Safety Planning for Suicidal Thoughts: How a Safety Plan Works

A suicide safety plan is a short, written, personalized list of steps to use when suicidal thoughts rise: your warning signs, things you can do on your own, people and places that help, professionals and crisis lines to contact, and ways to make your surroundings safer. You build it with a clinician, or with someone you trust, at a calm moment, so that you do not have to think it up in the middle of a crisis.

The best-known version is the Stanley-Brown Safety Planning Intervention, developed by psychologists Barbara Stanley of Columbia University and Gregory Brown of the University of Pennsylvania. It is a brief, collaborative intervention between a clinician and the person that aims to lower acute risk by giving them a specific set of coping strategies and resources to use in a crisis.

If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Why a written plan helps

Suicidal crises tend to come in waves rather than staying at the same intensity. Research summarized by the Harvard T.H. Chan School of Public Health concludes that the acute period of heightened risk is often only minutes or hours long. A plan is designed for exactly that window: a short sequence of things to try, in order, until the intensity passes or help arrives.

Thinking clearly is hardest at the worst moment. Writing the steps down in advance, in your own words, means you only have to follow them, not invent them. It also gives the people around you a concrete way to help.

There is real hope in the longer view as well. Harvard's Means Matter project notes that nine out of ten people who survive a suicide attempt do not go on to die by suicide later, based on a review of 90 follow-up studies. Getting through the crisis matters.

The six parts of a Stanley-Brown safety plan

The plan's steps are meant to be used in order, starting with what you can do alone and moving outward to other people and professionals if the first steps are not enough.

The developers also include an optional step: writing down your reasons for living. For many people this becomes the part they reread most often.

New York City's version of the plan uses the same structure in six steps and offers an online tool, My Safety Plan, that you can text or email to yourself or save as a PDF, along with a printable blank form.

What a filled-in plan can look like

The example below is illustrative, not a template to copy. Its value is in how specific each line is. A real plan should sound like the person who wrote it.

• Warning signs: "I stop answering texts. I lie awake replaying conversations. I start thinking everyone would be better off without me."
• Things I can do alone: "Take a hot shower. Put on the playlist my sister made. Walk around the block twice. Do the paced breathing my therapist showed me."
• People and places that distract me: "Text my cousin about the game. Go to the all-night diner on the corner and order something. Sit in the lobby where the doorman is."
• People I can ask for help: "My sister, who knows about this plan. My friend from work, who said to call any time."
• Professionals: "My therapist's number during office hours. 988 by call or text at any hour. The nearest emergency room."
• Making things safer: "My brother is keeping the hunting rifle at his place for now. I keep only a week of medication at home; the rest is with my partner."
• Reasons for living: "My dog. Seeing my niece grow up. The trip we planned for spring."

Notice that the plan does not depend on willpower alone. Each step gives a concrete action, and the later steps bring in other people before the crisis gets worse.

When to make or revise a plan

The best time to write a plan is when you are relatively calm, ideally with a clinician. Good moments to make one, or to update the one you have, include:

• after an emergency department visit or a hospital stay;
• when starting, changing or stopping a psychiatric medication, which should always be planned with your prescriber;
• before a predictable hard stretch, such as an anniversary, a breakup, a move or exams;
• when a person or place on your plan is no longer available;
• after any crisis, whether or not you used the plan.

What making a plan with a clinician looks like

A plan made with a clinician is more than a filled-in form. The Stanley-Brown intervention lists several tasks for the clinician: assess risk, review how your own crisis builds and eases, explain why the plan helps, write the plan together, explain how to use it, talk through where you will keep it and who you will share it with, ask how likely you are to use it and what might get in the way, and then review it later to see whether it helped and what to change.

A few details make a plan more usable:

• Use your own words. "Go sit on the stoop and call Maya" works better than "use social support."
• Be specific and realistic. Pick things you can actually do at 2 am as well as at noon.
• Keep it where you will see it: a photo on your phone, a card in your wallet, a copy with a trusted person.
• Write down what might stop you from using a step, and a workaround.
• Update it after any crisis, and whenever your circumstances change.

If you see a psychiatrist and a therapist, make sure both have a copy, and that your plan names who to contact during and outside office hours. Keeping your therapist while seeing a psychiatrist covers how two clinicians can coordinate.

Making the environment safer

This step, often called lethal means counseling, is the one people are most tempted to skip, and it may matter most. Means Matter's summary of the research is that intent is not all that determines whether someone survives a suicide attempt; the means available also matter, and reducing access to highly lethal means is an important part of suicide prevention.

Firearms

A meta-analysis of 16 observational studies found that people with access to firearms had about three times the odds of dying by suicide compared with people without access. For households with firearms, Means Matter advises that the safest option during a period of risk is to store them away from home until the person has recovered, for example with someone you trust, where state rules allow. If that is not possible, it recommends removing them until things improve or, as a second-best option, locking them very securely.

New York also has extreme risk protection orders. A family or household member, a police officer, a district attorney, certain school administrators, or a licensed health care practitioner who has treated the person in the past six months can petition a court. A temporary order requires the person to surrender firearms and bars buying or possessing them while it is in effect.

Medications

Means Matter advises families not to keep large quantities of medication at home and to keep prescription painkillers locked up; a doctor, pharmacist or Poison Control (1-800-222-1222) can help work out safe quantities to keep on hand. Your prescriber can also prescribe smaller supplies at a time. Do not stop a prescribed medication on your own because of this; talk with the prescriber about safer ways to keep what you need.

These conversations are not about blame or about assuming the worst. They are about putting time and distance between a short, intense moment and anything that could make it irreversible.

What the evidence shows, and what it does not

A large study tested the Safety Planning Intervention plus at least two follow-up phone calls in Veterans Health Administration emergency departments, for patients who came in with a suicide-related concern but did not need hospitalization. Over six months, 3.03% of the 1,186 patients who received the intervention had suicidal behavior, compared with 5.29% of 454 patients receiving usual care: about 45% fewer suicidal behaviors. The intervention group also had more than double the odds of attending at least one outpatient mental health visit.

A 2021 meta-analysis of six studies with 3,536 participants found that safety planning-type interventions lowered the risk of suicidal behavior (relative risk 0.57), but found no significant effect on suicidal thoughts themselves.

The key study was a cohort comparison rather than a randomized trial, and most participants were men treated in veterans' hospitals, so results may differ elsewhere. The plan is a tool for getting through crises safely; the treatment that reduces suicidal thoughts over time is a separate job, often involving therapies such as CBT or DBT and, when appropriate, medication. See depression treatment options compared and DBT and other treatments for borderline personality disorder.

Follow-up contacts matter

In the emergency department study, follow-up calls were part of the intervention: patients were contacted at least twice to check on risk, review and revise the plan, and support getting into treatment. That is a useful model for families and clinicians. A plan made and never revisited tends to fade.

• Agree on when you will look at the plan again, for example at the next appointment.
• After any crisis, ask which steps were used, which helped and which did not.
• If a hospital or emergency department made your plan, bring it to your first outpatient appointment; the weeks after a psychiatric hospitalization explains why that first visit matters.

For family and friends

If someone you love has a plan, ask if you can have a copy and what they would like you to do when you notice their warning signs. 988 suggests five steps for anyone worried about someone: ask, be there, help keep them safe, help them connect, and follow up. NYC's guidance adds: talk openly, do not promise to keep thoughts of suicide a secret, and help remove means such as guns or stockpiled pills.

If they will not engage with any help at all, what you can do when someone refuses psychiatric help covers next steps, and where to go in a psychiatric emergency in NYC lists each crisis option.

Safety planning in ongoing care

A safety plan works best inside ongoing treatment. Dr. Lewis's practice is in Brooklyn; like any outpatient office, it is not where to turn in a crisis, so the crisis steps in any plan should list 988, 911 and the nearest emergency room. The practice's care includes psychiatric evaluation and medication management, and psychotherapy including CBT and DBT. A free discovery call by phone or text is the first step, and the team can answer questions about care options, scheduling and insurance. All clinicians are out of network, so if you need in-network care, ask the team on the discovery call about options. More guides are in the guide to choosing psychiatric care.

Frequently asked questions

Can I make a safety plan on my own?

Yes. NYC's online My Safety Plan tool and printable form walk you through the steps. A plan made with a clinician is often more specific and includes follow-up, so bring your version to your next appointment.

Is a safety plan the same as a no-suicide contract?

No. A safety plan lists concrete steps, people and resources to use in a crisis. It is not a promise, and it does not depend on signing anything.

Will making a plan put the idea in my head?

Talking openly about suicide is what crisis services and city guidance recommend. A plan focuses on coping and staying safe, and it is designed to be used when thoughts are already there.

Who should have a copy of my plan?

Usually you, one or two trusted people named on it, and your treating clinicians. Decide together with your clinician who to share it with and where to keep it.

What if the steps on my plan do not work?

Move to the next step. If you reach the end and still feel unsafe, call or text 988, call 911 or go to an emergency room. Afterward, revise the plan with your clinician.

Does a safety plan work for teenagers?

Safety planning is used with adolescents too, ideally with a parent involved in the steps about home safety. A teen's plan should be made with their clinician; see teen depression treatment: a parent's guide.

Sources

1. Stanley-Brown Safety Planning Intervention. Stanley-Brown Safety Plan (suicidesafetyplan.com), 2026. suicidesafetyplan.com
2. Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry (PubMed 29998307), 2018. pubmed.ncbi.nlm.nih.gov
3. Safety planning-type interventions for suicide prevention: meta-analysis. British Journal of Psychiatry (PubMed 35048835), 2021. pubmed.ncbi.nlm.nih.gov
4. Safety Plan. NYC 988 (City of New York), 2026. nyc988.cityofnewyork.us
5. Means Matter: Families. Harvard T.H. Chan School of Public Health, 2026. hsph.harvard.edu
6. Means Matter: Attempters' Long-Term Survival. Harvard T.H. Chan School of Public Health, 2026. hsph.harvard.edu
7. Means Matter (overview) and Duration of Suicidal Crises. Harvard T.H. Chan School of Public Health, 2026. hsph.harvard.edu
8. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Annals of Internal Medicine (PubMed 24592495), 2014. pubmed.ncbi.nlm.nih.gov
9. New York Civil Practice Law and Rules Section 6340: Definitions (extreme risk protection orders). New York State Senate, 2026. nysenate.gov
10. New York Civil Practice Law and Rules Section 6342: Issuance of a temporary extreme risk protection order. New York State Senate, 2026. nysenate.gov
11. Help Someone Else. 988 Suicide & Crisis Lifeline, 2026. 988lifeline.org
12. Helping Friends or Family in Crisis. NYC 988 (City of New York), 2026. nyc988.cityofnewyork.us
13. Means Matter. Harvard T.H. Chan School of Public Health, 2026. hsph.harvard.edu

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.