One of the most effective ways of averting a suicidal crisis is to address difficulties before they fully emerge. The first step of a safety plan involves identifying the warning signs that immediately precede a suicidal crisis. Being aware of changes in thoughts, moods and behaviour that may signal a developing crisis allows the person to act earlier, helping to reduce further risk.

Questions to ask might include:

• How will you know when your safety plan should be used?
• What are some of the difficult thoughts, feelings or behaviours that you experience leading up to a crisis?

Warning signs might include:

• Moods such as sadness, anxiety or irritability.
• Thoughts involving hopelessness, helplessness, or self-criticism.
• Behaviours such as drinking more alcohol than usual, avoiding social situations, or arguing more often with friends or loved ones.

Experiencing suicidal ideation is often mentally consuming, and it can be hard to see the positive things in life that bring joy and meaning. The next step of a safety plan involves having a pre-written list of reasons to live. These help the person remember things they enjoy or can look forward to.

Questions to ask might include:

• What’s the best thing about living?
• What’s the most important thing in your life?
• What things in your future do you look forward to?

Reasons to live might include:

• family, friends or pets
• spiritual or religious beliefs
• everyday pleasures such as walking on the beach or enjoying nature
• life experiences such as having children or travelling.

The next step involves identifying ways of keeping the person’s immediate environment safe by reducing or eliminating their access to potentially lethal means. This step can also include being aware of and avoiding stressful or upsetting situations.

Questions to ask might include:

• Are there any specific situations or people that you find stressful or triggering, or that contribute to your suicidal thoughts?
• What things do you have access to that are likely to be used in a suicide attempt?
• How can we develop a plan to limit your access to these means and avoid these situations?

Restricting access to lethal means might include:

• Asking someone else to manage access to medication
• Reducing access to firearms or improving safety procedures. This step should always involve having a support person remove any firearms.
• Getting rid of glass or blades that might be used to cause harm.

Suicidal thoughts can make it hard to focus on anything else. Activities and internal coping strategies help the person distract themselves from suicidal ideation, potentially preventing a further escalation into crisis. Identifying internal strategies as a first-line response improves the person’s ability and self-confidence in managing warning signs or suicidal thoughts.

Questions to ask might include:

• What can you do on your own if you have suicidal thoughts in the future, to avoid acting on those thoughts?
• What can you do to help take your mind off your problems, even for a short amount of time?

Internal coping strategies might include:

• breathing or relaxation exercises
• going for a walk, doing yoga or other exercise
• watching a favourite movie or listening to a favourite band
• playing or cuddling with a pet

If the person isn’t able to reduce their distress or suicidal ideation using internal coping strategies, the next step is to try some passive socialisation strategies.

Just being around other people can help provide distraction from suicidal thoughts – this can include spending time with family and friends, or going to a busy park or shopping centre. This step is really about spending time in a social setting, rather than reaching out and discussing their thoughts and feelings – that comes next. You should also remind your client about avoiding social environments where alcohol or other drugs might be involved.

Questions to ask might include:

• Who helps you to feel good when you socialise with them?
• Where can you go and be around other people in a safe environment?

Socialisation strategies might include:

• Spending time with friends and family, remembering that socialising can include activities that don’t require much talking or engagement, such as watching TV.
• A coffee shop, park, place of worship or meeting group.

If the person is still in crisis after working through their internal coping and socialisation strategies, the next step in their plan involves sharing their thoughts and feelings with a trusted friend or family member. This differs from the previous step in that people are encouraged to explicitly reveal that they’re struggling with suicidal ideation and need support in coping with the crisis. For this step, the person should think carefully about who would be helpful in a crisis, and avoid listing people who could possibly exacerbate the situation.

Questions to ask might include:

• Among your friends and family, who do you feel you could talk to when you’re having suicidal thoughts?
• Who do you feel you could contact to support you during a suicidal crisis?

The final step involves listing professional support services the person can contact when they need to.

Questions to ask might include:

• Which services could you turn to for support?