Safety Planning
Core Mechanism
Structured plan created collaboratively provides concrete steps to manage suicidal crisis; reduces impulsive action
Ontology
Suicidal crises are time-limited; having a concrete plan interrupts the narrowing of perceived options
Therapeutic Voice
"The step I don't want us to skip is the one about the gun. Not forever. Just for the next few weeks, who could hold onto it for you?"
View of the Person
A being in acute crisis whose narrowed perception of options can be expanded by a concrete plan
Evidence
VA/DoD: recommended. Joint Commission: recommended
Randomized-trial evidence is limited; Stanley et al.'s (2018) widely cited 45% figure comes from a non-randomized cohort comparison, not an RCT
Included in suicide prevention reviews
Widely adopted as standard of care. Stanley et al.'s (2018) frequently cited result is a non-randomized cohort comparison (Safety Planning plus follow-up vs. usual care in VA emergency departments), not a randomized trial; it found 45% fewer suicidal behaviors over 6 months, not specifically fewer suicide attempts.
Conditions
Epistemology
Blind Spots
Intervention, not treatment: does not address underlying conditions; effectiveness depends on quality of therapeutic relationship
Contraindications
Not a standalone treatment: contraindicated as the sole intervention for complex clinical presentations requiring comprehensive therapy; also insufficient for actively psychotic clients unable to follow a plan
Training
Brief intervention from manual and brief training. Should be competency for all clinicians
No certification; free training available
2-4 hrs
Free-$100
Equity & Cultural Adaptations
Philosophical Roots
Shneidman (psychache: suicidal pain is psychological); means restriction research; crisis theory (time-limited states); pragmatism
Related Modalities
Test Yourself
Six steps of a safety plan?
Show answer
Warning signs, internal coping, social contacts, professionals to call, making environment safe, reasons for living.