Helping Teens with Suicidal Thoughts Make a Safety Plan

For many parents, there is nothing more terrifying than hearing your teen say they are thinking of suicide. Some parents freeze. Others become reactive or even dismissive. Despite these varying responses, a common theme is not knowing what to do or how to help.

Fortunately, there are some effective strategies parents can use to help their teens when they are struggling with suicidal thoughts. An especially helpful one is creating a safety plan.

Research studies have shown a strong evidence base for safety planning in a suicidal crisis. AnneMoss Rogers’ excellent post gives a broad overview of multiple safety plans. The Stanley-Brown Safety Planning Intervention is one example. This safety plan consists of strategies and supports to use when a person is experiencing a suicidal crisis.

Safety planning calls for identifying six crucial pieces of information

1) Warning signs of a suicidal crisis

2) Coping strategies to use

3) Friends to turn to

4) Family members/adult figures to reach out to

5) Mental health providers,  hotlines, or other resources to contact

6) Ways to remove lethal means from the home.

Safety Planning for Adolescents

Safety planning may be especially useful for young people because suicidal thoughts fluctuate considerably among adolescents, and the crisis that precedes a suicide attempt is normally short-lived.

Teen suicidal behaviors are distinct from those of adults, as they tend to be more impulsive and less lethal. That’s why maintaining a safe environment and identifying specific in-the-moment coping skills are an important part of safety planning with teens.

Adults who create a safety plan might include other adults, but the involvement of parents is considered paramount with adolescents. In order for means safety to be comprehensively addressed, and for adolescents to feel fully supported, trusted adults must be an active part of the safety planning process.

The Adolescent Safety and Coping Plan

The Adolescent Safety and Coping Plan (ASCP)  is designed for teens at risk for suicide. It directly involves their parents. The plan’s goals: keep the teen safe, encourage healthy coping, and increase parent-teen communication.

Even though the Adolescent Safety and Coping Plan was designed for use following discharge from a high level of care like a hospital, it can be used in all different types of outpatient care as well. Or even no professional care at all.

Ideally, the ASCP is ideally co-created together with the teen, parent(s), and the teen’s therapist, but it’s also possible for parents and teens to create the safety plan on their own. Just follow the instructions in the manual to complete the safety plan templates.

Whether created with or without a therapist, the Adolescent and Safety Coping Plan provides a practical way for parents and teens to communicate about the teen’s safety (or lack thereof), what the teen needs, and next steps to help the teen cope and resist acting on suicidal thoughts.

How to Create an Adolescent Safety and Coping Plan

There are four steps to creating an Adolescent Safety and Coping Plan:

1. The teen, with help from parents or a therapist, creates their plan.
2. The teen also creates a Safety Scale, described below.
3. The parents create their own safety plan, too. If a therapist is guiding the process, this is done while the teen creates the Safety Scale on their own.
4. The teen and parents discuss each other’s plans. (Depending on the situation, parents might want to keep separate their own need for support to avoid burdening their child, as well as where they might store dangerous items).

The Adolescent’s Part of the Safety Plan

In their safety plan, teens think through how to soothe themselves, recognize triggers, keep themselves safe, and get help from others. Here are the different sections, along with questions you can ask to generate ideas:

• My reasons for living. Ask, “What are your most important reasons for living?” and follow it up with, “What else?” You can also ask, “What gives you a feeling of meaning or purpose in life?” and follow it, too, with “What else?” If they’re not able to answer these questions, you can dig deeper by asking, “What’s stopped you so far from acting on your suicidal thoughts?”
• My stressors and triggers. These can be whatever moves the adolescent to a more distressed or dangerous state of mind. “What things in their life are currently giving you stress?” and “What triggers you to feel unsafe or like you want to die?” Like with the previous questions, you might follow up with, “What else?”
• Ways I can help myself. These questions gets at your teen’s coping skills. Here, a “coping skill” refers to any healthy behavioral or cognitive strategy that a teen can do (physically or mentally) to reduce their level of distress: “How can you help yourself when you are starting to feel stressed, sad, or unsafe? What else?” By building and practicing these skills, teens learn to regulate their emotions and gain control over their unsafe thoughts and behaviors.
• People who can help me. To help your teen identify potential supports, ask, “Who can help you when you are starting to feel stressed, sad, or unsafe?” Probe about family, friends, and professionals. Also, inform them about the Suicide Prevention Lifeline at 988, and the 24/7 Crisis Text Line service at 741741. Even better, put the numbers – or have them put the numbers – into their phone.

  

The Safety Scale

The Safety Scale gives parents concrete information to recognize what their teen needs in the moment. The teen rates their level of safety from 1 to 6. One is safest, and six is least safe. At each level (1 through 6), teens are prompted to report on: “How I feel,” “How I act,” and “What I need.”

“How I feel”: Your teen describes their internal experience. This might include physical sensations, emotions, imagery, and negative thoughts that go with each level of the scale.

“How I act”: You and your teen identify the outward physical signs that correspond to their internal emotions, so that you can know from their behavior if they’re in distress.

“What I need”: Teens identify things they can do, and people and places who can help, for each level of their scale.

The Safety Scale provides a verbal shorthand you can use with your child: “What number are you at on the Safety Scale today?” Be prepared to have the big conversations, too, and to ask directly if they’re having suicidal thoughts.

The Parent’s Safety Plan

The parent part of the Adolescent and Safety Plan addresses ways to help their teen, including getting dangerous items out of the house or locking them up.

• Stressors and triggers. This information is copied over from what the adolescent wrote in their plan.
• How I can keep the home safe. This is particularly relevant if you own a firearm (or firearms), but parents of a teen with suicidal thoughts or urges also need to keep other dangerous items out of reach, such as medications (prescription and over-the-counter), knives, household cleaners, and alcohol. Ideally, firearms will be removed from the home altogether or stored unloaded in a locked safe, cabinet, or room, with ammunition stored separately. You can also look into devices that make the firearm inoperable when locked, like a cable lock or a trigger lock. For common household items that you need access to regularly, you might want to buy a small safe – Amazon sells them for as low as $30.

• What I [the parent] can do. After you and your teen have created your own safety plans, discuss together what you can do to help them when they’re starting to feel stressed, sad, or unsafe. Also, go over their Safety Scale together so you can know other ways to help, too.
• People who can help. This is where you think through who can help you when you’re concerned about your child. Think about family, friends, and professionals. Also, you can record 988 and the text line 741741 in your phone, too.

Using the Safety Plan

Once the safety plans, including the safety scale, are done, it’s a good idea to take pictures of the items and save them to your phone. You can save them as well, or you can send them the photos.

Discuss with your teen what might make it easier to use the plan, along with what might make it harder. Try to problem-solve together any obstacles.

Turning to the safety plan when it’s needed may take effort, at first. It’s new. Keep in mind it’s a work in progress. It can – and should – be revised if it’s not working well.

Hopefully, in time, steps in the safety plan will become healthy habits for coping and survival.

_{© 2024 Kimberly O’Brien, PhD, LICSW. All Rights Reserved. Written for Speaking of Suicide.}