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Develop a Safety Plan for Mental Health Emergencies

How to Create a Safety Plan

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Updated June 13, 2014

A safety plan is a critical part of treatment for borderline personality disorder (BPD). People with BPD are among the most at risk of attempting suicide, or engaging in other high risk activities. Without a safety plan, you may be in danger of harming yourself or someone else. A safety plan can reduce your risk and make it less likely that you will make a decision in the heat of the moment that will have serious consequences.

This article covers the steps in making a clear and comprehensive safety plan. This is not something that can be done when you are already in the midst of a mental health emergency (e.g., planning to commit suicide or to harm or kill someone else). If you or a loved one are currently at immediate risk of harming yourself or someone else, do not read this article. Call “911” (in the U.S. or Canada) or get to an emergency room immediately.

If you are not at immediate risk of harming yourself or someone else, but this has happened to you in the past (or you are concerned it might in the future), this is a good time to create a safety plan.

Ask Your Therapist About A Safety Plan

If you have BPD, you should be working with a mental health professional on a safety plan. If you and your therapist have not yet developed a safety plan, ask them whether this is something you should do together. If you do not have someone to work with on this, find a therapist.

Target Your Safety Plan: Evaluate Your Risk Behaviors

Once you have enlisted your therapist, you can have them help you to evaluate your risk. For example, do you have thoughts of suicide? Urges to harm yourself? Thoughts of harming other people? Problems with violent behavior? What symptoms or behaviors do you have that put you most at risk of harming yourself or others? These will be the targets of your safety plan, so it is important that you think carefully about what behaviors you may need to plan for.

Along with evaluating your risk, you should evaluate whether there are factors that may be increasing your risk of completing a suicide or harming others. For example, are there firearms in your home? Are there medications in your house that could be used in a suicide attempt? Are there other items that might make it easier for you to harm yourself or others?

If you answered yes, you need to work with your therapist on a plan to get rid of these items or to reduce the likelihood that you will use them. For example, can you get your medications prescribed in smaller quantities? Can you leave firearms at the police station?

Identify Triggers for High-Risk Behaviors

Once you have a list of the behaviors or symptoms that put you at risk of harm, identify the events, situations, people, thoughts, or feelings that trigger those behaviors or symptoms.

For example, many people with BPD have abandonment sensitivity, which makes experiences of real or perceived abandonment very painful. For those individuals who suffer from this symptom, abandonment experiences may trigger suicidal thoughts or thoughts of harming others. Think about the events or thoughts that tend to trigger urges to engage in harmful behaviors for you, and create a list of triggers.

Make a Safety Plan for Coping Resources

Now, identify how you can respond to your triggers in ways that will keep you safe. These will be coping resources that you will use before your symptoms become so intense that you are having a mental health crisis.

Make a list of coping skills that you are familiar with and that work for you, as well as sources of social support, and people/places that can help you if you need it. For example, do you use mindfulness skills when you are starting to have negative thoughts about yourself, and do these skills help you to let go of negative thoughts before urges to harm yourself begin to happen? Do you have a friend you can call who is a good source of support when you are down?

For some ideas on coping skills you can include, as well as sources of support, read these articles:

Identify Emergency Services for Your Safety Plan

Next, write down things you will do if your coping resources do not work and you experience a mental health emergency or crisis (e.g., your urges to harm get to the point that you are at immediate risk of committing suicide or to harming or killing someone else). Is there a hospital nearby that you can drive to? Do you have an emergency phone number on hand (e.g., in the U.S., the National Suicide Hotline: 1-800-273-8255)? If you are not sure what you could do in an emergency, read this article:

Write Out Your Safety Plan

Now it is time to put it all together. You have a list of your risk behaviors, your triggers, ways you can cope before symptoms become too intense, and ways you will respond in the case of an emergency. Put these all together to give yourself a step-by-step plan of action.

For each risk behavior, write out the triggers for that behavior, the coping responses you could engage in if you experience a trigger, and what you will do if the coping responses do not work and you begin to experience an emergency situation. Continue until you have a safety plan for all of the risk behaviors you identified.

Make a Safety Plan Commitment

The last step is to make a commitment to your safety plan. This means committing to yourself that you will follow this plan when the need arises, and then committing out loud to someone else (e.g., your therapist) that you will follow this plan. This is also called “contracting for safety.” In fact, sometimes your therapist will have you actually sign a statement saying you will follow the plan.

Sources:

Klott J, Jongsma AEJ. The Suicide and Homicide Risk Assessment & Prevention Treatment Planner, Wiley, 2004.

Simon RI. Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk, American Psychiatric Pub, Inc, 2003.

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