Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Convert a depression-specific suicide formulation into a usable collaborative plan, reduce access to relevant means, provide active follow-up through high-risk transitions and escalate when current intent or impairment makes community planning unreliable.
Start from a formulation, not a template. Define the feared outcome, likely trigger, method, timeframe and sequence from first warning sign to action. Ask what the person notices in thoughts, body, behaviour, sleep, internet use, substance use and social contact. Choose internal coping that has previously created distance from action, such as moving rooms, grounding, music, delaying access or a short task. These steps support time but do not replace treatment or professional help when danger is high.
Build outward in layers. Identify safe places or activities, then specific people for distraction and people who can hear suicidal thoughts. Confirm who is awake, reachable and willing at the relevant time. Add GP, crisis team, local urgent line, emergency department and 999 in escalating order, with exact contact details and transport. A supporter should know warning signs and when to seek emergency help but should not become the sole untrained observer or medicine custodian without agreement.
A personal change in sleep, isolation, agitation, searching, substance use or medicine handling reliably precedes stronger intent and enables earlier action.
The person can perform a specific brief action independently that reduces intensity or creates time before contacting another person.
The method in the formulation remains immediately available despite verbal willingness, requiring concrete storage, supply or environmental change.
Discharge, rejection, bereavement, court event, antidepressant change or loss of support creates a foreseeable period needing increased contact.
Intent, impairment or environment prevents use of coping and contact steps, making urgent supervised assessment the safer route.
A rehearsed sequence allows action during cognitive narrowing without requiring the person to generate options at peak hopelessness.
Creating delay between impulse and method can allow distress to fall or another person to intervene even before mood improves.
Non-attendance may reflect deterioration, shame, executive impairment, transport or unsafe monitoring and requires curiosity rather than punitive closure.
Relatives can contribute but need permission, training, rest and professional backup and should not carry sole responsibility for survival.
A plan built for discharge may become obsolete after a move, relationship change or prescription refill and needs rapid revision.
Using a promise not to self-harm as evidence that discharge is safe.
Writing call for help without named contacts, hours, transport and alternatives.
Leaving the anticipated method accessible while discussing only coping strategies.
Treating family as unlimited observation without checking willingness and safety.
Scheduling routine distant follow-up despite ongoing concerns after self-harm.
Closing care automatically after missed contact during a high-risk transition.
Transferring a low-risk label instead of scenarios, actions and responsibility.
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After an episode of self-harm, which element most clearly distinguishes a collaborative suicide safety plan from a no-harm contract?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Follow-up is part of protection. NICE recommends initial aftercare within 48 hours when ongoing safety concerns remain after self-harm. Depression treatment reviews may need one-week timing after antidepressant initiation for younger adults or particular suicide concern. Contact should assess intent, means, activation, akathisia, sleep, adherence, psychosis, function, support and use of the plan. Missed contact is clinical information: check safety and barriers rather than closing the referral automatically.
Escalate when the plan is unusable. Intoxication, psychosis, severe agitation, intent with means or unsafe accommodation may require emergency or inpatient care. Assess decision-specific capacity and voluntary options, then use jurisdiction-correct law only if criteria are met. At transfer, confirm acceptance, transport and observation and communicate physical findings, medicines, dependants, legal status and warning signs. Review the plan after each crisis and remove steps that proved inaccessible or shaming.