Patient Safety Plan
At Heart & Mind Counseling Services, your safety and well-being are our top priorities. A patient safety plan is a personalized, confidential tool that helps you identify warning signs, coping strategies, and trusted supports to turn to when you’re struggling. It outlines practical steps to stay safe during moments of emotional distress or crisis and connects you with professional and emergency resources.
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Whether you’re managing anxiety, depression, suicidal thoughts, or another mental health challenge, creating a safety plan with your therapist can empower you to take proactive steps toward stability and healing. Our clinicians work collaboratively with you to ensure you always have support—both inside and outside of sessions.
Step 1. Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be
developing:
1. _________________________________________________________________________________________
2. _________________________________________________________________________________________
3. _________________________________________________________________________________________
Step 2. Internal coping strategies – things I can do to take my mind off my problems
without contacting another person (relaxation technique, physical activity):
1. _________________________________________________________________________________________
2. _________________________________________________________________________________________
3. _________________________________________________________________________________________
Step 3. People and social settings that provide distraction:
1. Name ________________________________________ Phone ____________________________________
2. Name ________________________________________ Phone ____________________________________
3. Place _________________________________________ 4. Place ___________________________________
Step 4. People whom I can ask for help:
1. Name ________________________________________ Phone ____________________________________
2. Name ________________________________________ Phone ____________________________________
3. Name ________________________________________ Phone ____________________________________
Step 5. Professionals or agencies I can contact during a crisis:
1. Clinician Name _________________________________ Phone ____________________________________
Clinician pager or emergency contact # ______________________________________________________
2. Clinician Name _________________________________ Phone ____________________________________
Clinician pager or emergency contact # ______________________________________________________
3. Local Urgent Care services _________________________________________________________________
Urgent Care services address _______________________________________________________________
Urgent Care services phone ________________________________________________________________
Suicide Prevention Lifeline Phone 1-800-273-TALK (8255)
National Suicide Prevention Hotlines: Call or Text 988
Veterans Crisis Line: 1-800-273-8255, press 1
Maryland Youth Crisis Hotline: 800-422-0009
National Domestic Violence Hotline: 1-800-799-7233 (SAFE)
National Alliance for Mental Illness (NAMI):
M-F: 10 A.M. – 10 P.M., ET
Call 1-800-950-NAMI (6264)
Text "HelpLine" to 62640
Step 6. Making the environment safe:
1. _______________________________________________________________________________________
2. _______________________________________________________________________________________
The one thing that is most important to me and worth living for is:
___________________________________________________________________________________________
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Safety Plan Template ©2008 Barbara Stanley and Gregory K. Brown, is reprinted with the express permission of the authors. No portion of the Safety Plan Template may be reproducedwithout their express, written permission. You can contact the authors at bhs2@columbia.edu or gregbrow@mail.med.upenn.edu.