Safety Planning at the Emergency Room
When a young person visits the emergency room (ER) because of suicidal thoughts or actions, a safety plan must be created before they leave the hospital. A safety plan is a written guide that helps youth, family, and care team know what to do to stay safe and what to expect if another crisis occurs.
1. Purpose of a Safety Plan
A safety plan:
- Helps your child and family recognize when risk is increasing.
- Lists practical steps and supports to reduce danger.
- Provides phone numbers, coping ideas, and people to call.
- Ensure everyone understands how to respond if warning signs return.
This plan is personal—it should use your child’s own words and be simple enough for anyone involved to understand.
2. Who Participates
The plan is created together by:
- Your child or teen (their voice leads the plan)
- Parents or caregivers
- A crisis worker, nurse, or therapist
- Anyone else who will help at home (family, close friends, babysitters, etc.)
Make sure every person who helps your child knows their role and has a copy of the plan. Keep one posted in an easy-to-find place, such as on the refrigerator.
3. What the Plan Should Include
Below are the main steps most safety plans follow. The crisis worker can help your child fill them in:
1. Warning Signs
- What thoughts, feelings, or behaviors show that a crisis may be coming?
- (Example: not sleeping, feeling hopeless, avoiding friends).
2. Coping Strategies
- What can your child do on their own to feel calmer?
- (Example: listen to music, walk outside, use deep breathing, write in a journal).
3. Social Distractions and Supports
- Who or what helps take their mind off unsafe thoughts?
- (Example: spending time with a friend, playing with a pet, visiting a favorite place).
4. People to Contact for Help
- Family or friends your child trusts and can reach anytime.
- Include names and phone numbers.
5. Professional and Crisis Contacts
- Therapist, doctor, or local crisis team.
- Call or text 988 for the Suicide & Crisis Lifeline (24/7).
- Oregon YouthLine: 877-96808491 | Text “teen2teen” to 839863.
6. Making the Home Safe
- Remove or lock up anything that could be used in a suicide attempt: firearms, medications, alcohol, sharp objects, ropes, cleaning chemicals, and cords.
- If your child has used something before, make sure it is no longer accessible.
4. Adding Family and Caregivers
A complete plan also lists:
- How parents or family will recognize warning signs that the youth may not notice.
- What kinds of words, gestures, or support help your child most.
- What is not helpful or could make things worse (for example, yelling, blaming, or pressuring).
- Who will call 988, a doctor, or emergency services if your child cannot do it themselves.
- How the household will stay safe—including plans for siblings, pets, and caregivers.
5. After the Hospital
Safety planning does not end when you leave the ED. The plan should:
- Be reviewed often and updated with your child’s therapist or doctor.
- Change as your child’s recovery progresses.
- Be revisited whenever stress increases or new triggers appear.
Encourage your child to help revise it—this builds confidence and ownership over their safety and wellbeing.
6. Remember
- A safety plan is not just paperwork — it’s a living agreement that everyone uses.
- Keep extra copies in your phone, care, or wallet.
- If you ever feel unsure, call 988 or your local crisis line immediately.
FAQs
What if I don’t agree with the safety plan? What if I feel I can’t enforce the safety plan?
A safety plan only works if it is realistic.
If you don’t agree or can’t enforce it:
- Say what parts will not work and why
- Ask to change it before you leave
- Ask for added supports, like follow-up calls, mobile crisis, or peer support
You should never be given a plan that:
- Relies only on you when you are overwhelmed
- Asks you to do things that are not safe or possible
- Ignores your concerns
The hospital social worker gave us a safety plan, but I know it won’t work. How can I receive more help with the plan before we leave?
Before discharge, you can ask for:
- A revised safety plan
- More supports added
- Clear follow-up appointments
- Crisis numbers written down
- A warm hand-off to services
Say:
“I am worried this plan will not keep my child safe. I need more help before we leave.”