Safety Planning
The Safety Planning Intervention is a crisis intervention developed by Barbara Stanley and Gregory Brown, published in 2012. Its core mechanism: structured plan created collaboratively provides concrete steps to manage suicidal crisis; reduces impulsive action. This catalogue links it to suicidality and self-harm, typically in individual format, single session.
Related condition topics
These links support exploration. They do not establish that Safety Planning is effective or recommended for each condition.
How Safety Planning works
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
Epistemology
Evidence
1 condition assessment available
An overall effectiveness assessment has not been completed. Completed assessments for specific populations appear below.
Condition-specific assessments
Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.
Suicidality & Self-Harm
Population and scope: Collaborative safety planning as part of care for people who have self-harmed; not a claim about a standalone plan preventing attempts.
Guideline recommendation
NICE NG225 1.11.7–1.11.8 advises considering collaborative safety planning as part of care. WHO mhGAP 2023 SUI1 conditionally supports multicomponent or supported safety-planning-type interventions for thoughts or plans of self-harm in the past month or acts in the past year, with very low-certainty evidence; standalone evidence is insufficient. VA/DoD 2024 includes planning in routine care but recommendation 7 is inconclusive about reducing attempts in people with recent ideation or a lifetime attempt history. No studies of the Safety Planning Intervention and one crisis-response-planning trial met that VA review’s inclusion criteria. The guideline label describes scoped care recommendations, not proof that the original Safety Planning Intervention alone prevents attempts or deaths.
Source assessment dated
- NICE NG225 (2022), Recommendations 1.11.7–1.11.8 — collaborative safety planning
- NICE NG225 (2022), rationale — interventions for self-harm
- WHO mhGAP (2023), SUI1, p.108 — supported or multicomponent safety planning
- VA/DoD 2024, Recommendation 7, pp.53–54 — safety planning and attempts
- VA/DoD 2024, routine care IX.C.a, pp.31–32 — safety planning
Guidelines and official sources (4)
3 clinical guideline checks · 1 professional reference check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Assessment and Management of Patients at Risk for Suicide
Insufficient evidence for or against
Recommendation 7 is neutral because evidence is insufficient for this outcome. The guideline also incorporates safety planning in routine care; these statements need to be read together. No Safety Planning Intervention studies and one crisis-response-planning trial met this review’s inclusion criteria; this is not a statement that no SPI research exists.
Scope: Reducing attempts in adults aged 18 and over with recent suicidal ideation and/or a lifetime attempt history.
- Study Evaluates Prevalence of Four Recommended Practices for Suicide Prevention
Discussed in the source
The Joint Commission article describes formal safety planning as expert-recommended practice and distinguishes it from explicit National Patient Safety Goal requirements.
Scope: Hospital suicide-prevention and discharge practices.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Recommendation for the stated population
WHO conditionally supports considering safety-planning-type interventions that include several components or follow-up/support, with very low-certainty evidence. It found insufficient evidence to recommend safety planning as a stand-alone intervention.
Scope: People with thoughts or plans of self-harm in the past month, or acts of self-harm in the past year.
- Self-harm: assessment, management and preventing recurrence (NG225)
Recommendation for the stated population
NICE says to consider a plan with the person. This practice recommendation draws on committee experience and supporting qualitative/component evidence; it does not independently prove that a standalone plan prevents attempts.
Scope: Collaborative safety planning as part of care for people who have self-harmed.
Recorded material under review
The existing notes below are retained separately from assessment records. These recorded claims await source checking, including study design, recommendations and numerical estimates.
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
Stanley et al. (2018) compared safety planning plus follow-up calls with usual care in a nonrandomized cohort of 1,640 adults at nine VA emergency departments for whom inpatient admission was not indicated. Over six months, the combined intervention was associated with 45% fewer recorded suicidal behaviors, not specifically suicide attempts. The observational design, combined intervention and predominantly male veteran population limit causal claims and generalization; the study does not establish the effect of a plan alone.
Sources for the corrected statements:
Training and certification
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
Clinical cautions and blind spots
Assessment and precautions
Safety planning is part of a broader assessment and care plan, not a substitute for treatment, follow-up, or an emergency response when immediate safety cannot be maintained. If the person cannot currently understand or use a plan, arrange the level of assessment and support they need and revisit collaborative planning when feasible. Adapt the plan to the person's circumstances and involve trusted supporters when appropriate.
Sources for the corrected statements:
Blind spots
Intervention, not treatment: does not address underlying conditions; effectiveness depends on quality of therapeutic relationship
Philosophical roots
Shneidman (psychache: suicidal pain is psychological); means restriction research; crisis theory (time-limited states); pragmatism
Compared with other approaches
Test Yourself
Six steps of a safety plan?
Show answer
Recognize warning signs; use internal coping strategies; identify social contacts and settings for distraction; identify people to ask for help; list professional and emergency contacts; make the environment safer by reducing access to lethal means. The numbered steps do not mean urgent safety action should wait.