As a clinical social worker, I often worry about my clients. Besides working with a higher-risk population that have had hospitalizions in the past year, I’m a human being and I care about my clients. I especially have a soft spot for people suffering with hopelessness, feelings of worthlessness, and depression. It’s a hell I’m familiar with.
When a client has self-harming or suicidal behavior (thoughts, plan, gesture, or attempt), no matter how meticulously I dot my i’s and cross my t’s to keep them safe, I worry. I worry even though I’m licensed now, and I’m trained in crisis management, suicide prevention, and safety planning. Even though I’ve done a hundred safety plans. Even when we write a comprehensive safety plan that identifies signs of a crisis, supportive people, and all the behaviors and coping skills that can redirect a client to consider alternative behaviors. I worry even though, ultimately, it is their decision to stay safe or not.
Plans are better than contracts. There is research that suggests that safety contracts are ineffective to reducing risk. When you turn a therapeutic tool into a legal document, I’m not quite sure how you would enforce it, God forbid anything terrible were to happen.
Safety planning helps me to feel better about giving clients identifiable tools to make healthy choices. My worry is not a buzzing static anymore like it was when I was green… it’s more like hoping that clients do what we want them to… to stay safe. I do the best that I can and hope that the client makes the best decisions for themselves.
The Old One
A safety plan that I often do with clients is one which identifies the signs of a crisis, internal coping mechanisms, external distractions, identifying whom the person can call for help, and phone numbers two important places (i.e. crisis line).
It’s comprehensive, informative, but its boring. Not that it should be fun, but still… it just looks like a bland medical document. I like using handouts with my clients… things like my self-care plan or self-assessment… something tangible that they can take home, reflect on, even hang up. So I made a new one.
On social media, I posted a draft of this safety plan, which a lot of people requested that I put up on my site – but of this post was birthed. That being said:
This is not to be construed as clinical, legal, or ethical advice. This is tool that I made for my own personal use to promote safety practices with my clients. It is unethical to use any kind of intervention, e.g. Safety Planning, without being trained in how to use it or understanding the risks and benefits. It is based on the work by Barbara Stanley and Gregory K. Brown (2008). This will not guarantee the safety of your clients. You use this tool at your own risk by downloading and implementing it in your own practice.
Also, I give credit where credit was due, but did not give myself credit because I didn’t think it was appropriate for me to put my logo/name on this serious document
The New One
I’ve reimagined the traditional safety plan to be something that a trained professional can work on collaterally with a client, and hopefully their support system, while creating something that they can hang up somewhere prominently, whether it is a refrigerator, dorm furniture, or bedroom mirror. As you can see, the formatting looks very familiar. It’s bold but hopefully, not boring.
I put the most important parts in the middle. También, hice una versión en Español (Mexicano) para los que hacen intervención con gente que solamente hablan Español.
How It Works
This is how I would talk to someone I’m making this safety plan with.
First thing’s first: Name and date. Easy right?
Step 1: Warning Signs of a Crisis
What are thoughts, images, moods, situations, behaviors, etc. that might show that a crisis might be developing or that you’re not doing so well? Let’s try to think of 3. We can only think of 2? That’s fine. Let’s get through the rest and come back to it later.
Step 2: Activities I Can Do by Myself to Try to Take My Mind off of Things
What are 3 activities you can do by yourself to try to take their mind off of things [i.e. distract themselves] without talking to someone else? Again, if you can only think of at least 2, we’ll come back later and try to think of a third.
Some ideas: taking a walk, taking a shower, listening to music, writing my feelings out, etc.
Step 3: Taking My Mind off of Things
You’re still trying to deal with this crisis by yourself. Try to identify at least 2 people you can call or 2 places that a person can go, without yet asking for help… this is to try to simply distract yourself from the crisis growing bigger and trying to decrease it. We’re going to write their name (or you would call them… you would write “mom” instead of “Connie” for your mom), their relationship to you, and their phone number, so that you always have it handy.
Step 4: People I Can Call for Help
So now, you’ve tried a bunch of things to shake off the feeling of a crisis. Now this is where you are gonna ask for help. Who’s the first person you would call who can help to get you through a crisis? Who else can you think of? Let’s write their number down in case you need to call them and you don’t have their phone.
Step 5: Ways That Supportive People Can Help Me Stay Safe
So what are some things you can do to keep your environment safe? What can your loved ones do to help you stay safe? Are there any weapons in the home? Can they lock them up? What about things like rope? Can they help you get rid of it? Medicine… can they lock it up or can someone be in charge of giving it to you every day?
Step 6: I Can Call These Very Important Phone Numbers
I’ve made this typeable so that you can plug in your local suicide prevention hotline, your local hospital, or other important numbers that the person can call if they need to. On the first line, I put my local emergency number: 9-1-1.
So these are some important phone numbers that I hope you can call if you need help. If you feel out of control, 9-1-1 can help you. Otherwise, here are some other numbers. What do you think about that?
I Have Great Strengths to Get By
What are some of the things that have helped you get through other tough times? What are the good things about you that you like about yourself? What has worked in the past to help you get through crisis?
Safety Plan in Action
This is what the safety plan looks like in Action.
While We’re on the Subject
Depression, anxiety, and substance use are medical conditions. They affect people across socio-economic barriers and culture (some more than others), social workers included. [Check out this fascinating podcast by The Social Work Podcast about social workers and depression.] Some of us got into this profession [I am a clinical social worker] because we know the hell that these conditions can do to us or to our loved ones. I can speak from experience that depression is a motherf-cker. I can also speak from experience that I got help with it through signing up for Obamacare.
I cannot judge a person’s decision to commit suicide, for I do not know the suffering that they have endured which would make them want to end their life; I hope that there’s existence past this one and that there we will find peace. In spite of that, I do not agree with suicide. Your life matters, you are loved, and we need you here.
If you’re thinking about suicide or things are so bleak that you don’t know know how you can get through it, please get help. If you are in school and have a mentor that you trust, please let them know that you need them to be supportive of you while you go seek help from your campus health center or counseling center. If you’re employed, ask your employer about a possible Employee Assistance Program (EAP) where you can possibly get free (if not, low cost) sessions with a therapist.
In the meantime, here are some phone numbers to use if you are in crisis.
- National Suicide Prevention Hotline: 1-800-273-8255
- The Trevor Lifeline (LGBTQ+): 1-866-488-7386
Helpers need help, too, sometimes and life comes at you fast. Thanks for reading.