The best time to do good crisis work is when you (or your client, child, partner, friend, etc) aren’t currently in crisis. Take some time out during the good times to intentionally plan, identify support networks, brainstorm self-care, and build skills so that when crisis comes, you don’t have to figure it out from scratch.
A crisis plan (sometimes called a safety plan) can sound intimidating, but at its core, it’s a resource: a list of what to do, safe places to go, ways to safely distract, and people to reach out to when Very Bad Days™ come along.
Crisis planning with a friend or family member doesn’t have to be an awkward, one-time conversation. Crisis planning might bring to mind forms with questions about risk factors, resources, and emergency contacts, but I think crisis planning is a tool all of us can use to have conversations about how to care better for ourselves and others.
Crisis Planning Conversations
Many of us have safety planned without even knowing it. These conversations might have sounded like “Last time you were really down, I was scared because I didn’t know how to help you. Can you tell me what could help a little when things feel that bad?” or “I like that you know you can reach out to me when you are feeling bad; do you know who you’d call if things were really bad and I wasn’t available?”
A good, usable safety plan is more than a printout of resources tucked in a drawer alongside medical receipts. A usable safety plan is a plan that keeps reminders of the care available, in sight – preferably in a way that’s not overly-clinical.
Reflecting on self-care and having conversations about what good support looks like during non-crisis times help set up care, resources, and expectations for how future crises can be handled.
Everyone can benefit from having a personal crisis plan – a list of what to do, safe places to go, ways to safely distract, and people to reach out to when our own crises come.
Safety planning (sometimes called making a crisis plan) might be a well-worn practice for you or it might be a completely new concept. Even if you have a long history with professional mental healthcare (as a recipient, provider, or both) the approach to safety planning in this article might be a very different approach from how you’ve framed the experience of safety planning in the past. As part of the movement to reduce stigma and increase comfort in conversations about mental health, the printable safety plan and information below embrace safety planning and conversations about safety planning as a new normal, rather than fence it off as a resource for people who are “ill.”
Creating this Safety Plan Printable
I was inspired to create this safety plan after completing a rotation as an intern at a mental health clinic in South Seattle. The prevalence of trauma, income inequality, and marginalization among many of the clients that the clinic served meant that, even as an intern, I found myself working regularly with people experiencing suicidal thoughts. As I followed the protocol of my organization, which involved turning away from my client to fill-in text box after text box on a screen that would spit out a formulaic safety plan at the end of a session, I wondered if there was a better way to use the concept of safety planning to have empowering, connecting conversations about how to keep ourselves safe when we’re feeling our worst.
Sometimes, it can feel like behavior contracts are little more than liability documents, but when safety plans are created collaboratively and put into practice by an individual and the people who care about them, they can be a lifeline to help someone get by until brighter days.
A study in The Netherlands done in 2012 by Ruchlewska, et al. (2014) showed just this. Researchers examined how the quality of crisis plans developed by a patient and their clinician compared to plans developed by a patient and the patient’s partner, family member, friend, or other personally-related advocate. In the trial, the patients were randomly placed into either 1. a group where they worked with a clinician to develop a Clinical Crisis Plan (CCP), or 2. a group where they worked with their advocate to create a Patient Advocate Crisis Plan (PACP). They found that the quality of the plan was much higher in the groups where people created a crisis plan with their advocate, supporting the idea that relationships matter when it comes to creating a crisis plan.
Research is clear that relationships are a major protective factor when it comes to helping people survive suicidal thoughts. Some researchers argue that behavior contracts, by nature, may risk dividing struggling people from relationships that could give them care (See this 2005 journal article by Dr. M.D. Rudd). Safety planning works a little differently: safety plans are created collaboratively. Rather than being primarily focused on creating a binary with no grey area, safety plans focus on sculpting a plan that helps ensure that potential escalating intensity of thoughts get increasingly appropriate care.
Safety Plans: Not Just for Professional Crisis Care
If you’ve experienced safety planning (sometimes called crisis planning) before, it was probably in a healthcare setting. Sometimes, safety planning in that setting can be pretty impersonal. It might look like a clinical form or a series of questions and answers that a healthcare provider types into in an electronic health record. Too often, the process can be pretty cold.
These types of safety plans have their place, but limiting safety plans to these formats and settings can actually limit access to parts of safety planning that could be beneficial for folks who aren’t – or aren’t yet – in crisis. A good crisis plan can actually help us get the care we need as to avoid getting so low that we need emergency psychological care.
I can’t take credit for this idea of making safety plans more normal, universal, and accessible. I was in my last year of graduate school when one of my professors mentioned, as a tip for clinician self-care, that having a safety plan on hand as a clinician could be a way to make sure resources were available when we, in the course of our work, would have very bad days. This prompted the printable resource and article you’ve found today.
Why All of Us Need a Safety Plan:
Most of us will have an experience at some point in our life of receiving devastating news: the death of a loved one, loss of a job, or a deep relational betrayal. Even if we have generally good mental health and strong support systems, getting through the first hours, days, or weeks after a devastating loss can strain all of our support systems.
Crisis plans can help us know what to do and who to call when we aren’t okay – and crisis plans support those supporting us by taking some of the guesswork out of know exactly how they can help.
Having a safety plan or crisis plan filled out and posted (or readily available) in our home can help us take better care of ourselves, and it prevents us from falling into the trap of having to, during our own crisis, soothe a helpless and confused caregiver.
Download This Printable Safety Plan
Because this resource feels extra important, a free, printer-friendly version of this worksheet is available to anyone at no charge for personal use.
Who Safety Planning Can Help
In the past, safety plans were limited to patients in crisis and psychiatrists or mental health care providers, but I created my safety plan printable PDF because I think everyone should have access to a safety plan, and that a safety plan worksheet shouldn’t be scary, clinical, stigmatized, or limited just to people who have access to professional care.
Safety Plans Can Be Helpful For:
- Your own use, creating a plan for good self-care while you’re in a good frame of mind.
- Making with a friend or group of friends to strengthen your ability to support each other through crisis.
- Partners who want to have intentional conversations (and written reminders) about what care for each other looks like on Very Bad Days.
- Parents supporting kids who struggle with self harm.
- Teachers who want to help students learn to care well for themselves and to ask for care (which is connected to the Positive Childhood Experiences researchers have correlated to childhood resilience and thriving).
- Alongside the traditional use of safety plans in mental health and healthcare settings.
Safety Plans Can Help All of Us Take Better Care of Each Other
Thinking clearly is hard in a crisis. Maybe you’ve experienced this first hand, such as an inability to make decisions when a loved one has just been in a serious accident or having difficulty finding your way back to your own home or apartment after a painful romantic breakup. When circumstances push us beyond our window of tolerance, we neurologically “flip our lid” and our brains become less effective at good decision making. This gets a lot of attention in research and even media when it comes to disaster response or physical illness, but experiencing a mental health crisis also – and especially – makes it hard to make decisions that help us get needs met safely.
When we aren’t doing well, our brains aren’t great at:
- thinking up ways to care well for ourselves,
- figuring out how to access those things,
- and then taking the action to do them.
Having a completed safety plan or crisis plan on hand can help.Whether we experience severe mental health issues, excellent mental health, or would locate ourselves somewhere in between, all of us can use a little help caring better for ourselves on bad days.
How Parents Can Use Safety Planning with Struggling Kids and Teens
For kids, one of the hardest parts about struggling with a mental health disorder or the effects of trauma is that it can interrupt the typical, important process of growing up and having more and more control over their lives and privacy.
Previous decades of parent coaching have supported behavior contracts, but most teens respond better to safety planning. Why? Behavior contracts can feel like something forced on them: an “or else” ultimatum that threatens the loss of stabilizing relationships if they can’t hold up their end.
Safety plans (aka crisis plans) are collaborative: they invite teens and parents to set a common goal and brainstorm what it would take to get there. Crisis plans give teens a voice and a sense of agency about their care: helping them identify the care that they would like or experiences they think they could benefit from when they are not doing well.
Safety Planning for Teachers with Students At-Risk for High-Risk Behaviors
Some approaches to dealing with “at-risk” teens take an us-versus-them approach, highlighting behavior contracting and ultimatums, which often undermine the relationships that researchers have clearly show are powerfully stabilizing for people who are in crisis.
In contrast, a trauma-informed approach to working with students who are struggling with behaviors that are harmful to themselves might view the behavior as kids struggling to find a way to cope. Joining with these kids in finding alternative ways to cope, that – with practice – can work even better than their current coping, with less harm to themselves, can be a more effective and collaborative plan. This type of planning can build relationships in the planning process and in how, once created, a teacher, parent, or caregiver can have insight into the best ways to show that particular student care.
Part of safely planning is identifying resources – including people they can call, text, or reach out to. When kids know that they have people to turn to and calming behaviors that they’ve helped brainstorm, kids are empowered to not just make safer choices, but develop patterns of support-seeking and self-care. Providing that can support mental health throughout a lifetime.
Safety Planning as A Classroom Activity for All Students
The U.S. mental health care system has a flaw in that, generally, the only people who get access to mental health resources are either very sick or are privileged enough to have access to supportive care.
Using this free printable PDF template as a safety planning classroom activity for all students can help close that gap. I believe everyone should know how to create a safety plan – not just for themselves but for the people they care about.
Creating a safety plan openly in a classroom may help reduce stigma around seeking mental health care. Safety planning together can help kids learn how to better support themselves and their peers – a vital social-emotional learning skill that is appropriate for middle school and high school students.
Safety Planning Between Best Friends and Partners
It’s no secret that a crisis or mental health diagnosis can strain both romantic and non-romantic relationships. One of the reasons these relationships can struggle is the pressure put on one partner (or that they put on themselves) to either always respond well or to be the sole source of care for the person who is struggling. Planning care in advance can establish outside resources and boundaries that may help reduce this strain.
In friendships and romantic relationships, talking about our safety plan with each other (a two-way street, even if it’s one partner that primarily struggles with dark thoughts) can be a tool to grow relationships.
When we create and share safety plans with friends or partners, we give our relationships two major boosts:
1. By outlining various sources of support, while not actively in crisis, we may experience a mood boost of knowing there are people we can turn to for support. This also lets our partner know that they won’t be alone in helping us manage.
2. Specific, easy to understand information about what helps us when we’re in crisis can take pressure off our partner. By making a list, we’re making it more likely that we get support that is actually helpful, and we relieve our partner from having to frantically guess at what we might need.
Mental Health Professionals Using this Non-Clinical Safety Plan
Mental health professionals know that the resources and tools we share with clients are only effective when our clients read them, use them, and integrate them into their daily life. When in-session safety planning culminates in a black and white computer printout with instructions, it’s reasonable to assume that most clients are not using, sharing, and adopting this document into the practices they use to care for themselves.
I created this template because I think we can offer the same valuable information in a format that’s less pathologizing. My safety plan has a softer look and feel, inviting collaborative creativity around accessing care. Its appearance makes it look less like a medical document and more like something that can be posted, shared, and talked about openly in families and relationships (sparking conversations that lead to awareness, which then lead to better care, which can result in better outcomes for our clients).
Crisis Plan Notebook with Tearaway Worksheets
Who should make a crisis plan?
Everyone. Even if you don’t struggle with dark thoughts or urges to do things that might harm yourself, what are the chances that you’ll have a Very Bad Day™ in the next year? In the next three years? Most of us intuitively know that when we are feeling our worst, we are not in the best frame of mind to figure out how to care for ourselves or to execute that plan.
For many people, asking for help when we’re very upset can feel overwhelming. And figuring out what activities might be soothing can feel like an insurmountable task. By creating a safety plan in advance, and tucking it away in a bullet journal, health binder, or even posting it in a shared space (like a refrigerator or family bulletin board) can make sure that a list of self-care ideas and resources will be around – both for ourselves and for the people who care about us – when we need it.
Where to Keep Your Safety Plan
After you have printed and filled out the safety plan you might think, “What next?”.
Although the process of filling out this crisis plan printable can be helpful in itself, I advise my clients to keep their safety plan close at hand.
Places to post your safety plan:
Copy it into your journal- Each time you start a new journal, create a new safety plan: a template page filled with resources to lean on, things to do, people to contact, and ways to care for yourself when you are really struggling. Keeping it handy in your journal also makes it easy to flip over and add new ideas when you think them.
Posting in a common place have your home – I believe safety plans work best when they are shared, collaborative documents, not just private resources kept for ourselves. When safety plans are shared, discussed, and posted in a home, it gives a chance for the people who care about us to become really familiar with the things that we have identified as being helpful when we are in crisis or feeling really low. Although we’d all like to believe that the people who care about us will always show up for us in the way that we need, the truth is that caring for each other is pretty hard, and having some hints can go a long way towards helping people care well for us.
When there are children in the home – You might be concerned about having your safety plan in a common visible location, especially if you have children in your home. Although age-appropriate conversations about a parent’s mental health diagnosis can help kids grow empathy and make meaning, children don’t need to know the specificity of their parents mental health struggles. But that doesn’t mean your safety plan belongs in a no-kid zone. On the contrary, making it a family activity to make safety plans can help model good self-care and can help kids develop skills they need to care better for themselves and others as they grow up.
Safety Planning and Suicide Prevention
In the past, safety planning has been reserved for people who are experiencing suicidal thoughts. Limiting safety planning to folks with extreme symptoms has made safety planning gain a reputation for being a rather intense and serious thing. While responding to suicidal thoughts and behaviors is, absolutely, a very serious thing indeed, the document itself doesn’t have to be cold, clinical, and alienating. Actually, the uses for a safety plan go far beyond just a response to suicidal thoughts and behaviors. Safety plans can be appropriate to have on hand for:
- responding to urges for self-harm
- responding to urges for substance use
- responding to personal relationship crisis
- responding to very low mood due to mental health symptoms
- providing emotional support during a physical health crisis
Safety Planning Foundations: Anti-Suicide Behavior Contracts
Healthcare providers have always struggled with how to respond to an individual expressing suicidal intent. An overly-reactive response, such as forcing someone with passive suicidal thoughts (example, “wanting to die,” but having no intent, plan, or means to bring that about) to go to the ER, can break trust and prevent the person from honestly engaging with providers in the future. A too-casual response, such as not taking a statement of active intent seriously enough to warrant extra supportive care can risk the life of the person expressing the thoughts, while also exposing the practitioner to liability issues.
In the early 1970’s, three psychiatrists published a paper proposing “no-suicide contracts” with at-risk patients. In the decades that followed, the practice was widely adopted (despite no significant research showing that these contracts were effective). The idea was that if a person could sign a contract promising that they wouldn’t hurt themselves – or would contact emergency services before doing so – people would be less likely to act on their thoughts.
Although some parenting manuals and even some mental health clinicians still use behavior contracts or “no-suicide contracts” in response to individuals expressing a desire, intent, and/or plan to harm themselves, new research suggests an alternative might be more effective: crisis plans and commitments to treatment. In a 2005 paper, M. David Rudd and fellow researchers describe the commitment to treatment statement as “making a commitment to living by engaging in treatment and accessing emergency services if needed.” You can read more about the commitment to treatment via the link above or through reading about the pioneering work of Marsha M. Linehan, who developed Dialectical Behavioral Therapy and, with it, these commitment to treatment statements.
Commitment to treatment statements are something that belong, exclusively, in a treatment relationship (like therapist or psychiatrist with a client) but I believe the partner document, the Mental Health Crisis Plan, is a tool that can be used for self-care, relationship building, and for supporting mental health for those of us who know what it is like to have a Very Bad Day™ now and then.
In the 2005 Baylor University journal article referenced above, the authors propose that a formulaic crisis plan could look like this: