If a crisis is happening now, do not stop to fill this in. If anyone is in immediate danger, has made an attempt, or has taken something to cause harm, call 911, even if they seem fine right now. For a mental health crisis without immediate danger, call or text 988. You can call on someone else’s behalf.
What this is for
A personal safety plan belongs to the person in crisis. This sheet is for everyone else in the house. It answers the questions that are hardest to answer at 3 a.m.: who do we call, what are they taking, which hospital, and who picks up the kids.
- Fill it in with the person, not about them. Their wishes go first. If they will not sit down for it yet, fill in the parts that are just facts (numbers, medications, who covers the kids) and leave box 2 for them.
- Write phone numbers, not names alone. Scrolling a contact list with shaking hands takes longer than you expect.
- Ask each clinician’s office what to do after hours, and write the answer down.
- Update it after every crisis and whenever a medication or clinician changes.
The guide Helping someone in a mental health crisis explains when to call 911 versus 988 and what to say while you wait. If box 5 stalls because nobody knows what a psychiatric advance directive is, read the guide to psychiatric advance directives first.
Early warning signs we have seen before
What it looked like last time, in order if you can. Examples: stopped sleeping, stopped answering texts, talked faster, said “I can’t do this anymore.”
What they want us to do when we see those signs
In their words. Examples: “Ask me directly.” “Call my therapist before you call anyone else.” “Don’t call my mother.”
Clinicians and after-hours instructions
Therapist, psychiatrist or prescriber, primary care. For each: phone, and what their office said to do after hours.
Diagnoses, medications and allergies
Current medications with doses, anything stopped recently, drug allergies. Emergency staff will ask for this.
Hospital and crisis preferences
Preferred hospital or crisis center, places to avoid and why, and whether they have a psychiatric advance directive (where it is kept).
Who covers what if they need to go to the hospital
Children, pets, work or school, rent and bills, their phone and keys. One name per job.
Who we call
Immediate danger, an attempt, or anything taken to cause harm: 911, even if they seem fine right now. Mental health crisis: call or text 988 (veterans press 1), or text HOME to 741741. Accidental poisoning or a medication mix-up, if they are awake and breathing normally: Poison Control 1-800-222-1222.
Local mobile crisis team (ask 988 if there is one): ______________________ · Nearest emergency room: ______________________
Copies with: ____________________ ____________________ ____________________ · Worksheet from mhrecovery.ai
Make it findable
Keep one copy on the fridge or inside a kitchen cabinet door, one photo on the phone of each person listed in box 6, and one with the person’s own safety plan. The sheet lists diagnoses and medications, so let the person decide where the paper copy goes. A cabinet door is still easy to reach, and guests will not read it.
This worksheet is an educational tool, not a substitute for care from a qualified clinician. If you or someone else is in immediate danger, call 911. For a mental health crisis, call or text 988.