ECG Safety Plan - Southern Version

 
 
 
 

Step 1: Warning Signs

(Thoughts, images, mood, situation, feelings, behavior) that a crisis may be developing:

 
 
 
 
 
 
 
 

Step 2: Internal Coping Strategies

Things I can do to cope with the problem by myself (relaxation, techniques, physical activity).

 
 
 
 
 
 
 
 

Step 3: People & Social Settings that Provide Distraction

 
 
 
 
 
 
 
 
 
 
 
 
 

Step 4: Professional & Agencies I can contact for help:

1. Rosecrance Crisis Line: 217-359-4141 2. National Suicide Hotline: 988 3. Suicide Hotline: 1-800-SUICIDE (784-2433) 4. Crisis Text Line: Text “HOME” to 741741 5. Regional Behavioral Health Network (RBHN): 1-866-567-2400 •Based out of LifeLinks in Mattoon; serves Clark, Coles, Cumberland, Douglas, Edgar, and Shelby counties 6. Heartland Crisis Line: (217) 342-5504 •Located in Effingham; serves Effingham and Clay counties 7. Sarah Bush Lincoln ER: (217) 258-2551 •Located in Mattoon 8. St. Anthony's ER: (217) 347-1211 •Located in Effingham 9. Paris Community Hospital ER: (217) 465-4141 •Located in Paris 10. Suicide Prevention Lifeline: 1-800-273-8255 11. Trevor Project Hotline - Crisis Intervention for LGBTQ+ youth: 1(866)488-7386

 
 

Step 5: How can I make my environment safe?

(Removing drugs, alcohol, pills, weapons).

 
 
 
 

Step 6: What is the one thing that is most important to me and worth living for?

 
 
 
 

Acknowledgement

By signing below, you agree that this form was filled out together by your therapist and yourself and you fully understand the help that is available to you.

 
 
 

Check this box to include these numbers in your copy of responses. (Once you check this box, you must also check the next box below and please enter the client's email or your email if you are the client.)