needed. Being specific helps ensure that the individual knows exactly who to reach out to in a moment of need.

People also often forget to include contact information for the individuals listed in the plan. Without phone numbers, reaching out for help becomes more difficult. Including this information makes it easier to connect with support when it is most needed.

Failing to update the Safety Plan regularly is another mistake. Life changes, and so do relationships and coping strategies. It’s important to revisit the plan periodically to ensure that it reflects the current situation and available support.

Some individuals may overlook the importance of including professionals or agencies in their plan. While personal support is vital, having access to trained professionals can provide critical assistance during a crisis. Listing specific clinicians and their contact information can make a significant difference.

Another issue arises when people do not take the time to think through their internal coping strategies. Relying solely on external support can leave individuals unprepared. Identifying personal strategies, such as deep breathing or going for a walk, is essential for self-soothing.

Additionally, many people fail to consider their environment when making their Safety Plan. It’s crucial to identify ways to make the environment safer. This could include removing harmful objects or creating a designated safe space. Addressing environmental factors can greatly reduce risk.

Sometimes, individuals may not fully engage with the process. Filling out the form quickly or without reflection can lead to incomplete or ineffective plans. Taking the time to thoughtfully consider each question can enhance the plan’s utility.

Lastly, neglecting to identify the one thing that is most important to them can be a significant oversight. This personal insight can serve as a powerful motivator during difficult times. Reflecting on what truly matters can provide strength and clarity.

By avoiding these common mistakes, individuals can create a Safety Plan that is thorough, personalized, and effective. This proactive approach can make a significant difference in times of crisis.

Documents used along the form

The Safety Plan form is a crucial document designed to help individuals identify warning signs and develop coping strategies during a crisis. Alongside this form, several other documents can enhance the effectiveness of a safety plan. Below is a list of these documents, each serving a specific purpose in crisis management and support.

  • Emergency Contact List: A document that contains names and phone numbers of individuals who can be contacted in case of an emergency. This list ensures that support is readily available when needed.
  • Crisis Intervention Plan: This plan outlines specific steps to take during a crisis, detailing actions to be taken by both the individual and their support network to manage the situation effectively.
  • Mental Health Treatment Plan: A comprehensive outline of the individual’s mental health goals, treatment methods, and progress. This plan helps in tracking the effectiveness of therapy and medication.
  • Support Group Information: A document that lists local support groups, including meeting times and contact information. Participation in these groups can provide additional emotional support.
  • Resource Guide: A compilation of local mental health resources, including hotlines, clinics, and online support services. This guide serves as a quick reference during times of need.
  • Medication Management Plan: A detailed list of prescribed medications, dosages, and schedules. This document assists individuals in managing their medications effectively.
  • Behavioral Contract: An agreement between the individual and their support system that outlines expectations and commitments regarding behavior during crises. This can foster accountability.
  • Safety Assessment Checklist: A tool used to evaluate the safety of the individual’s environment. This checklist helps identify potential hazards and areas for improvement.
  • Wellness Recovery Action Plan (WRAP): A personalized plan that outlines strategies for maintaining wellness and managing symptoms. WRAP emphasizes proactive measures for mental health stability.

Utilizing these documents in conjunction with the Safety Plan can provide a comprehensive approach to crisis management. Each document serves to empower individuals, offering them tools and resources to navigate challenging situations effectively.

Similar forms

The Safety Plan form serves as a crucial tool for individuals facing crises, particularly in mental health contexts. Its structured approach helps users identify warning signs, coping strategies, and support networks. Several other documents share similarities with the Safety Plan form, each designed to promote well-being and provide guidance in times of distress. Below are five such documents:

  • Emergency Contact List: This document outlines key individuals to contact during a crisis. Like the Safety Plan, it emphasizes the importance of having immediate support available, ensuring that individuals know whom to reach out to when they need help.
  • Personal Crisis Plan: Similar in purpose, this plan details specific actions to take when a crisis arises. It includes coping strategies and resources, much like the Safety Plan, but often focuses more on immediate steps to stabilize the situation.
  • Wellness Recovery Action Plan (WRAP): The WRAP document encourages individuals to outline their personal wellness strategies. It parallels the Safety Plan by identifying triggers and coping mechanisms, fostering a proactive approach to mental health management.
  • Behavioral Health Advance Directive: This document allows individuals to specify their preferences for treatment in advance. It shares the Safety Plan's focus on preparation and self-advocacy, ensuring that one’s wishes are respected during times of crisis.
  • Support Network Map: This visual representation helps individuals identify and connect with their support systems. Like the Safety Plan, it emphasizes the importance of community and relationships in navigating difficult times, enhancing the sense of connection and safety.

Dos and Don'ts

When filling out the Safety Plan form, it’s crucial to approach the task with care. Here are five things to do and five things to avoid:

  • Do: Take your time to reflect on your feelings and thoughts.
  • Do: Be honest about your warning signs and coping strategies.
  • Do: List people you trust and can reach out to in a crisis.
  • Do: Include contact information for professionals who can help.
  • Do: Make your environment as safe as possible.
  • Don't: Rush through the form; this is important for your safety.
  • Don't: Leave sections blank; every part matters.
  • Don't: List people who may not be available in a crisis.
  • Don't: Ignore the need for professional help; it’s vital.
  • Don't: Underestimate the importance of your safety plan.

Misconceptions

Misconceptions about the Safety Plan form can lead to misunderstandings regarding its purpose and effectiveness. Here are four common misconceptions:

  • The Safety Plan is only for individuals in immediate crisis. Many people believe that this form is only necessary when someone is experiencing a crisis. In reality, it serves as a proactive tool to help individuals identify warning signs and coping strategies before a crisis occurs.
  • Completing the Safety Plan is a one-time task. Some individuals think that once the Safety Plan is filled out, it does not need to be revisited. However, it is important to regularly update the plan to reflect changes in personal circumstances, support systems, and coping strategies.
  • The Safety Plan is only useful for mental health professionals. There is a misconception that only therapists or counselors can benefit from the Safety Plan. In truth, it is designed for anyone who may face mental health challenges, providing a personal roadmap for managing difficult situations.
  • Using the Safety Plan indicates weakness. Some people feel that needing a Safety Plan is a sign of weakness or inability to cope. This is a misunderstanding; creating and using a Safety Plan demonstrates strength and a commitment to self-care and safety.

Key takeaways

When filling out and using the Safety Plan form, consider the following key takeaways:

  • Identify Warning Signs: Clearly outline the thoughts, images, moods, situations, or behaviors that signal a potential crisis. This awareness can help in early intervention.
  • Develop Coping Strategies: List internal coping strategies that you can use to manage your feelings without relying on others. These might include relaxation techniques or engaging in physical activities.
  • Distraction Sources: Identify people and social settings that can provide distraction. Knowing who or where to turn to can be invaluable during tough times.
  • Support Network: Document individuals whom you can ask for help. Having their contact information readily available can facilitate reaching out when needed.
  • Professional Contacts: Include names and contact information for professionals or agencies that can assist during a crisis. This may include clinicians or local urgent care services.
  • Emergency Resources: Remember to include critical resources such as the Suicide Prevention Lifeline. Having this information on hand can be lifesaving.
  • Environment Safety: Make a list of steps to create a safer environment. This proactive approach can help reduce risks during a crisis.
  • Personal Importance: Reflect on what is most important to you and worth living for. This can serve as a powerful motivator during difficult times.
  • Regular Review: Review and update your Safety Plan regularly. Situations and relationships can change, so keeping the plan current is essential.
  • Share the Plan: Consider sharing your Safety Plan with trusted friends or family members. This can enhance your support system and ensure others are aware of your needs.