3. Suicide and Self-Harm - Fighting back against suicidal thoughts

Fighting back against suicidal thoughts: Seven steps to creating your personal safety plan

One of the best ways to prepare for times when thoughts of suicide become overwhelming is to create a personal safety plan. Your safety plan is a written road map for times when you're fighting against the urge to end your life. Choose a day when you have hope for life, or at least when you aren't overwhelmed by suicidal thoughts. Then, sit down with your counselor, a pastor, or a friend you can trust, and write out a plan to keep you alive. You can make it all in one sitting, or work on it over time. Make changes whenever you need to. Here are seven steps to creating your personal safety plan.

Step 1: Know your warning signs.
To find your warning signs, ask yourself: What kinds of situations, thoughts, feelings, behavior patterns, or sensations in your body do you feel when you're not doing well and may start thinking of suicide? Do you:

• Start to get in more fights with your family?
• Work such long hours that you miss food or sleep?
• Fall behind on school or work projects?
• Stay in bed much longer than usual?

Whatever your warning signs, watch for them. When they pop up, move on stage two of your plan. It's also helpful to tell loved ones, mental health professionals, and other people you trust about your warning signs so they can support you even when you haven't yet realized you need help.

Step 2: Choose coping strategies you can use on your own.
The second stage of your personal safety plan should be a list of things you can do without reaching out to others. Ask yourself: What can I do to distract, relax, or soothe myself? What kind of physical activity can I do? The goal is to steer your mind away from suicidal thoughts.

• Can you watch a funny movie to distract yourself?
• Would a jog or bike ride help you feel different?
• Would some stretches or a bath with essential oils be relaxing?

Work with your counselor, friend, or support system to choose strategies that have worked for you before, or that you feel will work well in the future. You can use these coping strategies when you have mild suicidal thoughts or even when you notice warning signs. This may be all you need, but when your coping strategies aren't quite enough, it's time to implement part three.

Step 3: Think of people and places that take your mind off suicide.
Make a list of the places you can you go that help you feel more grounded, or people you can call, text, or meet up with to feel better

• Do you like going to the park? Zoos? The movies?
• Who can you text to get your mind off your feelings
• Is there a friend you can meet for coffee or lunch?

At this phase, you are looking for friends or places to distract you from your suicidal thoughts. If distraction isn't enough and you need to find a safe person, go to the next step.

Step 4: Name the people you can call in a crisis.
Make a list of friends, family members, or spiritual leaders who you feel safe talking to when your suicidal thoughts are intense, and you don't believe you can cope on your own. Include contact info for your people in the safety plan, so you don't have to search for phone numbers next time a suicidal crisis strikes.

• Who in your family can you talk to in a crisis? Parents? Siblings? Others?
• Which friends can you trust to be safe for you if you need to talk at a crisis moment?
• Who else can you call? Is there a leader at your church that you trust?

Remember that if your contacts don't pick up right away, they still care about you. If you aren't able to reach anyone, or if you talk with someone and need more support, move on to part five.

Step 5: List mental health providers and crisis phone numbers.
In addition to family and friends, you'll want to make a list of mental health professionals, hospitals, and your therapist, with their contact information and the hours when businesses are open. Also, include 24-hour crisis hotlines so that you have someone to talk with at any hour. In a crisis, you'll want these numbers easy to find.

• What's your therapists' work phone? Cell phone? What times can you call?
• What is the closest hospital to you? What are its hours?
• 24-hour hotlines: 1-800-273-8255 in the US, (1.833.456.4566 in Canada).

Step 6: Make your environment safe.
Ask yourself: Which items around your house would you use if you tried to end your life? Or, if you have tried to kill yourself in the past, what did you use? Make sure all of these items, along with any accessible firearms, are safely locked away with someone other than you guarding the key. Don't wait to experience further suicidal thoughts to implement your safe-environment plan. Get those dangerous items out of your reach as soon as possible.

• Do you have any guns around the house? Give them to a friend, if local laws allow, or lock them up safely and have someone else take charge of the keys. Do the same with knives, rope, and anything you might be tempted to use as a weapon when suicidal thoughts attack.
• Do you take medication that could be dangerous in more substantial doses? If so, can a family member keep the bottle locked away and set out your daily doses for you?
• What else around your house might be dangerous for you? Work with your friend or therapist to make a plan for each item of concern, and to make sure there's nothing you've missed.

Special note on firearms: If you have access to a gun, getting it out of your reach is critical to your safety. People who try to kill themselves without a firearm die only 5 percent of the time – that means 95 percent of people who try to die from suicide without a gun can still experience the joy of living! But people who try to end their lives with a firearm die 90 percent of the time. Guns are extremely unsafe for people at risk of suicide. Make sure any firearms in your house are given to a friend or locked away so you cannot reach them. Talk with your therapist and the local police department about the gun laws in your area, so your lifesaving plan is both safe and legal.

Step 7: Remember your reasons to live.
When you're in a crisis, and any other time too, remind yourself of the beautiful parts of life– why you want to keep on living. Write those reasons down in your safety plan so that when depression and hopelessness say you have nothing to live for, you'll know the truth. Ask your friends for help and come up with as many reasons to live as you can. And as you feel better, you'll be able to add more. These reasons are a weapon to fight lying suicidal thoughts.

• Who do you love? Your family? Your friends? A beloved pet? Write them down. You want to live so you can take care of those people, and experience more of their lives.
• What do you enjoy doing? Or, if depression has sapped those feelings away for now, what did you use to enjoy? If you used to love painting, write it down.
• Imagine yourself feeling well enough to enjoy making art again. You can get there.
• What are the beautiful moments in life? Do you love hiking in nature? Sitting on the seashore? Shopping with friends? What can you look forward to?
• Make room for unexpected blessings. Life may seem dreary right now, but none of us know what the future holds. Imagine that the rest of your life is a gift that God wants to give you. Choose to live so you can see what's inside that gift.

Read through your reasons to live whenever suicidal thoughts strike, and any other time, as often as you want to. It's helpful to remind yourself of the beauty in life. You'll be able to experience that beauty so much more once your depression recedes.

Recovery will take time. You may not feel better right away. But with treatment, and patience, your depression, and the desire to end your life, will lessen, and then finally fade away. Until that happens, know you aren't alone, and hang on. You're stronger than this!