Safety Planning Checklist for You and Your Clients

Safety planning has proven an effective means of supporting those struggling with mental health crises, abusive relationships, or other forms of trauma. But no two safety plans are, or should be, the same. Here, we’ll discuss creating safety planning documents for some common types of crises:

• Suicidal ideation
• Substance use disorder
• Domestic violence
• Psychiatric Advance Directives

Suicide safety planning

At its most basic, safety planning is a way to help clients experiencing suicidal ideation navigate their feelings in a way that prevents self-injurious behavior. Typically, safety plans look like checklists of coping strategies and sources of support for individuals who are deemed to be at high risk for suicide.

For behavioral health specialists, a safety plan can help to open lines of communication with a client and provide a template on how you and your client can check in with one another.

Though empirical studies on the efficacy of suicide safety planning are ongoing, early results are promising. One study that evaluated the use of suicide safety planning in the emergency department resulted in “45% fewer suicidal behaviors in the six-month period following the ED visit compared with usual care.”

Another study showed similar reductions in suicidal behavior following the use of safety planning. While research continues, safety planning, either before or after a suicide attempt, is proving to reduce future suicidal behavior and increase engagement with an individual’s behavioral health specialist.

When creating a safety plan, make sure you work with your client to put the plan in their own words. It should also be easy to read, as clients will need to refer to it during times of crisis.

Creating a suicide safety plan

But what questions should you make sure to include in your clients’ safety plan? The Suicide Prevention Resource Center recommends using the following as a means of getting started:

• List warning signs that your client can recognize. Work with them to understand when the safety plan should be used and/or what they experience when suicidal ideation begins to occur.
• Identify potential roadblocks and their solutions. Collaborate with your client to understand if they would be capable of seeking help if suicidal ideation begins and what thoughts, emotions, or physical barriers would cause them to not seek help.
• Find safe places. Help your client to identify people and/or places they can use to distract themselves when suicidal ideation begins. This can be a comforting friend or family figure, a public space around other people, like a restaurant, or other social settings.
• Create a list of contacts. Help your client create a list of trusted family or friends who can act as emergency contacts. These should be people in whom your client is comfortable confiding during crisis situations.
• Create a list of behavioral health professionals. Identify agencies or professionals in your client’s area who they can call during an emergency. You should also work to assess how likely it is that your client will follow this step and then work with them to overcome whatever barriers they perceive.
• Make your client’s environment safe. Identify any lethal means your client may have access to (medications, firearms, etc.) and work with them to understand risks associated with these items.

Substance use disorders and safety planning

The purpose of substance use safety planning is to support the client in recovery, help them maintain sobriety, and work to prevent relapses. Unfortunately, the need for such work in the United States is growing.

According to the National Institute on Drug Abuse, drug-involved overdose deaths increased steadily from 1999-2020. In 2020, the United States saw 91,799 such deaths. The National Institute on Alcohol Abuse and Alcoholism reported similar numbers for alcohol related deaths, with approximately 95,000 dying from alcohol incidents every year.

The ramifications of these substance use disorders go beyond the individual. The families of those dealing with substance user disorders (SUDs) have also been shown to be greatly affected. In fact, nearly 9 million children live with at least one parent with an SUD. These circumstances can lead to trauma for the child and potential removal by the state, which may serve to compound their trauma.

If your organization works with individuals dealing with SUDs, helping these clients create a safety plan can provide a huge boon to their recovery efforts. This is because, like suicide safety planning, substance use safety planning is person-centered. This means that the safety plan is created around their needs: why they want to get sober, what they need to achieve and maintain sobriety, and what they need in case of relapse.

While these variables will look different for every individual, you can use a basic safety planning outline to get started with identifying the client’s needs.

Creating a substance use safety plan

To help your clients understand why they want to get sober and what steps they can take to maintain it – as well as what they need to do in case of relapse or overdose – work with them to answer the following:

• Identify your client’s top reasons for wanting to achieve sobriety. Sit down with your client and help write out a list of three to five reasons they want to remain sober every day. This can serve as a powerful reminder on both good and bad days.
• Create a list of activities that help your client stay sober. This could be anything that helps your client achieve and maintain sobriety. Examples include talking to a sponsor, regular interaction with friends and family, partaking in hobbies, and more.
• List out actions your client can take when cravings begin. This can include calling a sponsor, family member, or friend; reading material on recovery; going to a meeting; having a snack if hungry; or finding distraction through another activity.
• Find safe places. Help your client to identify people and/or places they can use to distract themselves when cravings begin. This can be a comforting friend or family figure, a public space around other people, like a restaurant, or other social settings.
• Identify your client’s triggers. Work with your client to understand what triggers them and how to avoid these people, places, and/or behaviors.
• Create a contact list. Help your client come up with a list of three to five people they can call when in need of support.

If your client is recovering from opioid drug use, also make sure they know the signs of overdose and have Narcan or Naloxone readily available.

Domestic violence and safety planning

Safety planning is a crucial step when working with clients in abusive relationships. Staying safe in these types of relationships is difficult and how your clients can stay safe will vary from person to person. These difficulties, too, can become compounded if your client has children, pets, or other dependents living with them.

While your first reaction as a human services professional may be to remove your client from the abusive relationship, this is not always the best course of action. In fact, attempting to leave an abuser can make the situation far more dangerous for some. Abusers hurt their partners out of a need for control. If the abuser feels this control is slipping away, they can become even more violent.

Because of this, it’s important to work with each client to craft an individualized safety plan tailored to their unique needs. Above all, a safety plan is meant to reduce the client’s risk of harm. By working with clients to lay out what they can do to seek safety amid an abusive relationship, you can help them identify actions and steps to take in the moment of crisis.

Creating a domestic violence safety plan

Since attempting to leave the abusive relationship can lead to an escalation in the abuse, effective safety planning can prove difficult. To help your client achieve the ultimate goal of safety, there are various steps you can guide them through, but don’t feel the need to apply every step to each situation. Some options to consider for a domestic violence safety plan include:

• Identify ways clients can stay safe during an incident. Help your client understand what they can do during a violent incident with their partner. This can include safe words to text to friends or family, creating an escape plan, picking places to go if they decide to leave, or strategies to protect themselves if they decide not to leave.
• Create a plan to leave. This can be the most dangerous time during an abusive relationship. As such, you should work with your client to identify the safest ways possible for them to leave their residence quickly. Such strategies can include keeping extra clothes, money, and keys with friends or family, always having their phone fully charged, and potentially practicing the escape plan (if the situation allows).
• Create a list of items to take. Make sure your client has a list of all the items they need to take with them when they have decided it’s time to remove themselves from the abusive relationship.
• Suggest a protective order. A protective order (or restraining order) is a legal document issued by local courts that provide legal penalties if the abuser contacts the abused. Advocate that your client has one created, and have the police serve the protective order as soon as possible.
• Outline a safety checklist for their new residence. Once your client has fled their abusive relationship, help them take steps to secure their new home. This can include installing security cameras, changing locks on the doors and windows, replacing wooden doors with metal doors, and creating a list of people with pickup permission for their children (if applicable).
• Build a network. Friends, family, and co-workers can offer great protection from abusive relationships. But knowing who to tell, and how, can be difficult. Work with your client to understand their family, friend, and work relationships so you can help to identify people to inform of the abuse.
• Provide mental health exercises. Create a list of exercise and resources your client can use to address the stress and trauma of the situation.
• Sobriety checklist. Substance use can have many negative consequences for those experiencing abuse, from creating addiction to legal issues around child custody. Therefore, it’s important to help your client to create a checklist they can follow to stay and remain sober, if applicable.

Psychiatric advance directives

If you work with clients whose mental health may one day preclude them from involvement in the creation of their own safety plan, consider discussing Psychiatric Advance Directives (PAD).

According to the National Resource Center on Psychiatric Advance Directives:

“Psychiatric advance directives are relatively new legal instruments that may be used to document a competent person’s specific instructions or preferences regarding future mental health treatment. Psychiatric advance directives can be used to plan for the possibility that someone may lose capacity to give or withhold informed consent to treatment during acute episodes of psychiatric illness.”

By working with your client before such constraints take hold, you can understand what they want from a safety planning document, and make sure their wishes are executed.

Research has shown that PADs lead to greater collaboration between clients and clinicians, less use of coercive interventions, improved perception of mental health needs, and improved balance of preferred and prescribed medications.

As PADs are still so new, however, they are currently only legal in 25 states. Before heading down this path with your client, make sure you live in an area that allows for their use.