How to build a six-step suicide safety plan
The 6-step plan with the strongest evidence for reducing suicide attempts.
In this guide
the Safety Planning Intervention (Stanley & Brown) has multiple RCTs showing reduced suicidal behavior. It's a collaborative document, not a contract — and it has to be built with the client, not handed to them.
the Safety Planning Intervention (Stanley & Brown) is the evidence-based standard for suicide risk: a six-step, client-collaborative plan covering warning signs, internal coping, social distraction, people to call, professionals to call, and means restriction. A safety plan takes 20–45 minutes to build and is associated with a roughly 45% reduction in suicidal behavior at 6 months.
Key takeaways
- Warning signs: Personal triggers, thoughts, moods, behaviors that flag a crisis is coming.
- Internal coping strategies: Things the client can do alone to take their mind off suicidal thoughts.
- Social contacts & settings: People and places that provide distraction and connection (not necessarily for disclosing crisis).
- People to ask for help: Family/friends the client can tell they're in crisis.
- Professionals & agencies: Therapist, crisis line, 988, ER.
When to use this
- Any client endorsing suicidal ideation, recent attempt, or psychiatric ED visit.
- Discharge from inpatient, IOP step-down, or after a near-miss.
- As a standing review item for chronic-SI clients every 30–90 days.
Steps
- 1
Warning signs
Personal triggers, thoughts, moods, behaviors that flag a crisis is coming.
- 2
Internal coping strategies
Things the client can do alone to take their mind off suicidal thoughts.
- 3
Social contacts & settings
People and places that provide distraction and connection (not necessarily for disclosing crisis).
- 4
People to ask for help
Family/friends the client can tell they're in crisis.
- 5
Professionals & agencies
Therapist, crisis line, 988, ER. Concrete numbers.
- 6
Means restriction
Reducing access to lethal means is the single most powerful step. Address it specifically.
Example
Warning signs: isolating in bedroom 2+ days, skipping meds, listening to 'the album' on repeat, googling methods. Internal coping: 20-min walk with dog, cold shower, 'leaves on a stream' audio. Social/places: text gym buddy to meet for lift; coffee shop on Main St. People to tell: sister (primary), Alex (backup). Professionals: therapist cell (...); 988; nearest ER (...). Means: partner will hold firearm at her parents' starting tonight; meds in lockbox; sister has the key.
Quick checklist
- Built collaboratively, in the client's words.
- All 6 steps populated with specifics.
- Means-restriction step addressed concretely with a who/how/when.
- Plan accessible — photo on phone, copy at home.
- Review date scheduled.
Common variations
Involve caregivers in means restriction; add school counselor and a safe friend's parent to contacts.
Coordinate with outpatient provider, schedule follow-up within 7 days, document warm handoff.
Evidence base
Stanley & Brown (2012, 2018) RCTs and the VA implementation study show ~45% reduction in suicidal behavior and improved engagement vs treatment as usual.
Deep dive
Means restriction — the single highest-leverage step
Means restriction (specifically firearm storage outside the home during a high-risk period, and limiting access to lethal medication quantities) accounts for the largest share of the safety plan's mortality benefit. Suicide attempts are often impulsive — 24% of near-lethal attempts had less than 5 minutes between decision and action. Reducing access to lethal means during that brief window converts attempts to survivable ones. Have the conversation directly, document it, and follow up at the next session. Resources like the Counseling on Access to Lethal Means (CALM) training provide language that does not feel adversarial.
Collaborative drafting beats clinician-written plans
A safety plan the clinician fills out and hands over is used less than a plan the client physically writes, in their own words, with their own examples. The clinician's job is to keep the structure and probe for specificity — 'Who specifically? What's their number? What if they don't answer?' — not to dictate content. Test the plan before the session ends: have the client describe how they would use step 3 if they noticed a step 1 warning sign tonight. Edit anything that does not pass the rehearsal.
What to do between safety plan and next session
A single safety plan, however well-written, is not a treatment. Pair it with: (1) explicit follow-up contact within 24–48 hours for high-risk clients; (2) a treatment plan goal that addresses the underlying driver (depression, substance use, trauma); (3) involvement of at least one identified support person with the client's consent; (4) a scheduled re-review of the safety plan at every session for the next month. Plans that go unrevisited become irrelevant within weeks.
Tips
- Build it in the client's words. Read it back aloud.
- Photograph it or send a digital copy so it's accessible in a crisis.
Common pitfalls
- Skipping means restriction because it's uncomfortable — it's the highest-impact step.
- Treating safety planning as paperwork rather than intervention.
Related tools
Frequently asked questions
No. No-harm contracts have no evidence of efficacy and may worsen outcomes. Safety planning replaces them.
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