If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.
A safety plan sounds clinical, but at its heart it is a short list, written while she is steady, for the moments when she is not. It holds the things she already knows help, the people she can reach, and the steps she can take when suicidal thoughts get loud.
Clinicians often build these plans with patients, and it is fine for a woman to ask for one by name.
Why it helps to write it down
In a dark moment, thinking clearly is hard. A plan written ahead of time does the thinking for her. For a woman in her forties or early fifties, who may be the one everyone else relies on, it can also be a rare thing that exists just for her.
What a plan usually includes
Plans vary, but many have parts like these:
- Her own warning signs. The thoughts, moods or situations that tend to come before a crisis, such as sleepless nights, a fight with an ex, or the anniversary of a loss.
- Things she can do on her own. A walk, a shower, a favorite playlist, sitting with the dog, writing for ten minutes.
- People and places that help. A neighbor to sit with, a coffee shop, a sister's kitchen.
- People she can ask for help. Names of two or three people she can call and say "I need you right now."
- Professionals to contact. Her clinician, her therapist, the 988 Lifeline and the nearest emergency room.
- Making the home safer. Agreeing on safe storage of medications and any firearms, or keeping them somewhere else for a while.
- Reasons to keep going. The people, plans and small joys she wants to hold onto.
Building it together
The best plans are made in her own words. A clinician can guide the conversation, ask questions she might not think of and help her be specific. She can keep a copy on her phone, one in her wallet and one with someone she trusts.
It also helps to share the plan with a partner, adult child or close friend so they know their role. They do not need every detail, just what to watch for and what to do.
Warning signs others can notice
People close to her may notice changes before she names them: talking about being a burden or trapped, withdrawing, sleeping much more or less, giving things away, or a sudden calm after a long low stretch. If you see these, ask her directly whether she is thinking about suicide. Asking does not plant the idea. It shows her she can tell you the truth.
How a plan fits with treatment
A safety plan works alongside treatment, and for some adults a clinician may discuss a treatment such as Spravato as part of that larger picture. Spravato (esketamine) is a nasal spray the FDA has approved, taken along with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is also approved for treatment-resistant depression. It is not a crisis treatment: it does not replace emergency care or a hospital stay when one is needed, and it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It is given only in a certified clinic under a safety program called the Spravato REMS. The patient takes it there under supervision, stays at least two hours to be monitored, and does not drive until the next day after a full night of sleep. It is never dispensed for home use. Whether it fits is a clinician's decision after an evaluation.
Whatever treatment she and her clinician choose, the safety plan stays in place. It is meant to be updated as her life and her care change.
A plan is a sign of hope
Making a safety plan is not admitting defeat. It is preparing for hard moments in a way that keeps her connected to people and help. People who live through dark seasons do get better, and a plan is one of the tools that helps them get there.
When she feels ready to talk about treatment, many clinics that offer this treatment begin with a free introductory talk. She can use it to learn whether an evaluation fits her situation, and she can bring both her safety plan and a trusted person along.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.