Suicidal Thoughts and Crisis Support

A safety plan is a short written list, kept somewhere easy to find, that you can follow when thinking clearly is hard. It works best when it is made with a healthcare professional, crisis worker or trusted supporter, rather than alone, and it should be personal to you.

A useful plan usually includes:

• Personal warning signs — the thoughts, feelings, situations, times of day or anniversaries that tend to come before things get worse.
• Things that help you pause safely — steps that have helped before, without pretending they replace urgent help.
• People and places that support you — names, numbers, and places where other people are around.
• Professional and crisis contacts — GP surgery, crisis team, care coordinator, NHS 111 or the urgent route for your nation, and listening services.
• Making your surroundings safer — practical steps agreed with someone you trust, such as asking a relative to look after medicines or particular items for a while.
• Reasons for staying alive — people, animals, responsibilities, beliefs, places or future events that matter to you. Some people include photographs.
• What to do if the plan is not working — the exact next step, ending with 999 if you cannot stay safe.

Keep it somewhere easy to reach: a phone note, a purse or wallet, the fridge door. Share a copy with somebody you trust if you can. Review it after a crisis, after a hospital stay, after a medication change or after any major life change.

A safety plan is not a contract and nobody should ask you to sign one. Signing a promise does not prove anybody is safe, and it must never replace proper assessment and care.

Take every disclosure seriously, however it is worded. Listen calmly, do not punish, and do not treat it as attention-seeking.

• Call 999 for immediate danger, or go to A&E.
• Use the urgent NHS mental health route for your nation for same-day advice.
• Involve a parent, carer or another safe adult — unless doing so could place the child at greater risk, for example where the home may be the source of harm.
• Contact children's social care or the police where abuse, exploitation, neglect or unsafe care is suspected.
• Speak to the school or college safeguarding lead, who can arrange support and referrals.
• Ask the GP about a referral to child and adolescent mental health services (CAMHS), or the equivalent service in your nation.
• Childline: 0800 1111 for anyone under 19, free and available day and night.
• HopeLine 24/7 (Papyrus) supports young people under 35 and anyone worried about them: call 0300 102 2470 or text HOPE to 88247, 24 hours a day.

Never assume that a parent or home is automatically safe. If a young person is frightened of the adults around them, safeguarding services need to know.

Not everyone who self-harms intends to die. For many people it is a way of coping with unbearable feelings. That does not make it minor: self-harm deserves medical and emotional support, and it is associated with an increased risk of suicide, so it should never be dismissed or treated as attention-seeking.

Get urgent medical help — 999 or A&E — for a serious injury, bleeding that will not stop, any overdose or poisoning (even if the person feels well), loss of consciousness, difficulty breathing, seizures or severe confusion. Some overdoses cause serious harm hours later, so never wait.

For ongoing support, speak to a GP or the urgent mental health route for your nation. Treatment should include an assessment of what is driving the self-harm, not just wound care.

Alcohol and drugs lower inhibition, deepen low mood and make impulsive acts far more likely. Someone who feels able to stay safe when sober may not be able to after drinking. If you are supporting someone who has been drinking or using drugs and they are talking about suicide, treat the risk as higher, not lower.

Withdrawal from alcohol, opioids and some prescribed medicines can also cause severe distress and needs medical support rather than sudden stopping at home.

If suicidal thoughts start or get worse after starting, stopping or changing a medicine, get urgent professional advice the same day.

Most hospital admissions for mental health are voluntary: the person agrees to stay, takes part in decisions about treatment, and can discuss leaving with the team.

Sometimes a person can be assessed or kept in hospital without their agreement, but only where strict legal criteria are met, and the law is different in each part of the UK:

• England and Wales — the Mental Health Act 1983 (as amended). See the NHS starting point below.
• Scotland — the Mental Health (Care and Treatment) (Scotland) Act 2003. The Mental Welfare Commission for Scotland explains rights and safeguards.
• Northern Ireland — separate mental health and mental capacity legislation. See nidirect for the official starting point.

Detention is not a punishment and it is not a criminal matter. Anybody detained must be told why, what will happen, how long it may last, how to appeal, and how to get independent advocacy. Family and carers can ask for information about the process even where clinical details stay confidential.

Sometimes people leave an appointment feeling unheard. If that happens, and you or the person you are supporting is still unsafe:

• Say the words explicitly: “I am having suicidal thoughts.”
• Say plainly whether you feel able to keep yourself safe today.
• Ask for the decision and the reasons for it to be recorded in your notes.
• Ask who to contact if things get worse, and write the number down before you leave.
• Ask for another assessment, or for a senior clinician to review the decision.
• Contact 111 or your nation's crisis route again if the danger changes.
• Call 999 if the person becomes unable to stay safe.

Complaints and advocacy matter, but they are for afterwards. Never wait for a complaint response during a crisis. Our Free Letter and Complaint Support page can help you raise concerns once the immediate danger has passed.

You can ask services to make the process easier. Ask early, and ask for it to be written into your care record so you do not have to repeat yourself:

• a quieter waiting area, or somewhere with less noise and light
• an interpreter, or British Sign Language support
• easy-read information
• extra time to process questions, and questions asked one at a time
• written follow-up, so you are not relying on memory
• a trusted supporter, advocate or family member present
• contact by text, email or a phone call at an agreed time instead of a letter
• a note in the care plan about how you communicate best

Services should consider reasonable adjustments and often can make them, but they cannot always provide every request exactly as asked, particularly at short notice in an emergency. Ask what they can offer instead.

Distress can be misread as “just part of the condition”, and standard assessments can rely on eye contact, tone of voice or emotional expression that do not apply to everyone. It is fine to say, “I may not look distressed, but I am not safe.” Ask for adjustments, and bring a supporter who can help explain if that is easier.

Ask for easy-read information, simple direct questions, extra time and a supporter or advocate. Carers and support workers can help describe changes in behaviour, sleep, appetite or routine that may show distress. Annual health checks are also a good place to raise mental health.

Ask for a BSL interpreter, and use text-based routes where they help: Shout offers free 24/7 text support (text SHOUT to 85258), and SignHealth provides Deaf-led mental health support. Emergency SMS to 999 is available in the UK if you register your phone in advance.

Low mood, pain, bereavement, isolation and loss of independence are often dismissed as a normal part of ageing. They are not. Ask the GP for a proper review, including physical causes, medicines and hearing or sight problems that increase isolation. Home visits and telephone appointments can be requested.

Discrimination, rejection, hostility and having to explain yourself repeatedly all add weight. You are entitled to respectful care, to have your identity and pronouns recorded correctly, and to ask for a different clinician if you are treated poorly. Specialist LGBTQ+ listening services exist alongside NHS routes.

Abuse, coercive control and financial control can make life feel inescapable. Safety planning must take the abuser into account — including phone and device safety. The 24-hour National Domestic Abuse Helpline is 0808 2000 247. In immediate danger call 999; if you cannot speak, dial 999, listen, and press 55 when prompted from a mobile.

Grief can bring thoughts of not wanting to carry on, particularly after a sudden death, a death by suicide, or the loss of a partner or child. This deserves support rather than silence. Our Bereavement page and bereavement services can help alongside urgent mental health routes.

Exhaustion, no breaks and no recognition wear people down. Carers can ask their local council for a carer's assessment, ask the GP to record them as a carer, and use carer support services. Asking for help does not mean you are failing the person you care for.

Practical crises often sit underneath suicidal thoughts. Free debt advice can pause collection activity and reorganise repayments; councils have duties towards people at risk of homelessness; benefit decisions can be challenged. These problems can be improved, usually faster than people expect.

Fear of judgment, previous poor treatment, language barriers and worries about how services will respond can all delay help. You can ask for an interpreter, ask for a different clinician, bring somebody with you, and ask for your concerns to be recorded. Community-based and culturally specific services exist in many areas.

Leaving service, injury, trauma and loss of identity and structure can hit hard. In England, Op COURAGE is the NHS veterans' mental health service; equivalent arrangements exist across the UK. Families can also seek advice.

The days and weeks after leaving are a high-pressure period, often with housing, money and isolation problems at once. Ask for a written follow-up plan before discharge or release, with named contacts and dates. If follow-up does not happen when promised, chase it — and use urgent routes in the meantime.