How to Build a Safety Plan With Your Teen

What a safety plan is and why it helps

A safety plan is a brief, prioritized written list a person can follow when they notice they are heading toward a crisis. The Safety Planning Intervention is a collaborative, evidence-informed best practice for reducing the risk of acute suicidal crises 1Ref 1Stanley B, Brown GK (2012).Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk.The Safety Planning Intervention is a brief, collaborative, evidence-informed best practice for mitigating acute suicidal crises.. The point is simple: when distress is high, it is hard to think clearly, so the plan does the remembering for you. You and your teen write it together, in their language, while things are calm. Suicide is a leading cause of death among adolescents 2Ref 2Shain B; AAP Committee on Adolescence (2016).Suicide and Suicide Attempts in Adolescents.Suicide is a leading cause of death among older adolescents and pediatricians should identify and manage at-risk youth., which is exactly why having a ready, agreed plan matters.

The steps, one at a time

Work through these together and write each part down 1Ref 1Stanley B, Brown GK (2012).Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk.The Safety Planning Intervention is a brief, collaborative, evidence-informed best practice for mitigating acute suicidal crises.:

1. Warning signs. Ask your teen what they notice right before things get hard — thoughts, feelings, situations, or body sensations. 2. Internal coping steps. Things they can do alone to take their mind off the crisis (music, a walk, a shower, a game). 3. People and settings that distract. Friends or places that help them feel better, without needing to talk about the crisis. 4. People they can ask for help. Trusted adults and friends they could actually call or text. 5. Professionals and crisis lines. Your teen's clinician, plus the 988 Suicide & Crisis Lifeline, which offers free, confidential 24/7 call, text, and chat support 3Ref 3Substance Abuse and Mental Health Services Administration (SAMHSA) (2024).988 Suicide & Crisis Lifeline.988 provides free, confidential, 24/7 call/text/chat crisis support.. 6. Making the environment safer. Steps to reduce access to anything dangerous (covered below).

Keep the plan short enough to use under stress, and let your teen own the wording.

How do you make the home safer?

Reducing a person's access to dangerous items — especially firearms and medications — during a high-risk period is one of the most effective suicide-prevention steps there is 4Ref 4Harvard T.H. Chan School of Public Health, Means Matter (2024).Lethal Means Counseling.Reducing access to lethal means, especially firearms, is an evidence-based suicide-prevention strategy.. The World Health Organization names restricting access to means as a core, evidence-based prevention strategy 5Ref 5World Health Organization (WHO) (2021).LIVE LIFE: An Implementation Guide for Suicide Prevention in Countries.WHO names restricting access to means as a core evidence-based prevention strategy.. Practically, this can mean locking or temporarily moving firearms out of the home, securing or removing larger quantities of medication, and storing other risky items away. Frame it as a normal safety step, like a seatbelt, not a punishment.

How does a clinician help build the safety plan?

A safety plan is strongest when a clinician helps build and review it 1Ref 1Stanley B, Brown GK (2012).Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk.The Safety Planning Intervention is a brief, collaborative, evidence-informed best practice for mitigating acute suicidal crises.. A provider can use validated tools — such as the Columbia-Suicide Severity Rating Scale (C-SSRS) or the brief ASQ screen — to understand how acute the risk is and tailor the plan accordingly 6Ref 6Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ (2011).The Columbia-Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults.The C-SSRS is a validated measure of suicidal ideation severity and behavior in adolescents and adults.7Ref 7Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M (2012).Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department.The 4-item ASQ has high sensitivity for identifying suicide risk in youth.. They can rule out medical or sleep problems that worsen mood, start evidence-based treatment such as cognitive behavioral therapy, and add medication when it is clinically indicated. A clinician can also coach you on lethal-means safety in your specific home 4Ref 4Harvard T.H. Chan School of Public Health, Means Matter (2024).Lethal Means Counseling.Reducing access to lethal means, especially firearms, is an evidence-based suicide-prevention strategy. and coordinate with your teen's school so support continues during the day. Pediatricians are explicitly asked to identify and help manage at-risk youth, so your teen's regular doctor is a good first call 2Ref 2Shain B; AAP Committee on Adolescence (2016).Suicide and Suicide Attempts in Adolescents.Suicide is a leading cause of death among older adolescents and pediatricians should identify and manage at-risk youth..

Keeping the plan alive

A plan only works if it is reachable. Save it in your teen's phone and on paper, and put 988 in their contacts 3Ref 3Substance Abuse and Mental Health Services Administration (SAMHSA) (2024).988 Suicide & Crisis Lifeline.988 provides free, confidential, 24/7 call/text/chat crisis support.. Revisit it together every few weeks and after any hard moment, updating what helped and what did not. Watch for warning signs that risk is rising — withdrawal, giving things away, talking about being a burden, or increased substance use — and treat those as a cue to reach out for help promptly 8Ref 8National Institute of Mental Health (NIMH) (2024).5 Action Steps to Help Someone Having Thoughts of Suicide (Ask, Be There, Keep Them Safe, Help Them Connect, Follow Up).Evidence-informed action steps for supporting someone at risk, including that asking about suicide does not increase risk..