This safety planning guide is a structured, evidence-based tool designed to help therapists collaborate with clients who are experiencing suicidal ideation, self-harming urges, or heightened emotional distress. Adapted from the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Stanley & Brown Safety Planning Intervention (2012), it provides a clear framework for identifying warning signs, developing coping strategies, reducing access to means, and outlining crisis resources. The worksheet supports clinicians in conducting compassionate, clinically sound interventions that promote safety, autonomy, and hope during moments of elevated risk.
This guide is modeled after the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Stanley & Brown Safety Planning Intervention (2012), both of which are evidence-based and publicly accessible tools (non-copyright restricted for clinical use).
Adapted by the Wellness Collaborative, based on publicly available materials from the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Safety Planning Intervention (Stanley & Brown, 2012).
Purpose:
This worksheet supports collaborative safety planning for clients experiencing suicidal ideation, self-harm urges, or acute emotional distress. It is informed by the Columbia-Suicide Severity Rating Scale (C-SSRS) for risk identification and the Safety Planning Intervention (Stanley & Brown, 2012) for structured prevention steps.
Section 1: Initial Risk Review
(Complete collaboratively and use to guide next steps — not as a substitute for professional judgment.)
| Recent Suicidal Thoughts | Yes/No | Frequency | Intensity (1–5) |
|---|---|---|---|
| Wish to be dead or not wake up | |||
| Thoughts of killing self | |||
| Plan for how to do it | |||
| Intent to act on thoughts | |||
| Recent preparation or rehearsal |
Protective factors: (e.g., relationships, responsibilities, values, faith, pets)
Warning signs / triggers of crisis: (e.g., thoughts, situations, feelings, losses, conflicts)
Section 2: Safety Plan Step
Step 1 – Recognize Early Warning Signs
How can I tell that a crisis may be developing?
(Include physical sensations, emotions, thoughts, or behaviors.)
Step 2 – Use Internal Coping Strategies
What can I do by myself to stay safe or reduce distress?
(e.g., grounding exercises, journaling, music, breathing, walking, mindfulness)
Step 3 – Contact People or Places for Distraction
Who helps me feel better when I reach out or spend time with them?
Name Phone Relationship
Step 4 – Contact Support for Help with the Crisis
Who can I call or text when I need help staying safe?
Include both personal and professional contacts (e.g., therapist, supervisor, hotline, trusted friend).
| Name / Service | Phone / Text | Availability |
|---|---|---|
Step 5 – Professional and Crisis Resources
If I am in danger or unable to stay safe, I will contact:
- 988 Suicide & Crisis Lifeline (U.S.) — Call or text 988 (24/7, free, confidential)
- Crisis Text Line — Text HOME to 741741
- Emergency services: 911 or go to the nearest emergency department
- Local crisis resource: ___________________________
Step 6 – Making the Environment Safer
What can I do to reduce access to means or items I could use to harm myself?
(e.g., give medications to a trusted person, secure sharps, remove firearms, etc.)
Step 7 – Reasons for Living
What are the most important reasons for me to stay alive?
(List even small reasons—connections, future plans, values, people, pets, etc.)
Section 3: Follow-Up & Review Plan
| Next Check-In / Review Date | Therapist / Supervisor Notified? | Crisis Review Notes |
|---|---|---|
Client & Therapist Acknowledgment
This plan was developed collaboratively to increase safety and identify supports. It is not a contract or legal agreement, but a shared strategy for crisis prevention.
Client Signature: ___________________________ Date: ____________
Therapist Signature: __________________________ Date: ____________
Reference Sources
- Posner, K., et al. (2011). The Columbia–Suicide Severity Rating Scale (C-SSRS): Initial validity and internal consistency findings from three multisite studies. American Journal of Psychiatry, 168(12), 1266–1277.
- Stanley, B., & Brown, G. K. (2012). Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral Practice, 19(2), 256–264.
- U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). SAFE-T Protocol with C-SSRS. (Public domain clinical tool).