Creating a Suicide Safety Plan
Note: This overview on how to create a suicide safety plan is based on my experience creating my own plan and guidance I have found online. It is an explanation of the steps of a suicide safety plan that considers the unique perspective of a person with migraine, but is not mental health advice. I am not a trained mental health professional.
If you have ever had suicidal thoughts or images, please consider creating a suicide safety plan. Even if you don't think you'll ever actually take your life, having a plan in place will help you cope with these scary thoughts and ensure that you are safe.
Suicide safety plans help people identify their warning signs and create a prioritized list of coping strategies and sources of support to help them through suicidal thoughts or ideation. They are designed to go through step-by-step, starting with the first step and progressing until you feel safe. Each person makes a plan based on their own needs, so they are tailored to your specific requirements.
Safety plans are best created in conjunction with a therapist or counselor. A National Suicide Prevention Lifeline counselor can also work with you to create a safety plan. Call 1-800-273-TALK (8255) and let the person who answers know that you're not in crisis, but would like help creating a safety plan.
Step 1: Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be developing.
As important as it is to know your warning signs, it's even more important to pay attention to them. When my migraines were at their worst and I had frequent suicidal thoughts, I routinely ignored my warning signs because paying attention to them was terrifying. Creating or reviewing your safety plan with a therapist or someone on the National Suicide Prevention Lifeline can be a tremendous help in learning how to both acknowledge and respond to your warning signs. They can talk you through the thoughts, images, thought process, moods, and behaviors that signal your suicidal thoughts. Being able to recognize all these components will help you more readily identify when you need to put your safety plan into action.
Step 2: Internal coping strategies – Things I can do to take my mind off my problems without contacting another person (relaxation technique, physical activity).
Mindfulness, relaxation, prayer, and meditation are what I think of as "mental health" coping strategies, but straight up distraction is also an effective internal coping technique. Listening to music, playing a game, curling up with a pet, doing a craft, reading, watching TV, listening to podcasts, exercising, or even cleaning the house are all possibilities.
When adding your coping strategies to your safety plan, put the ones that are easiest or likely to be most effective at the top of your list. You want to be sure the strategies that are best for you are the ones you try first. Also, if your suicidal thoughts tend to coincide with severe migraine attacks, choose coping strategies and distractions that you can comfortably engage in during a migraine.
Step 3: People and social settings that provide distraction.
These are people to talk with or places to go that will provide you comfort or distraction without discussing suicidal thoughts. You could call a friend who tells great stories, go to a yoga class or the gym, visit your favorite coffee house, or stop by your place of worship.
This is a standard component of suicide safety plans, but if your suicidal thoughts come in the throes of a severe migraine, going out -- or even talking on the phone -- may not be possible. An alternative would be creating a list of friends or family who would be willing to come sit with you in a time of migraine crisis. You don't have to tell them it's because of suicidal thoughts, just that occasionally you need company when you're very sick. Maybe you'd want them to talk with you, hold your hand, or watch a movie with you, but maybe all you need is their presence while they read or play games on their phone.
Step 4: People whom I can ask for help.
Think about the person or people you would feel comfortable reaching out to when you are having suicidal thoughts. It could be your partner, a family member, a friend, or a religious leader. It is vital that you choose people who will be helpful and supportive and not add any additional burden or stress. If possible, let them know in advance that they are on your safety plan. That way, they can know to get back to you immediately if they get a panicked voicemail message from you. They can also tell you if it's not a role they are comfortable being in. You may also want to share your safety plan with them so they have access to resources to help you through your time of crisis.
Step 5: Professionals or agencies I can contact during a crisis.
If you see a mental health professional, their contact information can go in this section. It's important to also consider other resources in case it is after work hours or your therapist is unavailable. This could include a local urgent care facility or emergency room, as well as the 24-hour Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Step 6: Making the environment safe.
This step requires asking yourself which methods of suicide you might consider and whether or not you have access to those means, then figuring out how to limit your access to them. For items like pills or guns, the usual recommendation is to have a trusted friend or family member store them in a safe place.
The bold headings describing each of these steps comes from the Suicide Prevention Resource Center's suicide safety plan template (PDF), which you can print and fill out.
If you are currently having suicidal thoughts or are considering self-harm, call the 24-hour Suicide Prevention Lifeline at 1-800-273-TALK (8255). They can talk you through this immediate crisis and help you find resources for coping with suicidal thoughts in the future.
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