Mental Health Crisis Safety Planning Worksheet

Safety Plan

Step 1: Warning Signs

• Thoughts of hopelessness, feeling like a burden to family, and increased social withdrawal.

1. Pacing around the house and inability to sleep for > 24 hours.
2. Ignoring phone calls and text messages from close friends.
3. Intrusive thoughts that "things will never get better."

Step 2: Internal Coping Strategies — Things I Can Do to Take My Mind Off My Problems Without Contacting Another Person

• Grounding exercises, physical movement, and auditory distraction.

1. Take a brisk 20-minute walk around the neighborhood with the dog.
2. Practice 4-7-8 deep breathing or use the 5-4-3-2-1 sensory grounding technique.
3. Listen to favorite upbeat playlists or a comedy podcast while taking a warm shower.

Step 3: People and Social Settings That Provide Distraction

• Safe, low-stress contacts and public environments where I do not need to discuss my mental health.

1. Name: Marcus Vance (Friend) Contact: (312) 555-0148
2. Name: Chloe Miller (Cousin) Contact: (312) 555-0192
3. Place: Metropolis Coffee Shop on Granville Ave
4. Place: Lincoln Park Conservatory

Step 4: People Whom I Can Ask for Help During a Crisis

• Trusted family members and close friends aware of my safety plan.

1. Name: Sarah Jenkins (Sister) Contact: (312) 555-0114
2. Name: David Jenkins (Father) Contact: (847) 555-0163
3. Name: Elena Rostova (Best Friend) Contact: (773) 555-0189

Step 5: Professionals or Agencies I Can Contact During a Crisis

• Outpatient psychiatric team and local emergency services.

1. Clinician/Agency Name: Dr. Aris Thorne, MD (Psychiatrist) Phone: (312) 555-0200 Emergency Contact: (312) 555-0299 (After-hours paging service)
2. Clinician/Agency Name: Rebecca Lin, LCSW (Therapist) Phone: (312) 555-0245 Emergency Contact: Text 988 or call clinic crisis line at (312) 555-0299
3. Local Emergency Department: Northwestern Memorial Hospital ED Emergency Department Address: 251 E Huron St, Chicago, IL 60611 Emergency Department Phone: (312) 926-5188
4. Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255)

Step 6: Making the Environment Safe

• Remove access to lethal means and substances in the home.

1. Surrender all old prescription medications and over-the-counter analgesics (e.g., paracetamol (acetaminophen, Tylenol®)) to sister (Sarah) for safe disposal; keep only a 7-day supply of current prescribed sertraline (Zoloft®) 100 mg PO daily on hand.
2. Remove all alcohol from the apartment.
3. Have father take possession of the locked gun safe key and remove the firearm from the residence prior to discharge.