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The safety plan: what it is for and how to build it

· By The Orekio team

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The safety plan is a brief, structured tool built by two, for people who are going through, or at risk of going through, a suicidal crisis. It is prepared calmly, during a quiet consultation, in the patient's words, so it is available when they need it.

An action plan, rather than a promise

The safety plan differs from the "no-suicide contract". Asking the patient to commit to not making a suicide attempt has no demonstrated protective effect, and can strain the alliance (Rudd, Mandrusiak and Joiner, 2006). The safety plan works the other way round: rather than a promise, it provides a sequence of concrete, ranked actions to try as tension rises.

The method is the Safety Planning Intervention of Stanley and Brown (2012). It was evaluated, combined with telephone contact afterwards, in a cohort of 1,640 patients seen in the emergency department (Stanley et al., 2018); the measured effect concerns suicidal behaviours, not ideation, and it is not demonstrated for a plan used on its own.

Its six steps

In Orekio, the six steps carry the titles the patient reads on their screen (the wording is Orekio's; Stanley and Brown's original form is protected, the method is not):

  1. Warning signs: how I feel when a crisis is approaching.
  2. Internal calming strategies: what I can do on my own to calm down, without contacting anyone.
  3. People or places for distraction: who to see, where to go to take my mind off things, without having to say that I feel bad.
  4. People close to me to contact: who can listen to me and help me if I feel in danger, with their number.
  5. Professionals and emergencies: which professionals or services to contact.
  6. Keeping at a distance what could hurt me: what I have decided to move away, how, and until when.

Each line is written with the patient, in their words, with their real contacts. For step 6, the app never names, lists or suggests a means: the patient writes what they are keeping at a distance, the way and the deadline, in a full sentence, and these measures are presented as temporary.

What Orekio does with it, and what belongs to you

In Orekio, the plan is a module you open and build with the patient in consultation. You can both write, edit and complete it; each line carries its author and its date, and you see what has changed since your last shared review. Afterwards, the patient has it permanently on their phone, pinned at the top of their home screen, outside the list of other tools, readable without a network. A single large card, "I feel bad", opens the pathway: someone who feels bad should not have to choose.

The contacts of steps 4 and 5 can be reached with one gesture, without the number appearing on screen. The 3114, France's national suicide prevention number, free and open 24 hours a day, is recalled under each list of contacts, and an emergency sheet, reachable without going through the pathway, brings together the 3114, the 15 (112 in Europe) and the 114 by text message for people who are deaf or hard of hearing.

When the patient opens their plan, nothing is recorded: neither the moment, nor the duration, nor what they read. No one is informed, not even you. This is deliberate: an opening counter would be a risk indicator, and a month at zero would falsely reassure. The pathway never asks the patient to assess their state.

Alongside the six steps, the patient has two spaces that are never passed on to you: their reasons to hold on, photos each accompanied by a sentence, and an anchor sentence shown at the end of the pathway. You know they exist, never what they contain. It is the only Orekio module where part of what the patient writes is, by design, invisible to you.

Another particularity deserves to be said: the plan is the only module that is not subject to the patient's sharing consent, because it is built by two and hiding it would take away from you what you wrote yourself. The patient is told so where they write.

Orekio makes the plan available, and nothing more. Consistent with its status as a digital logbook, not a medical device (see About): risk assessment and care remain yours.

In practice

The plan benefits from being reviewed: after a crisis, after a change in circumstances, or simply at regular intervals, and Orekio lets you date that review. A version using the informal "tu", with more concrete titles, exists for adolescents; it is you who switch it on. The Grounding, Breathing and Distress tolerance modules are often opened alongside, as a toolkit for step 2. A safety plan supports care, without replacing it.

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