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Client Name:
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Step 1: Warning Signs:
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List warning signs that show the client is or might be experiencing suicidal ideation (SI).
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1.
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2.
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3.
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Step 2: Internal Coping Strategies - Things I Can Do to Take My Mind Off My Problems Without Contacting Another Person:
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List internal coping strategies spelled out by the client that might help them cope with SI or other issues.
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1.
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2.
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3.
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Step 3: People and Social Settings That Provide Distraction:
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List people and social settings that help distract the client from their problems.
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1. Name/Contact:
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2. Name/Contact:
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3. Place:
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4. Place:
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Step 4: People Whom I Can Ask For Help During a Crisis
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List anyone the client would find helpful during a crisis as well as their phone numbers.
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Person #1 (Name and Phone Number)
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Person #2 (Name and Phone Number)
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Person #3 (Name and Phone Number)
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Step 5: Professionals or Agencies I Can Contact During a Crisis
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List different people the client can contact during an emergency.
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Mental Health Crisis Centers (Colorado)
• • •
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Mental Health Crisis Centers (Texas)
• • •
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Mental Health Crisis Hotlines
• • •
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1. Clinician/Agency Name, Phone Number, and Emergency Contact There:
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2. Clinician/Agency Name, Phone Number, and Emergency Contact There:
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Local Emergency Department (Including Address and Phone Number):
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Step 6: Making The Environment Safer (Plan for Lethal Means Safety):
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List two different ways the client can ensure safety in their environment physically, emotionally, etc.
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1.
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2.
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