How to write and chart a Stanley-Brown safety plan in the visit

A Stanley-Brown safety plan is a six-step worksheet you build in the visit after a risk assessment. Write warning signs, internal coping, people and places that distract, people to ask for help, professionals and agencies (including 988), and means safety in the patient’s language. Chart that a copy left with them, who else may see it, and when you will review it.

C-SSRS and risk interpretation stay in C-SSRS scoring and risk documentation. The safety plan does not replace that work. It follows it.

Complete a risk assessment first

You need a recent crisis narrative to know what the warning signs even are. C-SSRS or your equivalent, current stressors, access to means, intoxication, protective factors, and a clinical risk statement (acute and chronic).

If acute risk is high and they should not leave, the disposition is ED, voluntary admission, or mobile crisis. You can still start a plan in that setting. Do not use a safety plan as the reason a high-intent patient drove home.

Acute risk moderate. Ideation with method, no intent today. Last crisis Friday after a fight, 40 minutes of pacing with pills in hand, then slept. Protective: dog, sister, engaged in CBT. Plan indicated at this visit.

Build the six steps in the patient’s words

The official SPI steps, in order:

1. Warning signs (thoughts, moods, behaviors that mean a crisis is starting).
2. Internal coping strategies (what they can do without calling anyone).
3. People and social settings that distract (not yet “tell them I’m suicidal”).
4. People to ask for help during a crisis (named, with numbers).
5. Professionals and agencies (you, on-call, 988, local crisis, ED).
6. Means safety (what will be secured, by whom, by when).

Write their phrasing. “When I start making the playlist I only play when I want to be gone” is a warning sign. “Increased isolation” is a clinician’s summary and they will not recognize it at 1 a.m.

If a step is empty, that is clinical information. An empty internal-coping step means you stay in the room until one real action exists, or you escalate care.

Document means restriction with who does what

Step 6 is where charts go vague.

Firearms: who will store, where, cable lock vs removal from the home, by when, and whether that person confirmed. Medications: lockbox, who holds extra lithium or tricyclics, how much is in the house tonight. Alcohol and cars if those were the method.

“Discussed means restriction” is not step 6. “Sister will pick up the 9mm tonight and store it at her apartment; patient texted her in session; sister replied 18:12 confirming” is step 6.

If they refuse all means work, chart the refusal, the residual access, and whether that changes disposition.

Record copies, sharing, and the review date

Where the plan lives: photo on their phone, paper in the wallet, app, copy in the chart. Likelihood they will use it, and barriers (“I won’t call my ex, so we removed him from step 4”).

Consent to share specified lines with a partner or parent. Covering clinician notified if risk is up.

Follow-up: when you will review each step, and what would trigger an earlier review (return of intent, missed visit, drinking binge). Stanley-Brown is a living worksheet. A 2024 plan in the media tab is not today’s plan.

988 belongs in step 5 as a real number, not a footer. If a local crisis line is faster in your county, put that first.

Sample chart block

SPI completed collaboratively this visit after C-SSRS (ideation item 3,
no behavior since last visit). Copy: photo on patient's phone + PDF in
chart. Shared step 6 only with sister (consent documented).

1. Warning signs: playlist, "heavy arms," skipping work texts.
2. Internal: shower, feed the dog, 10-minute walk without phone.
3. Distract: gym front desk people; cousin Devin (not for crisis talk).
4. Help: sister Dana [phone]; friend Omar [phone].
5. Professionals: this clinic [phone]; 988; [county] crisis; ED at [hospital].
6. Means: sister taking firearm tonight (text confirmation 18:12);
   lockbox for meds; no more than 7 days of amitriptyline in the house.

Barriers: patient doubts they will call 988. Rehearsed the first sentence
in session. Review at next visit 8/24 or sooner if they miss work 2 days.

Questions people ask

Is a contract for safety enough? No. Do not substitute “patient contracted for safety” for a Stanley-Brown plan. Contracts do not tell anyone what to do at 1 a.m.

Can Aria fill the six boxes from the conversation? It can draft. You still have to check names, numbers, and whether step 6 actually happened. Wrong phone numbers are how plans fail.