Coping

in a Crisis

Resources for suicide prevention

and coping during covid19
sara m. williams, phd candidate, mssw, csw
suicide prevention
compassion and community
Suicide is the 2nd leading cause of death for individuals aged 15-34 and the 10th
leading cause of death overall. On average, one suicide occurs every 11.7 minutes
in the U.S., with approximately 25 attempts occurring for every suicide death.*

warning signs of suicide warning signs of acute risk

Expressed or Communicated Ideation
I Suicide ideation • Threatening to hurt or kill themselves
Increased substance use • Talking of wanting to hurt or kill themselves
S • Looking for ways to kill themselves, such as seeking

• Talking or writing about death, dying, or suicide

P Sense of purposelessness

A Anxiety, agitation, sleep changes

What to do if you're concerned
T Feeling trapped
Ask. Are you okay? How can I support you?
H Hopelessness
Have an open, honest conversation.
• Talk to them in private.
• Listen to their story.
W Withdrawal from friends/family • Tell them you care about them.
• Ask them directly if they’re thinking about suicide or
A Rage, uncontrolled anger taking their life.
• Encourage them to seek treatment or contact their
R Acting reckless therapist/doctor.
If the person says they are considering suicide:
M Dramatic mood changes • Take them seriously.
• Stay with them.
? • Help them remove lethal means.
• Call the Suicide Prevention Lifeline (1-800-273-8255)
or text the Crisis line (741-741) for support from a
Suicide prevention is trained counselor.
• Go with them to the nearest Emergency Room or
everyone’s business. mental health services

Crisis Resources
National Suicide Prevention Lifeline 1-800-273-8255 | TTY 1–800–799–4889
Crisis Text Line Text “Home” to 741741
Trans Lifeline 1-877-565-8860
The Trevor Project 1-866-488-7386 | Text “Trevor” to 1-202-304-1200 | Chat @ thetrevorproject.org
Veterans Crisis Line 1-800-273-8255 and press 1

Learn More
American Association of Suicidology www.suicidology.org
American Foundation for Suicide Prevention www.afsp.org
National Instititue of Mental Health www.nimh.nih.gov/health/publications/suicide-faq

Resources/FactSheets/2013datapgsv2alt.pdf
Resource developed by Sara M. Williams, MSSW, PhD Candidate
Digital version available at bit.ly/smwresources
One mindful minute

If you are able, Stand up and/or stretch. breathe. Feel your connection to the earth.
Tune in to your body. Lower your gaze. Scan your body and notice physical sensations
or emotions. Discharge any unpleasant sensations, emotions or feelings on the out
breath. Notice any pleasant ones and let them fill you up on the in breath.
Observe. Lift your eyes and take in your surroundings. Observe something in your
environment that is pleasant and be grateful for it and its beauty.
Possibility. Ask yourself what is possible or what is new or what is a forward step.

If you find yourself being reactive, try the following steps:

Pause and take one to three big breaths.
Say “step back.” ( You don’t have to physically step back, you can just do it in your
mind.)
Say “clear head.”
Say “calm body.”
Breathe again. Say “relax,” “melt” or “ease.”

17
 ffFor methods with low lethality, clinicians may ask patients to remove
or limit their access to these methods themselves.
ffRestricting the patient’s access to a highly lethal method, such as
a firearm, should be done by a designated, responsible person –
usually a family member or close friend, or the police. Safety Planning
WHAT ARE THE STEPS AFTER THE PLAN IS DEVELOPED?
Guide
ASSESS the likelihood that the overall safety plan will be used
and problem solve with the patient to identify barriers or
obstacles to using the plan. A Quick Guide for Clinicians
DISCUSS where the patient will keep the safety plan and how it may be used in conjunction with the “Safety Plan Template”
will be located during a crisis.
EVALUATE if the format is appropriate for patient’s capacity and
Safety Plan FAQs?
circumstances. WHAT IS A SAFETY PLAN?
A Safety Plan is a prioritized written list of coping strategies and
REVIEW the plan periodically when patient’s circumstances or
sources of support patients can use who have been deemed to be at
needs change. high risk for suicide. Patients can use these strategies before or during
a suicidal crisis. The plan is brief, is in the patient’s own words, and is
remember : the safet y plan is a tool to engage the patient and easy to read.
is only one part of a comprehensive suicide care plan
WHO SHOULD HAVE A SAFETY PLAN?
Any patient who has a suicidal crisis should have a comprehensive
THE WICHE Center for Rural Mental Health Research is supported by the Federal Office suicide risk assessment. Clinicians should then collaborate with the
of Rural Health Policy, Health Resources and Services Administration (HRSA), patient on developing a safety plan.
Public Health Services, Grant Award, U1CRH03713
HOW SHOULD A SAFETY PLAN BE DONE?
Safety Planning is a clinical process. Listening to, empathizing with,
and engaging the patient in the process can promote the development
Western Interstate Commission for Higher Education of the Safety Plan and the likelihood of its use.
3035 Center Green Drive, Suite 200 Boulder, CO 80301-2204
303.541.0200 (ph) 303.541.0291 (fax)
IMPLEMENTING THE SAFETY PLAN
www.wiche.edu/mentalhealth/
There are 6 Steps involved in the development of a Safety Plan.

Safety Planning Guide ©2008 Barbara Stanley and Gregory K. Brown, is reprinted with the express permission
of the authors. No portion of the Safety Planning Guide may be reproduced without their express, written
permission. You can contact the authors at bhs2@columbia.edu or gregbrow@mail.med.upenn.edu. Western Interstate Commission for Higher Education
 I le enting t e Safety Plan
Ste P ess
Step Warning Signs
ffAsk How will yo now when the safety plan sho ld be sed?
ffAsk What do yo e perien e when yo start to thin abo t s i ide
or feel e tremely depressed?
ffList warning signs thoughts, images, thinking processes, mood, and
or behaviors using the patient’s own words.
Step Internal Coping Strategies
ffAsk What an yo do on yo r own if yo be ome s ididal again to
help yo rself not to a t on yo r tho ghts or rges?
ffAssess likelihood of use Ask How li ely do yo thin yo wo ld be
able to do this step d ring a time of risis?
ff f doubt about use is e pressed, ask What might stand in the way of
yo thin ing of these a ti ities or doing them if yo thin of them?
ff se a collaborative, problem solving approach to address potential
roadblocks and alternative coping strategies.
Step So ial Conta ts Who May Distra t from the Crisis
ff nstruct patients to use Step if Step does not resolve the crisis or
lower risk.
ffAsk Who or what so ial settings help yo ta e yo r mind off yo r
problems at least for a little while? Who helps yo feel better when
yo so iali e with them?
ffAsk for safe places they can go to be around people i.e. coffee shop .
ffAsk patient to list several people and social settings in case the first
option is unavailable.
ffRemember, in this step, the goal is distraction from suicidal thoughts
and feelings.
ffAssess likelihood that patient will engage in this step potential
obstacles, and problem solve, as appropriate.
Step Family Members or Friends Who May Offer Help
ff nstruct patients to use Step if Step does not resolve crisis or lower
risk.
ffAsk Among yo r family or friends who do yo thin yo o ld
onta t for help d ring a risis? or Who is s pporti e of yo and
who do yo feel that yo an tal with when yo ’re nder stress?
ffAsk patients to list several people, in case one contact is unreachable.
Prioritize the list. n this step, unlike the previous step, patients reveal
they are in crisis to others.
ffAssess likelihood patient will engage in this step potential
obstacles, and problem solve.
ffRole play and rehearsal can be very useful in this step.
Step Professionals and Agen ies to Conta t for Help
ff nstruct the patients to use Step if Step does not resolve the crisis
or lower risk.
ffAsk Who are the mental health professionals that we sho ld
identify to be on yo r safety plan? and Are there other health are
pro iders?
ffList names, numbers and or locations of clinicians, local urgent care
services.
ffAssess likelihood patient will engage in this step potential
obstacles, and problem solve.
ffRole play and rehearsal can be very useful in this step.
Step Ma ing the En ironment Safe
ffAsk patients which means they would consider using during a suicidal
crisis.
ffAsk Do yo own a rearm s h as a g n or ri e?? and What
other means do yo ha e a ess to and may se to attempt to ill
yo rself?
ffCollaboratively identify ways to secure or limit access to lethal means
Ask How an we go abo t de eloping a plan to limit yo r a ess to
these means?
 Patient Safety Plan Template
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_____________________________________________________________________
4. Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255)

Step 6: Making the environment safe:

1. _____________________________________________________________________________________________
2. _____________________________________________________________________________________________
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 reproduced
without their express, written permission. You can contact the authors at bhs2@columbia.edu or gregbrow@mail.med.upenn.edu.

The one thing that is most important to me and worth living for is:
________________________________________________________________
A PLAN FOR COPING WITH DISTRESS, STRESS, AND DIFFICULT EMOTIONS
When you are feeling distressed or upset, it is extremely helpful to have a plan for coping
and managing those feelings. When you are feeling okay, make this plan and keep it with
you so when you need it, you’ll have it! (You can keep it in your bag, wallet, or even take
a photo to save on your phone!)
DEAL
Questions to ask yourself:
What are some signs I’m feeling out of control?
What do I need to do to stay safe?
What have I done in the past that has helped?
What would I say to a close friend who was feeling this way?
What will I tell myself (as alternatives to the negative thoughts)?
What will I do to help calm myself?
TO

Who can I call? What do I want out of the phone call?

What could others do that could help?
Here are some example coping strategies and activities:
Text/call/snapchat a friend Exercise -- do yoga, go for a walk Gratitude journal
HOW

Journal for a few minutes
Draw, color, paint, or craft
Listen to music
Play music
Play a game on phone
Watch a funny video/show/movie
Do a mindfulness exercise
Play with pet
Organize a drawer
Bake or cook something
Write yourself a love letter
Put together a puzzle
Look at memes
Go to a coffee shop or park
Make a list of goals

MY COPING PLAN
I WILL COPE, CALM, AND SOOTHE MYSELF BY:

I WILL TELL MYSELF:

IF THESE AREN’T HELPING ME FEEL BETTER. . .

I WILL CALL: I WILL GO TO:

If your coping activities are not helping, call a help or crisis line, go to the emergency room, or call 911.
National Suicide Lifeline: 1.800.273.8255 Trans Lifeline: 1.877.565.8860
TTY: 1.800.799.4889 Crisis Text Line: Text “home” to 741741
Veterans Crisis Line: 1.800.273.8255 press 1 Trevor Project: 1.866.488.7386
(C) Sara M. Williams, 2019
 PLEASANT ACTIVITIES LIST:
PANDEMIC EDITION
Sorting vacation photos Buying, selling stock
Going on a virtual date Doodling
Relaxing Exercising
Watching a movie Thinking about buying things
Jogging, walking Having discussions with friends
Thinking, “I put in a full day’s work Riding a bike
today” Singing around the house
Listening to my favorite music Arranging flowers
Thinking about past parties Practicing religion
Buying household gadgets online Organizing tools
Lying in a sunbeam Going to the beach
Planning a career change Thinking, “I’m an OK person”
Laughing Having a day with nothing to do
Thinking about past trips Reuniting with old class mates on
Listening to other people social media
Reading magazines or newspapers Painting
Engaging in hobbies (model building, Doing something spontaneously
knitting, etc.) Doing needlepoint, crewel, etc.
Planning a day’s activities Sleeping
Meeting new people online Listening to an audiobook
Remembering beautiful scenery Driving
Saving money Thinking about getting married
Drawing a “tattoo” on myself Taking a sauna or a steam bath
Writing a song parody Thinking about having a family
Going “home” from “work”: shutting Dancing
down email, changing shirt Thinking about happy moments in
Eating my childhood
Sewing Splurging
Practicing karate, judo, yoga Doing something new
Thinking about retirement Working on jigsaw puzzles
Repairing things around the house Playing cards
Working on my machines Soaking in the bath
Remembering the words and deeds Thinking, “I’m a person who can
of loving people cope”
Deep clean appliances Taking a nap
Wearing shocking clothes Figuring out my favorite scent
Having quiet evenings Making a card and sending it to
Cuddling my pet(s) someone I care about
Taking care of my plants Instant-messaging/texting someone

By Dr. L. Gollino, C.Psych. Adapted from Linehan, M. (2015). DBT skills training handouts and worksheets (2nd ed.).
New York: The Guilford Press.
 Playing a board game Looking at the moon or stars
Putting on favorite clothing Taking an online class
Drinking a smoothie slowly Outdoor work in my yard (cutting or
Thinking, “I am doing well right now” chopping wood, farm work)
Putting on makeup Creating memes
Working on my car Sorting clothes
Planning how to get out of debt Playing in the sand, a stream, the
(applying for funding, creating a grass; kicking leaves, pebbles, etc.
budget etc.) Protesting social, political, or
Thinking about a friend’s good environmental conditions
qualities Reading cartoons or comics
Completing something I feel great Reading sacred works
about Thinking how it will be when I finish
Surprising someone with a favor school
Surfing the Internet Dying my hair
Playing video games Creating art with photography
E-mailing friends Rearranging or redecorating my
Planning a career room or the house
Going walking or sledding in a Thinking about how much I’ve grown
snowfall Snowmobiling or riding a dune
Trimming my own hair buggy/ ATV
Solving riddles Writing silly poems
Installing new software Social networking
Buying music Soaking in the bathtub
Watching sports on TV Learning or speaking a foreign
Meditating language
Following an online tutorial Dressing up my pet(s)
Taking care of my pets Talking on the phone
Doing volunteer service Composing or arranging music
Watching funny videos/comedies Baking
Working in my garden Browsing Wikipedia
Blogging Sorting your change
Fighting for a cause Playing a math game
Conducting experiments Making paper dolls
Putting lotion on myself/others Telling a joke
Expressing my love to someone Teaching someone something new
Going on nature walks, exploring Making someone laugh
(hiking away from known routes) Telling someone about my day
Playing a visual/spatial game Doing my nails
Political discussions with friends Asking someone about their day
Joining or forming a band Colouring
Learning to do something new Checking in on people who are sick,
Listening to the sounds of nature isolated, or in trouble

By Dr. L. Gollino, C.Psych. Adapted from Linehan, M. (2015). DBT skills training handouts and worksheets (2nd ed.).
New York: The Guilford Press.
 Showing off my collection ___________________
Planning an ideal vacation
Playing dress-up ___________________
Browsing daily deals on online stores ___________________
Listening to a podcast
Watching roller coaster videos ___________________
Browsing e-books in the library ___________________
Discovering new music
Reflecting on my own past kindness ___________________
Trying out a new free App ___________________
A virtual evening with good friends
Watching the helpers ___________________
Being a helper ___________________
Sending someone a gift
Turning something old into ___________________
something new ___________________
Lighting a candle and focusing on
the flame ___________________
Kissing ___________________
Hanging out on the balcony
Having virtual family get-togethers ___________________
Going camping in my backyard ___________________
Researching the history of something
that I own ___________________
Starting an online group chat ___________________
Join an online club
Watching nature videos ___________________
Playing a word game ___________________
Ordering from a new restaurant
Livestream myself playing music ___________________
Posting pictures of my pet(s) ___________________
Going swimming in a private pool
Cutting paper with scissors ___________________
Putting something in my window for ___________________
neighbours to see
Reading fiction ___________________
Following a recipe ___________________
Other ideas: ___________________
___________________ ___________________
___________________ ___________________
___________________ ___________________
By Dr. L. Gollino, C.Psych. Adapted from Linehan, M. (2015). DBT skills training handouts and worksheets (2nd ed.).
New York: The Guilford Press.