Making Safety Plans Actionable Between Sessions
Safety plans often sit unused in client files because they lack practical steps for moments of real crisis. This article shares expert strategies for transforming standard safety protocols into tools clients actually use when distress hits between therapy appointments. Learn how simple adjustments like numerical scales and concrete tasks can make the difference between a plan that collects dust and one that saves lives.
Use Code Word at Agitation Seven
In working with the Collaborative Assessment and Management of Suicidality (CAMS), I concentrate on what I call "Drivers," which are the specific areas or life circumstances that cause an individual to want to die (e.g., loss of a job, loss of family, etc.). To empower the Stabilization Plan from session to session, I have created a "Living Document" based on "near misses" that we update each week. This process is similar to a post-game analysis in sports.
We also take a specialized approach to the Stabilization Plan: instead of identifying general coping skills, we use Implementation Intentions based on the "If-Then" model. For example, if someone is staring at the medicine cabinet (the trigger), then the Implementation Intention would be that they immediately go to the kitchen and drink a glass of ice water.
One of my most successful additions to the Stabilization Plan is a "Red Flag Communication Protocol." We include a line stating that when a person feels their "Internal Agitation" has reached a Level 7, they will text a designated person the code word "ORANGE." This informs their support system that they are struggling without requiring a full explanation. This approach significantly reduces barriers to seeking help. Many chronically suicidal individuals feel like they would be a burden to those they reach out to and do not wish to initiate a "heavy-duty" conversation about their ideation. By utilizing an agreed-upon code word, the individual can reach their supportive people without the additional stress of explaining their situation.
Add Neutral Task When Hope Feels False
In modifying the Stanley-Brown Safety Plan to accommodate chronic ideation, I focus on shifting from "Abstract Safety" to "Micro-Interventions" that target the particular levels of cognitive dissonance experienced by the client between appointments. Because clients struggling with chronic issues often begin to view the standard safety plan as "wallpaper"—something they see but no longer process—I incorporate the "Lethality Leveling" concept into Steps 3 and 4 (Social Situations and Social Support).
This allows clients to distinguish between individuals with whom they can simply be present in silence and those with whom they can actually speak about their pain. By making this distinction, we limit the social fatigue that typically increases risk levels in social situations.
The specific statement I have added that has caused the most significant change in clients is: "If I feel my Reasons for Living today are lies, I will complete one 'Neutral Maintenance' task." I include this on the front of the plan because chronic clients may regularly experience "hope fatigue," where viewing pictures of family or envisioning a positive future causes more pain than comfort. By giving them permission to pivot to a neutral task (e.g., washing a single dish, bathing, etc.), the bar for success is lowered. This allows them to maintain a sense of agency without having to force an emotional state that is currently inaccessible to them.
Schedule Short Prompts in Calendar
Turn each safety step into a clear, scheduled reminder with a verb and a time. Use a calendar or timer app to set alerts that match daily routines, such as after breakfast or before bed. Keep each reminder short and direct so it is easy to follow under stress.
Adjust the frequency based on need, with more prompts during high risk hours and fewer during calm periods. Review the reminders weekly and delete ones that no longer help so the list stays useful. Open your calendar now and create the first three reminders for today.
Create Pocket Crisis Flowchart with Icons
Design a small flowchart that shows simple if-then steps for common crisis cues. Use plain words and add icons or colors so it can be read fast when focus is low. Include brief prompts for breathing, grounding, and who to contact if the first steps do not work.
Print it on a card, protect it, and keep copies where it can be reached in seconds. Practice tracing the arrows with a finger so the sequence becomes automatic in tense moments. Draft and print the flowchart today and tuck one copy where it can be reached quickly.
Script Brief Help Phrases and Rehearse
Write short scripts for what to say to self and to others during tough moments, such as a simple help request. Practice them out loud for one minute at a time to build speed and calm. Use a mirror or a voice memo to check tone and adjust words until they feel natural.
Rehearse in different places so the words come easily at home, at work, and outdoors. Track how tense the body feels before and after practice to see progress. Pick one script and rehearse it twice today so it is ready when needed.
Set Geofenced Support Alerts by Place
Set up geofenced alerts on a phone so a coping cue appears when entering stress hot spots. Choose a brief action for each alert, like a breathing exercise, a grounding task, or a check-in message. Start with a generous radius to avoid missed triggers, then narrow it as the system proves reliable.
Name each alert by place and action so the cue is clear at a glance. Test the alerts during a calm time and update them if they fire too often or not enough. Create one geofenced coping alert today for a place that often raises stress.
Assemble Rapid Access Calm Kit
Build a small coping toolkit that can be grabbed fast when stress rises. Pack items that engage the senses, a written mini plan, key phone numbers, and any prescriber-approved supplies. Add a low-effort snack and water so blood sugar and hydration do not worsen mood.
Place the kit in a bag used daily and make a backup for work or the car if helpful. Schedule a monthly check to replace used items and remove anything that is not helpful. Gather the items and assemble the toolkit today so it is ready between sessions.