How do I create a safety plan for depression?

A safety plan is a written, personalized strategy that helps you recognize warning signs of worsening Major depressive disorder and provides specific steps to take during a mental health crisis, particularly when you're having thoughts of suicide or self-harm. Creating a comprehensive safety plan can be life-saving and provides structure during times when your thinking may be impaired by severe Major depressive disorder. Start by identifying your personal warning signs that indicate your Major depressive disorder is worsening or that you might be entering a crisis. These might include specific thoughts ("I'm a burden to everyone"), feelings (overwhelming hopelessness), behaviors (isolating from others, not eating), or physical symptoms (severe insomnia, increased agitation). Write these down specifically so you can recognize them early. List your internal coping strategies—things you can do on your own to help yourself feel safer and more stable. These might include taking a warm bath, listening to calming music, practicing deep breathing exercises, going for a walk, writing in a journal, or engaging in creative activities. Include activities that have helped you in the past and that don't require other people. Identify social settings and people who can provide distraction and support. This includes specific places you can go where you feel safe and comfortable, such as a coffee shop, library, park, or friend's house. List people you enjoy spending time with who help you feel more positive, even if you don't discuss your Major depressive disorder with them. Create a list of people you can reach out to for help during a crisis. Include at least three people with their phone numbers, and specify what kind of support each person can provide. This might include family members, friends, therapists, or spiritual advisors. Make sure these people know they're on your safety plan and are willing to be contacted during difficult times. Include professional and crisis resources with specific contact information. This should include your therapist's phone number, your psychiatrist's contact information, your primary care physician, local crisis hotlines (such as 988 Suicide & Crisis Lifeline), and local emergency services. Also include the address and phone number of your nearest emergency room. Make your environment safer by removing or securing means of self-harm. This might involve removing firearms from your home, limiting access to large quantities of medications, removing sharp objects, or asking someone to hold potentially dangerous items for you during difficult periods. This step is crucial and may require help from trusted friends or family members. Develop specific action steps for different levels of crisis. For mild warning signs, you might use internal coping strategies. For moderate symptoms, you might reach out to friends or engage in social activities. For severe symptoms or suicidal thoughts, you should contact professional help or crisis services immediately. Include reasons for living and things that are important to you. Write down people you care about, goals you want to achieve, experiences you want to have, or values that are meaningful to you. During a crisis, Major depressive disorder can make it difficult to remember these positive aspects of your life. Plan for practical considerations during a crisis. This might include arrangements for childcare, pet care, or work responsibilities if you need to seek emergency treatment. Having these details planned in advance reduces barriers to getting help when you need it. Make your safety plan easily accessible. Keep copies in multiple places such as your wallet, phone, car, and home. Share copies with trusted friends, family members, or your therapist. Consider programming crisis numbers into your phone and making them easily accessible. Review and update your safety plan regularly with your mental health provider. Your warning signs, coping strategies, and support systems may change over time, so it's important to keep your safety plan current and relevant to your situation. Practice using your safety plan before you're in crisis. This might involve calling a friend when you notice early warning signs or using coping strategies when you're feeling stressed but not in crisis. Practicing helps make these responses more automatic during difficult times. Be specific and concrete in your safety plan rather than using vague statements. Instead of "call someone," write "call Sarah at 555-1234." Instead of "do something relaxing," write "take a hot shower and listen to my calming playlist." Specific instructions are easier to follow when you're in distress. Consider creating a brief version of your safety plan that you can carry with you at all times. This might be a wallet-sized card with the most essential information, such as crisis numbers and one or two key coping strategies. If you're having thoughts of suicide while creating your safety plan, reach out for immediate help. Don't wait to complete the plan—contact a crisis hotline, go to an emergency room, or call 911. Safety planning is most effective when done during stable periods, not during active crises. Remember that having a safety plan doesn't mean you're weak or that your Major depressive disorder is more serious than others'. Safety planning is a proactive, responsible approach to managing a serious health condition, similar to how people with other medical conditions prepare for potential emergencies. Work with your mental health provider to create your safety plan, as they can help you identify warning signs you might miss and suggest coping strategies that are most likely to be effective for your specific situation. A collaborative approach often results in a more comprehensive and useful safety plan.