A safety support plan is a list of coping strategies and supports a young person can use to help manage their suicidality when thoughts occur.  It encourages them to have control over their own safety.  Safety support plans are commonly based on the young person’s past and recent suicidality, current risk and protective factors.  Ideally, the young person should develop their own safety plan with close guidance from a professional support; this ensures the plan is personalized and most helpful for them.

A safety support plan should include:

• Early warning signs for the young person to watch out for
• The kinds of situations, thoughts, feelings that may lead to feeling suicidal
• A list of coping strategies that can help them feel calmer
• e.g. music, breathing, meditation
• A list of activities that can be used as distractions
• e.g. exercise, TV, calling a friend, shopping
• A list of reasons for living
• In times of distress, it’s easy to lose focus on the positive aspects of life and concentrate only on the pain.  This acts as a reminder.
• Family and friends to contact for support (including contact details)
• Professionals and agencies to contact for help (including contact details)
• e.g. counsellor, telephone counselling services such as Lifeline, Suicideline and Kidshelpline
• How to make the environment safe
• e.g. ways to remove or secure items that may tempt them to hurt themselves, avoiding alcohol
  (beyondblue, 2010; Headspace, 2013; Suicideline, n.d.)

It is best that the safety plan is created when the young person is feeling calm and clear-headed, rather than suicidal or distressed.  It is often helpful that the safety plan is written down and kept in a place where he/she can easily find it when needed, and shared with trusted friends and family.  When the suicidal thoughts arise for the young person, the practitioner can refer the young person to his/her safety support plan and support him/her to implement it.

The following elements drawn from Solutions Focused Therapy and Dialectical Behaviour Therapy may assist in forming safety support plans.

• Competence-seeking / Looking for strengths
• Distress Tolerance techniques

Supporting a young person with ongoing suicidality

Sometimes a young person may present with ongoing suicidality, including threats and incidents of self-harm or suicide attempts.  Similar to the ‘boy who cried wolf’ fable, practitioners may not take the risk of suicide seriously and perhaps think ‘they haven’t yet acted upon their thoughts so won’t act now’.  However, young people with ongoing suicidality are at a higher risk of suicide in the long term (Hawton & James, 2005; Larkin & Beautrais, 2010).  It is important to take their suicidality seriously.  It can be challenging for practitioners to assess the level of risk of suicidality and remain supportive of the young person with ongoing suicidality.  The following provides a guide for practitioners to work with a young person with ongoing suicidality (Berk, Grosjean & Warnick, 2009; National Health and Medical Research Council, 2012): 

Assess the risk of suicidality at that moment
It is important to understand the current circumstances for the young person with ongoing suicidality (Berk, Grosjean & Warnick, 2009; National Health and Medical Research Council, 2012).  Recent precipitating events, such as relationship breakdown, loss of something or someone of significance and/or substance misuse, may significantly cloud the young person’s ability to cope.  This places them at greater risk of a suicide attempt.  Listen carefully to the current circumstances in the story, and assess if known suicide risk factors to the young person are heightened.  Some questions can include:

• What has happened since we last spoke?
• Are you feeling worse than previous days?  If so, what is more difficult or upsetting for you at the moment?
• How strong are your suicidal thoughts today?
• Are there any objects at your home that are unsafe to have? (e.g. new medication, purchase of rope, knives etc.)

Revisit their safety plan
A safety plan encourages a young person to have control and responsibility over their own safety and helps remind them of options they have.  As part of their ongoing care, it is important to continue to empower the young person to be active in managing their safety.  For example:

• Did you use your safety plan?
• If so: what on the plan was helpful?  What wasn’t helpful?
• If not: what stopped you from using the safety plan?
• Let’s think of some things we can add to your safety plan

Some research has indicated that building a ‘hope box’ with young people with ongoing suicidality can be beneficial (Berk, Grosjean & Warnick, 2009).  A ‘hope box’ is a box or container that the young person fills with tangible reminders of reasons to live (e.g. photos of loved ones or pets, personal achievements such as trophies/letters/awards) and cues to use coping skills (music, relaxation tape, positive affirming statements (Berk et. al.). 

Encourage the young person
It is important to continue to build the young person’s self-esteem and confidence in their capability to cope.  Highlight to the young person the positive steps (even small ones) they have taken that you have observed.  For example:

• I can hear how upset you were feeling last night.  It shows strength to look after yourself and keep yourself safe like you did.
• Remember that despite how distressed you felt, you got through it. That shows me you are more resilient than you may feel you are
• What small step did you take today to keep yourself safe?

It is not uncommon for practitioners to feel frustrated and disheartened when a young person continues to present with suicidality.  Often young people with ongoing suicidality have not had the opportunity to develop resilience and helpful coping strategies, and this seems like their only option.  As practitioners, remember their thoughts of suicide are real to them, and your role is to support the young person to better manage their thoughts and feelings.  Debriefing and supervision can help practitioners manage such frustrations.