Safety Discussion Form

COUNSELING OFFICE OF HEIDI WEIPERT

218 S. Warren Ave; Big Rapids MI 49307; 231-683-2101
Safety Plan
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When thoughts of suicide or self-harm are overwhelming, staying safe for even short periods of time takes a great deal of strength. Right now, why do I want to stay safe? *
While I focus on safety, how can I make it harder to act on any plans I might have for suicide? (ex: Where can I put things I could use to harm myself so they are harder to get to if I am overwhelmed?)*
What coping strategies can I use? (ex: What has worked in the past? Is there anywhere I can go that will feel safe? Use the coping skill list from Heidi to consider some options.)*
What strengths do I have as a person and how might this keep you safe? (ex: What do people who care about me say about this? Am I creative? Determined? Caring? Do I have a faith in a higher power or any positive statements I use for inspiration?)*
Below is my list of 3 people I can use for support (ex: at least one adult, friends, etc.) *
-ALWAYS call 911 for all mental health emergencies!!! Mental health emergencies are urgent and may be life threatening matters. If you are unsure what to do, call 911.

-Go to the closest Emergency Department or urgent care center for a mental health crisis (MHC). A mental health crisis may not be life threatening. A MHC occurs when you cannot wait for a scheduled visit with a mental health professional. Going to the Emergency Department can help when you have a MHC and would like to talk to someone in person ASAP.

-Call or text 988, the 24-hour national suicide/mental health hotline. There are professionals on stand-by to help you for free and the help is confidential, any time you need them!
My electronic signature is agreement to this safety plan.*

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COUNSELING OFFICE OF HEIDI WEIPERT