JOURNEY

HEALTH & HOPE

TOWARD

A

A JOURNEY TOWARD HEALTH AND HOPE H i

Your Handbook for Recovery After a Suicide Attempt

This booklet is a guide to help you take the first steps toward recovery 

after your suicide attempt. The tools and stories it contains come from the 

experiences of others, some named, some anonymous, who have survived a 

suicide attempt. It is our hope that their experiences can help you keep yourself 

safe, develop hope, and, most importantly, remind you that you are not alone.

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Division of Prevention, Traumatic Stress, and Special Programs

Suicide Prevention Branch

JOURNEY

HEALTH & HOPE

TOWARD

A
A JOURNEY TOWARD HEALTH AND HOPE H ii

Acknowledgements

This booklet was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) 

by Gallup, Inc. and Shari Sinwelski, M.S./Ed.S., and the Didi Hirsch Suicide Prevention Center’s Suicide 

Attempt Survivor Support Group, under contract number HHSS28320070231/HHS23800001T with 

SAMHSA, U.S. Department of Health and Human Services (HHS). Nainan Thomas, Ph.D., served as 

Government Program Officer and Eileen Zeller, M.P.H., served as Task Order Manager. 

Disclaimer

The views, opinions, and content expressed herein are the views of the authors and do not necessarily reflect 

the offical position of SAMHSA or HHS. Nothing in this document constitutes a direct or indirect endorsement by 

SAMHSA or HHS of any non-federal entity's products, services, or policies, and any reference to non-federal 

entity's products, services, or policies should not be construed as such. The information presented in this 

document should not be considered medical advice and is not a subsitute for individualized patient or client care 

and treatment decisions.

Public Domain Notice

All material appearing in this report is in the public domain and may be reported or copied without 

permission from SAMHSA. Citation of the source is appreciated. However, this publication may 

not be reproduced or distributed for a fee without the specific, written authorization of the Office of 

Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at http://store.samhsa.gov/SMA-15-4419 or by 

calling SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727).

Recommended Citation

Substance Abuse and Mental Health Services Administration. A Journey Toward Help and Hope: Your 

Handbook for Recovery After a Suicide Attempt. HHS Publication No. SMA-15-4419. Rockville, MD: Center 

for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2015.

Originating Office

Suicide Prevention Branch, Center for Mental Health Services, Substance Abuse and Mental Health 

Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, HHS Publication No. SMA-15-4419. 

Printed 2015.
A JOURNEY TOWARD HEALTH AND HOPE H iii

Contents

How Did It Get to This Point? .................................................................................Page 1

Terry’s Story. Page 2

What Am I Feeling Right Now?.Page 3

Am I the Only One Who Feels This Way?.Page 4

Jordan’s Story .............................................................................................. Page 5

Taking the First Steps.Page 6 

Talking With Others About Your Attempt........................................................Page 7

Re-establishing Connections.Page 10

Planning To Stay Safe. Page 11

Finding a Counselor. Page 17

Getting What You Need From Counseling.Page 18

If You Don’t Go to Counseling......................................................................Page 19

Moving Toward a Hopeful Future.Page 21

Maintaining Hope.Page 21

Staying in Control by Being Organized.Page 21

Getting in Touch With Your Spirituality .........................................................Page 22

Maintaining a Healthy Lifestyle .....................................................................Page 22

Taking Medication.Page 23

Advocating for Others To Support Your Recovery.Page 24

Hopes for a Safe Journey.Page 25

Sample Safety Plan 1.Page 26

Sample Safety Plan 2 (Keeping Yourself Safe)......................................................Page 28

Places to Get More Information.Page 30

References ............................................................................................................Page 33

Appendix—Additional Acknowledgments .............................................................Page 34
A JOURNEY TOWARD HEALTH AND HOPE H 1

How Did It Get to This Point?

The time right after your suicide attempt can be the most confusing and emotional part of your entire life. In some 

ways, it may be even more difficult than the time preceding your attempt. Not only are you still facing the thoughts 

and feelings that led you to consider suicide, but now you may be struggling to figure out what to do since you 

survived.

It’s likely that your decision to try to kill yourself didn’t come out of the blue. It probably developed over time, 

perhaps from overwhelming feelings that seemed too much to bear. Experiencing these emotions might have been 

especially difficult if you had to deal with them alone. A variety of stressful situations can lead to suicidal feelings, 

including the loss of a loved one, relationship issues, financial difficulties, health problems, trauma, depression, or 

other mental health concerns. It’s possible that you were experiencing some of these problems when you started 

to think about suicide.

While the events that lead to a suicide attempt can vary from person to person, a common theme that many 

suicide attempt survivors report is the need to feel relief. At desperate moments, when it feels like nothing else is 

working, suicide may seem like the only way to get relief from unbearable emotional pain.

Just as it took time for the pain that led to your suicide attempt to become unbearable, it may also take some time 

for it to subside. That’s okay. The important thing is that you’re still here; you’re alive, which means you have time to 

find healthier and more effective ways to cope with your pain.

Survivor Stories

“Life became like an endurance test. That’s really how it felt. It felt like life was an 

endurance test for me. And making it to the next day and to the next day and to the 

next day was truly...it was just a fight for survival.”

—Terry Wise

“It felt like there was still a hole inside of me, and I couldn’t figure out why I had a lack 

of motivation to get out of bed, why I was randomly crying. So when I was 16, I was 

going to school with a mask on my face, acting and pretending as though I was really 

happy with the things that were going on around me.”

—Jordan Burnham

“I could not feel hope; I did not even care if things would get better; I was in pain and I 

wanted it to stop, period.”

—Cathy Singer

“I thought, well yeah, maybe, maybe the family’s better off without me. So the entire 

day this thought began to build and dwell and it escalated very quickly...and when the 

pain got real bad I was going to do what I needed to do, not thinking that they loved 

me.”

—David Lilley
A JOURNEY TOWARD HEALTH AND HOPE H 2

Terry's Story

On the morning of December 25, 2000, Terry Wise tried to kill herself. She awoke two days later in the intensive 

care unit. The death of Terry’s husband from Lou Gehrig’s disease was a trigger for her suicide attempt. But in 

reality, her attempt was the culmination of years of depression and other problems that started in her childhood. 

Terry was overwhelmed by an intense emotional pain that had been building for years, and when her husband died, 

the pain became unbearable. For Terry, suicide felt like a way to end the pain. Terry explains:

Suicide doesn’t stand alone. It doesn’t just happen as the result of nothing out of nowhere; 

it’s the result of something. My husband’s illness and death really became the catalysts that 

brought a lot of other things to the fore front that I had been grappling with my whole life. 

If you’ve gone through your life and you’ve had traumas, or you’ve had difficulties or you’ve 

had things that you think you have buried and then you have a significant loss or a significant 

trauma occur later in your life as I did with my husband dying, all the things that have been on 

simmer in your life come to a full boil.

Right after Terry tried to kill herself, she felt lost. She didn’t know what to do. She found no joy in living. Terry 

went to therapy, and ultimately it changed her life. By working with a counselor, Terry realized that the trauma she 

experienced when she was younger still affected her emotions as an adult. Her counselor helped her find ways to 

cope with her feelings. Therapy also allowed her to see how others would have reacted to her death by suicide. 

Most importantly, Terry’s therapist trusted her and respected her, and for Terry, her therapist’s compassion made a 

huge difference.

Terry’s recovery was a process. It took time and hard work. Terry recalls:

And that is really the first step, to go from feeling that life is an endurance test to being able 

to tolerate being alive. And then you hope that the unendurable becomes bearable. Then 

you hope the bearable becomes manageable. Then you hope the manageable becomes 

pleasurable. And so it’s a process. It evolved over time.

Now, Terry is a well-known writer and public speaker whose mission is to educate others about suicide prevention. 

She finds fulfillment in traveling the country to share her story and help others who are struggling with suicide. Terry 

has learned ways to cope with negative emotions and enjoy life.

For help in developing your own strategies to cope with negative emotions, see pages 10–16.

Watch Terry tell her inspirational story at: http://www.suicidepreventionlifeline.org/learn/video
A JOURNEY TOWARD HEALTH AND HOPE H 3

What Am I Feeling Right 

Now?

Right now, you’re probably experiencing many conflicting emotions. 

You may be thinking:

• “Why am I still here? I wish I were dead. I couldn’t even do this 

right.”

• “I don’t know if I can get through this. I don’t even have the 

energy to try.”

• “I can’t do this alone.”

• “How do I tell anyone about this? What do I say to them? What 

will they think of me?”

• “Maybe someone will pay attention to me now; maybe someone 

will help me.”

• “Maybe there is a reason I survived. How do I figure out what 

that reason is?”

Right after a suicide attempt, many survivors have said that the 

pain that led them to harm themselves was still present. Some felt 

angry that they survived their attempt. Others felt embarrassed, 

ashamed, or guilty that they put their family and friends through a 

difficult situation. Most felt alone and said they had no idea how to 

go on living. They didn’t know what to expect and even questioned 

whether they had the strength to stay alive. Still others felt that if 

they survived their attempt, there must be some reason they were 

still alive, and they wanted to discover why.

You’re probably experiencing some of the same feelings and may 

be wondering how others have faced these challenges. The next 

section provides some examples of the steps others found helpful in 

recovering from a suicide attempt.

My Feelings

You may want to note how you feel 

today, so you can come back later and 

see how you are progressing in your 

recovery.

How am I feeling now?

 Afraid  In pain

 Angry  Lonely

 Ashamed  Numb

 Depressed  Overwhelmed

 Dread  Relieved

 Grateful  Tired

 Guilty  Other

 Hopeful

It is normal to feel several conflicting 

emotions after your suicide attempt. 

Whatever you are feeling is okay, but 

it’s important to find ways to deal with 

negative emotions so that you are able 

to stay safe.

What do I need and want?

	Not to return to the hospital

	Relief from depression

	Relief from distressing voices

		A life without alcohol or other

drug problems

	Financial help

	A place to live

	A trusted friend

	Better relationships with:

 Parents

 Spouse/partner

 Friends

 Sisters and brothers

 Co-workers

	Hope for the future

	Other: 

Know that you can have 

these things.
A JOURNEY TOWARD HEALTH AND HOPE H 4

Am I the Only One Who Feels This Way?

Knowing how others made it through can help you learn new ways to recover from your own suicide 

attempt. 

It’s estimated that more than one million people attempt suicide each year in the United States, from all parts of 

society. In other words, you’re not alone. However, it can be hard to know how other survivors recovered because 

suicide is a personal topic that often is not discussed openly and honestly. This can leave those affected feeling like 

they don’t know where to turn.

Shame, dreading the reaction of others, or fear of being hospitalized are some of the reasons that prevent people 

from talking about suicide. This is unfortunate, because direct and open communication about suicide can help 

prevent people from acting on suicidal thoughts. Hopefully, reading about the experiences of other survivors in this 

booklet will make it easier for you to talk about your own attempt, learn ways to keep yourself safe, know when to 

ask for help, and most importantly, find hope as you think about what happens next on your journey.

It’s okay if you feel conflicting emotions right now. Other suicide attempt survivors know that what you’re 

experiencing is normal. They understand that your concerns are real. Going on won’t be easy, and finding a way to 

ease your emotional pain may be challenging, but this can be a time to start down a new path toward a better life—

to start your journey toward help and hope.

Those who have recovered from a suicide attempt want you to know that:

You are not alone. You matter. Life can get better. It may be difficult, but the effort you invest in your 

recovery will be worth it.

Right now, moving forward may seem impossible. And while it probably won’t be easy, many other survivors will 

tell you that they’re glad they held on and worked for a better life. By taking a few steps now, and then a few more 

when you’re ready, you can regain your strength.

Sometimes it can be helpful just to take a few steps forward, even when you don’t feel like it. In fact, you might 

start to remember that others care about you. You might discover that suicide is not the only way to relieve your 

pain. You may find that your feelings will change, either on your own or by working with a counselor. You could 

wake up one day surprised to feel less pain than you do today.

Survivor Stories

“After my attempt I needed to be able to talk and be heard—not counseled, not 

encouraged—to really be listened to, like what I had to say was the most important 

thing in the world at that moment, for someone to connect to my pain without losing 

control of themselves.”

—Cathy Singer

(After my attempt) “I felt exhausted. I felt empty: What now? I soon felt angry. As I told 

a therapist, staying alive means that now I have to rationalize being a loser, a failure. 

That is the way you can think sometimes.”

—Cara Anna
A JOURNEY TOWARD HEALTH AND HOPE H 5

Jordan's Story

Jordan was only 16 when he was diagnosed with depression. He was popular and had almost everything he 

wanted; yet there was still a hole in his life. Jordan said that he hated himself. As an African-American, he felt that 

he didn’t fit in with the mostly white students in his school, and he felt like a failure if he didn’t get the grades he 

and his parents wanted him to achieve. He went to therapy for his depression before attempting to kill himself, but 

he didn’t talk honestly with his therapist.

He didn’t take his medications consistently and kept his drinking problem a secret. After his suicide attempt, he 

ended up in a hospital. He was in a coma, and his doctors didn’t know if he would survive. When Jordan woke up, 

he had to heal physically and went through the pain of learning to walk again. He decided to be at peace with the 

way things were. He knew he had a second chance at life, and he felt he should get better so he could help others.

Jordan saw a psychiatrist who helped him choose treatment options, including medication to treat his depression. 

They worked together to adjust and manage his medications, talk about his problems, and help him learn how 

to cope with depression. Jordan explained that therapy taught him more about himself and what he could do to 

make himself feel better. For Jordan, this meant learning how to have a healthy emotional balance, including being 

around other people and working out regularly. He is now a motivational speaker, traveling across the country and 

telling his story to help others. Jordan finds great satisfaction in letting youth know that they’re not alone with their 

problems. He takes pride in helping others speak up when they need help.

I have the same depression that I had before, but the way that I cope and deal with it is in a much more 

positive way than I did before. I don’t have thoughts of wanting to try and take my own life. Do I question, 

you know, how I am going to get through this day and why am I here? Yeah, I definitely have thoughts of 

that. But what I do with those thoughts is different.

An important part of Jordan’s recovery was understanding his diagnosis, finding ways to cope with his depression, 

and learning how to live a healthy, productive life. It can be difficult to open up and accept help in our society, but 

taking this first step can be very important in your recovery.

What support do you need right now? What might make it easier for you to get it?

You can hear more about Jordan’s recovery at: http://www.suicidepreventionlifeline.org/learn/video
A JOURNEY TOWARD HEALTH AND HOPE H 6

Taking the First Steps

Making big changes right now might be out of the question for you. You may not even know where to begin. That’s 

okay. Recovery is a process, and it’s important that you move at your own pace. There are a few things you might 

want to do to ease your transition back to everyday life. Some important steps that others have found helpful are listed 

below. You’ll find additional information about each of these steps on the following pages.

First, it might be less stressful to decide in advance how to deal with others’ questions about your 

suicide attempt. The people around you may be surprised by your suicide attempt and have questions or 

comments about what happened. Thinking about what you might say in advance can help you prepare for their 

reactions.

Second, re-establishing connections may help you feel better. Often, the stress or depression that leads to a 

suicide attempt can cause people to disconnect from others who care about them or the things they used to enjoy 

doing. Reconnecting with the people and things you love or loved can help instill hope.

Third, because suicidal thoughts might return, you’ll want to be prepared with a plan to stay safe. A 

safety plan is a tool that can help you identify triggers (like events or experiences) that lead to suicidal thoughts and 

can help you cope if the pain that led to your suicide attempt returns.

Fourth, finding and working with a counselor can help you start to recover. Unlike friends or family, a 

counselor is an unbiased listener who won’t be personally affected by your suicide attempt. The counselor’s role 

is to help you sort through your feelings and find ways to feel better. You may find it helpful to use this booklet with 

your counselor to begin discussing your experiences and feelings about your suicide attempt. A counselor can be 

a peer supporter, psychiatrist, social worker, psychologist, or other skilled person. If counseling isn’t possible, there 

are also ways you can help yourself, but please remember that you don’t have to go through this alone. (See page 

17, Finding a Counselor.)

Survivor Stories

“There are a lot of things that happen in your life that you have no choice over. But the one 

thing that can never be taken away from you is your ability to choose how to respond.”

—Terry Wise

“The hospital was the first place where I felt like I could acknowledge my illness, to 

myself and to others. Even knowing I had depression, they still saw me as a human 

with great potential. That led me to understand that seeking help would not lead to 

me becoming defined by my depression, as I had feared. It inspired me with the most 

basic conviction that I was inherently worthy of health and happiness, regardless of 

what others thought of me.” 

—Misha Kessler

“When I woke up in the hospital, I didn’t feel positive about life. But I watched TV a lot 

and saw stories about people who went through worse than I had. It inspired me to 

stop focusing on what l couldn’t do and start focusing on what I could do.”

—Suicide Attempt Survivor
A JOURNEY TOWARD HEALTH AND HOPE H 7

Talking With Others About 

Your Attempt 1

One of the most difficult tasks you might face will 

be responding to the questions people ask about 

your suicide attempt. The shame, guilt, confusion, 

and other emotions that might follow an attempt 

can make it tough to speak about it with others, 

especially if people respond in a way that doesn’t 

feel supportive.

Often, those closest to you may be feeling lots 

of emotions about your attempt. They may be 

scared, confused, or angry about what happened, 

causing them to focus on their own feelings, rather 

than being as supportive as you need them to be. 

Their reactions might hurt you, whether they mean 

to or not.

To make it easier, here are some suggestions that 

can be helpful:

It’s your story to tell, or not.

The details of your experience are personal, and 

it’s up to you to determine what you want to share 

and with whom. Sharing what happened with your 

doctors, nurses, counselor, or peer supporters 

can help them give you the right kind of support. 

In most cases, they’re required to keep the details 

of what you share confidential.

You may want share some of the details and your 

feelings about what happened with other people 

you trust, such as family or friends. How much you 

share, or the details you decide to give, are up to 

you and what you feel comfortable with.

1

 Adapted from Bryan and Cunningham (2009)

Answering Tough 

questions

Potential tough questions/reactions to plan for:

• I heard you were in the hospital. What was the 

matter?

• Did you really try to kill yourself?

• How could you do this to me?

• Things could never be that bad.

• How did you do it?

• What happened after you tried it? 

• Was it something I did to you?

• Why didn’t you trust me and tell me what was 

going on?

Practice what you want to say when: 

You don’t want to talk:

• “You’re so thoughtful to worry about me, but I’d 

rather not talk about it right now.”

• “Even though I’ve been through a tough time, 

I’m getting better.”

• “I know you’re trying to be helpful, but it’s hard 

to understand if you haven’t experienced the 

kind of pain that led me to attempt suicide.”

• “I appreciate your concern, but I’m just not 

ready to talk about it yet.”

You want to reach out:

• “The most important thing for me right now is 

knowing that people still care about me.”

• “You could be really helpful by being there for 

me as I recover.”

• “I just need you to listen to me without judging 

me for what happened.”

• “Right now, I need people to help me stay safe. 

Can I count on you?”

Add your own words:
A JOURNEY TOWARD HEALTH AND HOPE H 8

People don’t always say the right things.

It’s difficult to predict how people will respond when they learn that you tried to kill yourself. Some people might 

change the subject or avoid the topic altogether because of their fear of death or suicide. Others who are close 

to you may be confused, hurt, or angry about what’s happened. They may judge or blame you. They may feel 

betrayed or be wondering what they could have done to prevent you from attempting suicide.

Often, those who care the most about you have the strongest reactions to your suicide attempt because 

they can’t imagine life without you. It’s helpful to remember that a strong reaction may reflect your family’s or 

friends’ depth of concern about you.

Sometimes you may feel that they’re being overly controlling. It may seem like they’re watching everything you do 

or won’t leave you alone because they’re afraid you may attempt suicide again. This can be very frustrating when 

you’re trying to recover from an attempt.

It can take time to repair the trust in your relationships. If you can show that you’re committed to safety, it might allow 

those close to you to feel more comfortable giving you the space you need. Completing a safety plan, like the ones 

on pages 26–29, can help you show those who are worried about you that you want to stay safe.

Learning more about suicide can help the people who care about you be more supportive. If they better 

understand what led to your suicide attempt, they might be better able to give you what you need, especially if you 

communicate your needs in a clear and direct way. 

Because this booklet contains general information about suicide attempts, you might want to give loved ones their 

own copies. It may help them understand some of the feelings that led to your suicide attempt and enable them to 

support you more effectively.

Survivor Stories

“Attempt survivors most want and need someone they can just talk to who will listen 

and let them mull things over without rushing to intervene. They are looking for 

someone who can understand and make them feel valued.”

—Heidi Bryan

“When I had these suicidal thoughts, I didn’t know how to talk to anyone because I 

figured I was the only one who had those thoughts and emotions and if I told someone, 

I just figured that the automatic reaction would be I’d have to go to a psych ward.”

—Jordan Burnham
A JOURNEY TOWARD HEALTH AND HOPE H 9

Direct communication may help you get what you need.

While it may be hard for you to talk about what happened, 

it is also important for you to try your best to be direct in 

communicating what you need. It may seem obvious to you, 

but others may not understand or know the best way to 

support you. This period can be challenging because you 

might want to ask people for help, but you don’t want to scare 

anyone if you’re still struggling. This is especially true if you’re 

concerned that people might overreact and insist on care in 

a hospital when you believe you just need more support and 

understanding.

A system for monitoring the intensity of your suicidal thoughts, 

should you have them, can help you notice if things are getting 

better or worse. It can also help you communicate how much 

assistance you need from those supporting you. Using a scale 

from 1 to 5 (with 1 being minimal distress or no thoughts of 

suicide and 5 being extreme distress and thoughts of imminent 

suicide) can make it easier to express how you’re feeling. The 

tips on this page provide additional ideas on asking for help.

Take note of not only what’s going on around you and through 

your mind when you’re at a “4” or a “5,” but also when you’re at 

a “1” or a “2.” These may be the situations, people, or strengths 

that will help you get through the hard days.

Support can make things easier.

It might be hard at first, but having someone you feel comfortable talking to after your attempt is very important. 

You may face some challenges as you move forward; knowing there is at least one person you can turn to will 

make the road to recovery less daunting. Being alone with suicidal thoughts can be dangerous. Having supportive 

people around you and educating them on how to help you can be a crucial part of staying safe.

Ask yourself, “What do I need from a support person?”

Different people need different things after a suicide attempt, so make sure the person you choose meets your 

unique needs. Maybe you need someone who will listen to you without judgment, or maybe you need someone 

who will come and be with you when you’re feeling alone. Perhaps it would be helpful to have someone close to 

you who can go with you to appointments, or perhaps you want to schedule regular phone calls with a trusted 

friend. No matter what kind of assistance you need, it’s helpful to have at least one person with whom you can 

share your thoughts of suicide—someone who will stay calm and help you when you need support. Once you 

know what you need, it may be easier to find someone to help. And remember, because you might not get 

everything you need from one person, it can be helpful to have a variety of people available to support you, 

if possible.

Tips for Asking 

for Help

When you ask for help, let people know 

you are dedicated to safety but need their 

assistance to maintain that commitment. 

For example:

“Mom, I want to keep myself safe, 

but I am feeling really depressed right 

now. Do you think we can just talk for 

a while?”

Be direct. It may seem obvious to you 

that you need support, but others may 

not understand or know how to help you. 

Asking for what you need specifically can 

help others respond appropriately.

“I’ve been having a hard time figuring 

out how to get to my doctor’s 

appointment. Could you help me?”

Know the strengths and limitations of the 

people in your support system. It’s good 

to know who can help you with what.
A JOURNEY TOWARD HEALTH AND HOPE H 10

Re-establishing Connections

It’s likely that the overwhelming life events, stress, and depression that led to your suicide attempt affected your 

ability to enjoy life. Struggling with suicidal thoughts can be exhausting and leave you with little energy to do the 

things you once loved. It also can put stress on your relationships with friends and family. The irony of depression 

and suicidal thinking is that they may cause you to give up the things in life that help you feel better, just when you 

need them the most.

Establishing Your Connections

It may be hard to answer some of these questions right now. It’s okay if you can’t answer them immediately.

WHO ARE THE IMPORTANT PEOPLE IN MY LIFE? (Friends, family, colleagues, counselors, clergy, pets, etc.) 

WHAT ARE MY PLANS FOR THE FUTURE? WHAT THINGS HAVE I ALWAYS WANTED TO DO IN LIFE? 

WHAT HAVE I COME TO BELIEVE ABOUT SUICIDE? 

WHAT ARE THE THINGS I CHERISH IN LIFE?

WHAT THINGS DO I ENJOY DOING? WHAT DID I USED TO ENJOY? 

WHAT GIVES ME A SENSE OF PURPOSE IN LIFE?

WHAT ARE MY OTHER REASONS FOR LIVING?
A JOURNEY TOWARD HEALTH AND HOPE H 11

Even up until the moment of their attempts, many suicide 

attempt survivors report that there was an internal 

struggle going on inside them. One side argued that 

suicide was the best way to end the pain they were 

experiencing. The other side struggled to find another 

way to feel better. To put it another way, most people with 

suicidal thoughts had reasons for dying AND reasons for 

living.

Before your suicide attempt, you might have lost connections to your reasons for living, but it’s important to 

re-establish those connections because they can help 

instill hope. They can remind you about the things you love 

in life. The exercise on the previous page will help you 

consider reasons for living. Personalizing this can help 

remind you of where you were before you started to feel 

suicidal and where you would like to be again.

Planning To Stay Safe

You might still have thoughts of suicide after your 

attempt, even if you’ve decided that you want to stay 

alive. Perhaps the pain that led to your suicide attempt 

is still there. It’s okay to have suicidal thoughts. Everyone 

needs to feel relief from unbearable pain, and suicidal 

thoughts may be one of the ways you’ve learned to cope. 

What’s important is that you don’t act on those thoughts 

and that you try to find other, safer ways to ease your 

pain. A safety plan can help you do this.

What is a safety plan?

In times of trouble, you may not see that you have options 

other than harming yourself. A safety plan is a written list 

of coping strategies and resources to help you survive a 

suicidal crisis. A safety plan can help you discover other 

ways to ease your pain so you don’t feel tempted to act 

on suicidal thoughts you may experience.

Your plan will be a personalized list of strategies to help 

you cope. You can use these strategies before or during 

a suicidal crisis. By writing them down, you’ll always know 

what they are, even if you’re upset or not thinking clearly.

You can complete your plan by yourself or with the 

help of a counselor, peer, family member, or friend. The 

following pages will help you brainstorm elements of your 

safety plan.

Things to Think 

About

What Do I Write in My Safety Plan?

• Things that lead to suicidal thoughts

• Things I can do to take my mind off my 

problems

• People and places that distract me from 

my problems

• People I can ask for help

• Doctors, counselors, peer specialists, or 

other professionals to contact in a crisis

• The number for the local crisis line or 

National Suicide Prevention Lifeline 

(1-800-273-TALK)

• Items to remove so that I won’t use 

them to hurt myself

• Reminders of hope and reasons for living

Have People Ready to Help

You will feel more secure with someone you 

can trust as your supporter in times of crisis. 

It may be a family member, friend, peer 

support or health professional. Try to select a 

person you can trust to respect you and stay 

level-headed in an emergency. To cover all 

your bases, you may want to ask a second 

person to serve as a backup contact.

It’s important that those you ask to be your 

primary support person and backup support 

person feel comfortable in these roles and 

know what to do. Share your safety plan with 

them and keep them aware of how you are 

feeling. Don’t forget to thank them for their 

help.

My primary support person is:

My backup support person is:
A JOURNEY TOWARD HEALTH AND HOPE H 12

Developing Your Safety Plan2

(Blank Safety Plans can be found on pages 26–29). You can also download a free Safety Plan app—MY3—for 

your Android or Apple phone or tablet.)

1. WHAT TRIGGERS MY SUICIDAL THOUGHTS?

Many suicide attempt survivors indicate that their suicidal thinking became almost automatic over time. When 

something negative occurred, they would start to have negative thoughts.

It may have been an event or behavior (called triggers), such as failing a test, not sleeping well, or arguing with a 

loved one, that led to suicidal thoughts. Some survivors noticed that their suicidal thoughts occurred with a certain 

mood, such as feeling angry or sad, while others started feeling suicidal when remembering a painful event from 

the past. No matter what the trigger, many survivors experienced a common theme: When something negative 

occurred, they would start thinking things like:

• “I’m no good.” “I can’t do anything right.” “I fail at everything I do.”

• “I hate myself. I’m worthless.” “I don’t want to be here anymore.”

• “Nobody cares about me.”

• “I can’t take it anymore. I wish I were dead.”

Coping with these types of negative thoughts can be difficult. If you don’t talk about how you’re feeling with 

someone, the thoughts might start to escalate. One survivor indicated that it was like having “tunnel vision.” Even 

though her negative thoughts weren’t always true, the feelings they created became so strong that she started to 

believe them.

It’s important to recognize what triggers your suicidal thoughts for several reasons, but the most important reason 

is to recognize when you’re in crisis and that it’s time to use your safety plan. The questions below can help you 

figure out what triggers your suicidal thoughts.

Think about what happened the last time you attempted suicide. What events preceded your attempt? 

Examples include: “Argument with a good friend.” “Yelling.”

How did you react to those events? Examples include: “Couldn’t breathe.” “I ran into the bedroom.” “I slammed 

the door.”

2 Adapted from Stanley and Brown (2011).
A JOURNEY TOWARD HEALTH AND HOPE H 13

What were your thoughts or feelings, memories, or 

behaviors? This is what is meant by “triggers.” The more 

specific you can be about your triggers, the more likely you’ll 

be able to identify them and prevent another attempt in the 

future. Examples include: “I’m a failure.” “Everybody hates 

me.” “Memories of my mother screaming at me, saying that I 

couldn’t do anything right.” “Thoughts of how good it would 

feel if I could just get rid of the pain.”

2. WHAT CAN I DO TO TAKE MY MIND OFF THESE 

THOUGHTS?

You learned earlier that it can be common to have suicidal 

thoughts after an attempt. While these thoughts may 

be common, it’s important to find ways to keep them 

from escalating into suicidal behaviors. One way is to do 

something that helps you feel better and takes your mind 

off your problems. For this step of the safety plan, you 

should think of internal coping strategies or things you 

can do when you’re by yourself. These strategies vary 

from person to person. To identify your internal coping 

strategies, ask yourself:

What can I do when I’m alone and I start to have 

thoughts of suicide? What can I do to take my mind 

off my problems? Examples include: reading a book, 

playing computer games, exercising, playing with my dog, 

shopping, or writing down my thoughts and feelings in a journal.

3. WHERE CAN I GO OR WITH WHOM CAN I TALK TO FEEL BETTER?

Another way to take your mind off your suicidal thoughts is through external strategies, like talking to certain people 

or visiting places that improve your mood. Finding places that make you feel better or people who cheer you up are 

good ways to keep your thoughts from escalating. Ask yourself:

Where can I go to be around other people in a safe environment? Who can I be around that makes me 

feel positive? Examples include: the coffee shop, the gym, place of worship, neighbors, friends, or family.

How Have others 

Coped With Suicidal 

Thoughts?

“I journal, I call a friend, I remember 

what it would do to certain people. I 

remember how hard it is to recover physically and mentally if I don’t 

succeed. ...I keep busy at work; I 

volunteer my time to others who are 

in need of support. I take a mood 

stabilizer; I wait one more minute; I 

think it through while I wait.”

—Cathy Singer

“For me, recognizing automatic 

thinking was a big thing, challenging 

my thoughts, thinking of my suicidality as an entity rather than a part of 

me or who I am. I keep a folder of 

nice cards and emails I’ve received 

that make me feel like I’ve done 

something with my life or that I’m 

valued and cared about/for when I 

read them.”

—Heidi Bryan
A JOURNEY TOWARD HEALTH AND HOPE H 14

4. WHOM CAN I ASK FOR HELP? WHO KNOWS THAT I’M STRUGGLING WITH THOUGHTS OF SUICIDE?

If the ideas above don’t seem to be helping, you may need more specific assistance, like talking to someone with 

whom you feel comfortable sharing your thoughts of suicide. Ideally, this is a support person who already knows 

about your suicidal thoughts and is aware of his or her role as a support person in your plan. You may want to have 

several people listed here, if possible, in case your primary support person is unavailable. If it’s difficult for you to ask 

people for support, you might say, “I’m calling you today because I feel like I might need to use my safety plan.” Ask 

yourself:

Who do I feel comfortable talking to when I’m in crisis? Examples include: a trusted friend, parent, minister, 

or other family member.

5. WHAT RESOURCES CAN I CONTACT IF I’M IN CRISIS?

The next step of the plan involves contacting professionals who can offer assistance if the other parts of the plan 

don’t seem to be increasing your ability to stay safe. Ideally, you want to have resources that are available 24 hours 

a day, 7 days a week. The National Suicide Prevention 

Lifeline (1-800-273-TALK (8255) is a resource that’s always 

available. You might also want to consider:

What professionals have I spoken to who can provide 

assistance? Who can I contact at any hour of the day 

or night? You may have a doctor, nurse, or counselor 

available. Other examples are urgent care centers, crisis 

hotlines, emergency departments, crisis teams, crisis 

respite centers, or (if it isn’t an immediate crisis) warm lines 

in your area.

Survivor Stories

“Pain has a beginning and an end. It 

comes, then it goes. We need to 

make it to the finish line so we can 

feel the satisfaction of having made 

it through. We don’t know what 

we might miss if we don’t. It could 

be something really fantastic; you 

never know until you live to the next 

moment.”

—Cathy Singer

“Suicide, for me, had become almost 

like a coping mechanism, and I 

learned in therapy that death wasn’t 

the only way to end my pain. There 

were other ways to end my pain 

besides death. And one of them was 

developing coping skills and learning 

how to manage my feelings in a 

different way, which I did.”

—Terry Wise
A JOURNEY TOWARD HEALTH AND HOPE H 15

6. ARE THERE ITEMS AROUND ME THAT MAY PUT ME IN DANGER?

As an attempt survivor, it’s likely that suicide became one of the strategies you developed to end a painful situation. 

It’s natural for human beings to want to avoid pain. When pain is unbearable, you need relief and you probably want it 

quickly. While suicide may seem like a quick way to end your pain, it can have devastating consequences for you and 

the people who care about you

You can use your safety plan to help find alternate ways of relieving your pain that don’t involve ending your life. 

However, if you forget to use your plan, or it doesn’t make you feel better, having items close to you that you could 

use to harm yourself can create a dangerous situation. It’s important, then, to remove items that you may use 

impulsively in a moment of unbearable pain.

Most suicide attempt survivors indicate that their thoughts 

of suicide changed over time. While they had periods when 

the pain seemed unbearable, those times didn’t last forever. 

Removing dangerous items gives you time to allow the way 

you’re feeling to change. Ask yourself:

What items am I most likely to use to harm myself? 

Examples include guns, pills, etc. 

How can I safely remove them for the time being? 

Who can I call to come and get them?

7. INCORPORATING REASONS FOR LIVING AND HOPE 

INTO YOUR SAFETY PLAN

Earlier, this booklet mentioned that when you’re suicidal, 

you’re likely to identify both reasons for dying AND reasons 

for living. Depression and suicidal thinking tend to make you 

focus only on your reasons for dying, while not allowing you 

to appreciate your reasons for living. It can be helpful to add 

your reasons for living into your safety plan as reminders 

of the things in life that are important to you, as well as the 

people whom you care about and who care about you. 

Reminding yourself of your reasons for living can help build 

hope and increase your motivation to stay safe.

Turning points for 

other Survivors

“I think the main difference is the 

coping abilities that I have now and 

the honesty that I have in being 

able to verbalize my thoughts and 

emotions with my depression.”

—Jordan Burnham

“I recognized my value to other 

people.”

—Suicide Attempt Survivor

“I found I could do something 

for someone else. I could do 

something useful with my life.”

—Suicide Attempt Survivor

“I recognized the value of talking. 

Talking doesn’t change the event, 

but it can change how I felt about it 

and can make me feel less alone.”

—Suicide Attempt Survivor

“I realized depression was a disease.”

—Suicide Attempt Survivor

“I accept that my feelings are not 

who I am. I am an intelligent, strong, 

determined woman.”

—Cathy Singer
A JOURNEY TOWARD HEALTH AND HOPE H 16

What should you do with your plan?

The exercise you just completed was designed to help you think of items to include in your personalized safety 

plan. You can find blank safety plans on pages 26–29 of this handbook into which you can transfer your ideas. 

When your plan is complete, you can tear it out and keep it with you. Be sure to add contact information for the 

resources and support people you included. You can also find a copy of a safety plan at www.sprc.org/sites/sprc.

org/files/SafetyPlanTemplate.pdf or download a free safety plan app—MY3—for your Android or Apple device.

Your plan is for your use, but it’s a good idea to share it with a few other people. Your support person and backup 

person can do a better job in times of crisis if they have your most recent copy. If you’re using a paper safety plan, 

you may want to keep multiple copies in various places so it’s nearby whenever you need it. Your safety plan may 

change over time. You can add information to it in the future as you identify more triggers or want to change the 

names of contacts. You wouldn’t want to search around for information in a crisis situation, so it’s a good idea to 

keep contact information up-to-date.

There’s one more thing about your safety plan that’s very important—you have to actually use it! It’s important to 

think about ways you can use it when you’re afraid your suicidal thoughts might escalate to suicidal actions. For 

this reason, it should contain items and ideas that work for you, not things you feel others are forcing you to do. If 

you don’t like the options or you feel they’re unrealistic, say so. If you can’t find options that are right for you, this 

may indicate that you need more support until you feel comfortable that you can stay safe. You may want to ask 

yourself:

How likely am I to use this plan when I’m feeling unsafe? What might keep me from using it? Is there 

anything about the plan that makes me uncomfortable?

With whom might I share my safety plan? Where will I keep my safety plan to make sure it’s nearby 

when I need it?

Survivors Experiences with Safety plans

“You don’t realize what to do when you are in that situation (feeling suicidal). Having 

planned activities, like going to a coffee shop and remembering to breathe, were 

effective.”

“It made me feel a little more comfortable knowing that I had a way to defuse the 

situation.”

“Having a plan in place was comforting to myself and my spouse.”

—Suicide Attempt Survivors
A JOURNEY TOWARD HEALTH AND HOPE H 17

What can I do to make it more likely that I’ll use the 

strategies in my plan to stay safe? Examples include: 

keeping multiple copies close by, sharing it with others 

who will encourage you to use it, ensuring that you’re 

comfortable with the contents, practicing using it, and 

talking with someone about how practicing went.

Finding a Counselor

Suicide attempt survivors and researchers who study 

suicide recommend professional help as your best bet for 

finding long-term strategies to ease the emotional pain 

that led to your attempt. And, of course, if you’re in less 

pain, you’re much more likely to experience joy and be 

motivated to keep yourself safe.

Making a decision to go to therapy can be intimidating. 

You might worry that it will be uncomfortable or that it 

could lead to hospitalization, but most people who give it 

a try find it really helps. 

When looking for a counselor, it might be difficult to know 

where to start. It’s always smart to ask others which 

counselors in your area have good reputations. Your 

doctor or the people that helped you in the emergency 

room might have suggestions. Here are other ideas:

• Call the National Suicide Prevention Lifeline (1-800-

273-TALK (8255). Lifeline crisis workers know their

local communities and may be able to refer you to a

counselor or support group in your area. Crisis workers

are also available to talk with you about your suicidal

thoughts until you find other sources of support.

• Check out the SAMHSA Behavioral Health Treatment

Services Locator online at https://findtreatment.

samhsa.gov or call them at 1-800-662-HELP (4357).

• In many communities, you can reach an information

and referral hotline by dialing three simple digits:

2-1-1. If dialing 2-1-1 doesn’t work for you, check

out www.211.org for the seven-digit number of your

local information and referral hotline.

TipS if You're 

concerned about 

affording care

If payment is a problem, there may be ways 

to get low-cost or free help through various 

programs in your community.

If you have insurance:

Call your doctor and ask for a recommendation 

for a counselor/therapist. Your insurance 

provider should be able to provide a list of 

people in your area that take your insurance.

If you don’t have insurance:

• You may be eligible for insurance coverage

through the marketplace. For more

information about your coverage options,

visit www.healthcare.gov.

• It may not be simple to find a counselor

if you don’t have coverage, but it’s not

impossible. Most communities have

counselors who provide low-cost or free

counseling services.

Things to try:

• If you were in the hospital after your attempt,

the staff there may be able to refer you to

low-cost or free counselors in your area.

Additionally, your primary-care doctor may

know of options.

• See if your workplace has an Employee

Assistance Program (EAP). Many businesses

offer an EAP to their staff with access to free

and confidential counselors.

• If you’re a member of a church or other

place of worship, you may want to check

there. Sometimes they offer free counseling

with clergy or other members of the

congregation.

• If you live near a university with a school of

psychology, or near a seminary, see if they

have free or sliding scale fees for therapy.
A JOURNEY TOWARD HEALTH AND HOPE H 18

• Try the Suicide Prevention Therapist Finder: http://www.helppro.com/SPTF/BasicSearch.aspx

• You can also check with a local chapter of a mental health organization, such as the American Psychiatric 

Association, American Psychological Association, Anxiety Disorders Association of America, Mental Health 

America, National Alliance on Mental Illness, or Depression and Bipolar Support Alliance.

Getting What You Need From Counseling

Selecting a counselor is an important decision, and you’ll find many options for various types of therapy. When 

choosing a counselor, it’s vital to find someone who is comfortable with and has experience talking about suicide. 

It’s also important to remember that if drugs or alcohol played a part in the problems that led to your suicide 

attempt, your counselor should have experience in substance abuse treatment.

Medication could be an important part of your path to recovery, especially if you’ve ever been diagnosed with major 

depression, bipolar disorder, schizophrenia, or an anxiety disorder, or if your symptoms are so troubling that you’re 

having problems getting through the day. This might include having serious problems sleeping; having no appetite 

or eating too much; thinking negative thoughts that you can’t stop, no matter how hard you try; or hearing voices. 

If this sounds like you, you’ll want to discuss medication with your counselor. Together you can find a doctor or 

psychiatrist who can work with you to determine whether medication might be helpful.

Different people have different needs, and sometimes it takes time to find a counselor who is right for you. This can 

be a frustrating process, but if one counselor, doctor, or type of therapy doesn’t work, you have the right to keep 

trying until you find one that does. Think about your preferences in a counselor (or clinician, therapist, doctor, or 

psychiatrist): a man or a woman, their age range, ethinicity, language, etc. If you have a choice of counselors, call 

ahead for an interview or use the first session to get to know them better. Ask questions to see if they might be a 

good match for your style and needs. 

The following questions can be helpful when selecting a counselor (Bryan and Cunningham, 2009): 

1. What type of education do you have?

2. How long have you been practicing?

3. What types of treatment do you offer?

4. Do you specialize in any particular issues or treatment types?

5. Have you treated clients with problems similar to mine? Have you worked with a person who has survived 

a suicide attempt?

6. If I need help after regular business hours, how should I get it? Do you take after-hours/emergency calls?

7. What will you expect from me in therapy, and what can I expect from you?

8. How will your treatment help me with thoughts of suicide?

9. If I’m feeling suicidal, do you believe that the first course of action is for me to be in a hospital, or will you 

work with me on ways to stay safe in my home (or with family or friends)?

10. If I want to try medications, can you help me with that?

Remember, it’s crucial that you be persistent. Any important decision requires some research, and sometimes it 

takes trial and error before you get it right. 
A JOURNEY TOWARD HEALTH AND HOPE H 19

While there are many different approaches to therapy, research shows that the following methods are especially 

helpful for those struggling with suicidal thoughts and attempts:

Cognitive behavioral therapy (CBT) is a short term, goal-oriented counseling approach. The premise behind 

CBT is that changing your thoughts can change the way you feel and behave. CBT has been used to treat a variety 

of disorders and issues, including helping people struggling with suicide. 

Dialectical behavior therapy (DBT) combines techniques of cognitive behavioral therapy 

with additional skills of emotion regulation. A goal of DBT is to help you to accept the things 

you cannot change and change the things you can.

Collaborative Assessment and Management of Suicidality (CAMS) is an approach 

to suicide risk assessment and therapy that engages a person in a collaborative way and 

specifically works to address suicidal thinking and motivation.

The Lifeline was mentioned earlier as a source for finding referrals for counselors, but it’s also 

a great place for support if you’re in crisis. While not a substitute for ongoing therapy, the Lifeline is a network of 

confidential crisis hotlines across the country that are staffed by trained crisis workers. This means they won’t be 

shocked or scared by what you say, and, importantly, they won’t judge you. Lifeline crisis workers will talk with you 

about your suicidal feelings and brainstorm ways to help you stay safe. Crisis workers are available 24 hours a day, 

7 days a week. Best of all, it’s a free service.

If You Don’t Go to Counseling

While it might be easier to recover from your suicide attempt with the help of a counselor, you may choose to try 

to get better on your own. This might be because you don’t have insurance and can’t afford counseling (if that’s 

the reason, see the tips on page 17 for ideas on how to access affordable counseling services). Maybe you tried 

counseling, but had difficulty finding a counselor who was right for you. Maybe you don’t feel like taking that step 

right now. It’s important to remember that if struggles with a mental illness led to your suicide attempt, it might be 

difficult to get better and recover on your own. Just as with some physical ailments, you may find it particularly 

challenging to heal without medications or help from a professional.

Whatever your reason for not seeing a counselor, there are things you can do to get better on your own. The ideas 

already mentioned in this booklet are a good start. When you’re ready, you might find the following options to be 

helpful as well. And even if you do have a counselor, these ideas can be great resources for additional support.

Call the National Suicide Prevention Lifeline.

The Lifeline can be a great resource for your friends and family as well. If they’re having difficulty understanding 

your struggles with suicide or don’t know how to support you, a crisis worker can speak to them about their 

concerns and give them ideas on how to help. Evaluations of crisis hotlines have shown that they can reduce 

emotional distress and suicidal thinking in callers (Gould, et al., 2007).

If talking about suicide is difficult for you, you may want to check out the Lifeline Website, www.

suicidepreventionlifeline.org. The organization also provides an online chat service with crisis counselors.
A JOURNEY TOWARD HEALTH AND HOPE H 20

Join a support group. 

A support group is composed of people who meet regularly to talk about common concerns and look out for each 

other’s wellbeing. Support groups can be helpful because they allow you to meet others who have had experiences 

similar to yours. It can be a huge relief to learn that you’re not alone and that there are others who feel the way you 

do. It also can be helpful to learn about strategies others have found useful.

Just as there are different types of counselors, there are support groups for a variety of topics, such as:

• Depression

• Anxiety

• Substance abuse

• Self-esteem

• Anger

• Post-traumatic stress, sexual assault, and other 

traumas

• Hearing voices (e.g., schizophrenia)

A few communities across the country are even beginning 

to offer support groups specifically for people who 

have survived a suicide attempt or who are struggling 

with persistent thoughts of suicide.

Many times, support groups are led by an experienced 

counselor; other times they are peer-led by people who 

have experienced similar issues. If you don’t have insurance 

to pay for individual counseling, a group may be one way 

to get help. They are often free of charge or much less 

expensive than seeing an individual counselor.

The information and referral hotline in your community (dial 

2-1-1 or visit www.211.org) or the Lifeline (1-800-273-TALK 

(8255) or www.suicidepreventionlifeline.org) can give you 

more information about support groups in your area.

Read books or visit websites.

Sometimes, if you aren’t ready or don’t have access to a 

counselor, you can find helpful information on your own. 

There are many websites and books that address issues 

related to stress, depression, or other mental health issues. 

There are even several books written by people who have 

survived a suicide attempt. A list of recommended websites 

is available on pages 30–32.

Survivors' 

Experiences Talking 

to peers

“(In a support group for survivors) we 

are in the same club of profound 

personal pain. And once you assure 

yourself that you are talking with 

someone like that, then you know 

that what you’re going to get is 

understanding, compassion, and 

sympathy.”

—Suicide Attempt Survivor

“There were things that I told 

complete strangers because I knew 

that they understood where I was 

coming from. And I couldn’t say that 

to my therapist, I couldn’t say that 

to my parents, I couldn’t say that to 

my friends because they didn’t truly 

understand the real Jordan, the real 

Jordan who hated himself, wondered 

everyday whether I should be here.”

—Jordan Burnham
A JOURNEY TOWARD HEALTH AND HOPE H 21

Moving Toward a Hopeful Future

After you’ve taken your first steps back into daily life, it might be time to consider taking on a few more challenges. 

You’ve already made it through the toughest part. Now it’s time to think about doing some things that can give you 

a greater sense of wellbeing and happiness.

Many survivors talk about a “second chance,” or slowly 

coming to value what would have been lost if their attempt 

had resulted in their death. Over time, they begin to reclaim 

a sense of purpose in their lives, a new sense of identity, 

and real reasons for hope.

Maintaining Hope

When you made your suicide attempt, you felt as if suicide 

was a way to end your pain. At that moment, in your mind, 

your reasons for dying outweighed your reasons for living. 

As you’ve learned, reconnecting with your reasons for 

living can help you build hope. Some survivors recommend 

putting together a “hope box” that can serve as a physical 

reminder of the things in your life that bring you joy. When 

you begin to feel bad about yourself or your life and feel 

depressed, the contents of your hope box can help lift your 

spirits. It also is a good place to keep your safety plan.

Staying in Control by Being 

Organized

Dealing with stress or emotional pain can feel 

overwhelming and lead you to neglect day-to-day tasks 

and responsibilities. Feeling like life is out of control can 

make anyone feel anxious. It might help to make a list of 

the things you have to do each day. That way, you won’t 

forget important events or get distracted and not complete 

things you need to get done.

Checking items off a to-do list can also help you feel a 

sense of accomplishment. Keep it simple and short to 

begin with; you can always add more when you have more 

energy. Keeping a calendar and using a daily planner are 

great ways to help yourself stay organized and maintain a 

sense of control over your life.

Things to 

Think About

Creating a Hope Box

Your hope box can contain anything that 

might help you put aside painful thoughts or 

negative emotions and instead remind you of 

things in life that you enjoy. Decorating the 

box can be fun, as well. Here are some ideas 

for things to include:

• Photos or letters from people you care 

about.

• Poems, books, or scripture passages 

that lift you up.

• Movies or music you like.

• Note cards with uplifting words or 

thoughts, things that have kept you 

going in the past, or memories of happy 

times.

• Special trinkets or mementos that help 

you feel grounded.

• Your safety plan.

Your box can contain actual objects or be a 

collection of links or digital files on your computer, cell phone, e-reader, or other device.

You can also download a free “Virtual Hope 

Box” app for your Android or Apple phone or 

tablet. What would you put in your hope 

box?
A JOURNEY TOWARD HEALTH AND HOPE H 22

Getting in Touch With Your Spirituality

Some suicide attempt survivors find comfort in spirituality. Spirituality can mean different things to different 

people, and for some it can provide a feeling of being connected to something larger than themselves. Some 

may experience this by attending churches, temples, synagogues, mosques, and other places of worship. Others 

discover deeper meanings in nature, philosophy, or music. Would getting in touch with your spirituality bring you 

comfort and peace? Only you can answer that, but it does help some people.

Maintaining a Healthy Lifestyle

Maintaining a healthy lifestyle can affect the way you feel, 

not only physically, but emotionally. If you feel depressed or 

overwhelmed emotionally, it’s easy to forget the basics of 

taking care of yourself physically. It will make a difference if 

you maintain a healthy lifestyle during your recovery. Of

course this means limiting your use of alcohol and 

eliminating other drugs, as these can negatively affect your 

emotions, but it’s more than just that. Getting enough sleep, 

eating well, and exercising are also crucial to your recovery.

Sleep

A link between sleep and depression is well-documented. When depressed, many people find themselves sleeping 

a lot more than usual, while others are unable to sleep adequately. Poor sleep can lead to fatigue, inactivity, anxiety, 

and irritability, making depression or other mental health issues even worse. Insomnia can also be associated with 

suicidal thoughts and actions. If you have depression that includes sleep disturbances, certain kinds of talk therapy 

(like CBT) can help, as well as medication. So it is important to discuss sleep problems with your counselor or 

psychiatrist. 

Getting enough sleep is crucial because your body restores itself during sleep. For more information you can read 

Healthy Sleep Tips from the National Sleep Foundation (http://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips).

Diet

Appetite changes—either poor appetite with weight loss or increased appetite with weight gain—also can be 

symptoms of major depression. If your appetite has changed and you have low, depressed mood, please talk with 

your psychiatrist or counselor about whether you should consider medication.

While no particular diet has been proven to decrease depression and anxiety or improve emotional health, there 

does seem to be a correlation between what we eat and how we feel. A healthy diet is recommended as a key part 

of the overall treatment for depression. Additionally, ensuring that your body has the nutrients it needs can increase 

your energy level.

Enrolling in a healthy cooking class can help you find ways to eat well and meet new people. You also can find out 

how to prepare healthy food online.

The United States Department of Agriculture (USDA) has a diet and nutrition website: http://snap.nal.usda.gov/

basic-nutrition-everyone that could be a good starting point.

Survivor Story

“I contacted a church and found faith, 

which gave me a lot of coping skills. 

And then I started opening up.”

—Suicide Attempt Survivor
A JOURNEY TOWARD HEALTH AND HOPE H 23

Exercise

When you exercise, your body releases endorphins, a 

chemical that affects how people perceive pain. It’s 

believed that the release of endorphins can help people feel 

more energized and even improve their emotional states, 

allowing them to be more hopeful about life. In fact, some 

studies suggest that exercise can be an effective treatment 

for depression.

Given that exercise can improve your mood, you might 

want to join a local gym, take a walk every day with a friend, or do exercises at home. Incorporating an exercise 

plan into your daily life (exercising three or more times each week) is highly recommended. You can find more 

information about depression and exercise online. The National Alliance on Mental Illness (NAMI) has resources 

about exercise and mental health at http://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/

Taking-Care-of-Your-Body.

For more information about maintaining a healthy lifestyle, see SAMHSA’s Wellness Strategies at 

http://www.samhsa.gov/wellness/strategies.

Taking Medication

If you choose to go to counseling, your counselor may recommend taking medication to improve your mood, 

especially if maintaining a healthy lifestyle and counseling aren’t giving you the results you’re looking for. You may 

struggle with the decision to take medication and feel as though it’s a sign of weakness. It’s important to remember 

that people take medications for all sorts of illnesses, and there is no reason to be embarrassed if you choose to 

try medications to alleviate depression, anxiety, or another mental health concern that causes you pain.

Certainly, only you can decide if you want to take medication; however, many people have felt that their depression 

and anxiety improved after taking medication. Most people (including researchers) indicate that counseling 

combined with medication provides the best results.

If you do choose to try medication, here are a few important things to remember:

• It can take some time for medication to have an effect. While some medications (for instance, sleep medication) may work immediately, medications for depression may take up to 8 weeks to reach their full effect. Your 

psychiatrist or doctor can tell you what to expect.

• You must take your medication as directed, without skipping dosages, for it to be effective.

• It’s important to continue taking your medication for the entire period it is prescribed. You may be tempted to 

stop taking medication when you start to feel better. Stopping too soon can cause a relapse. Always work with 

your psychiatrist or doctor if you want to stop or change your medication.

• If your thoughts of suicide increase after you start taking medication, be sure to contact your psychiatrist or 

doctor immediately.

• Different medications work for different people. Be patient; sometimes it can take time to find the medications 

that work best for you. If one medication doesn’t work, that doesn’t mean none of them will. Finding the right 

medication can take persistence.

Survivor Story

“I believe that like treating any other 

chronic illness, [with depression] I 

have to be vigilant about maintaining 

a healthy lifestyle.”

 —Heidi Bryan
A JOURNEY TOWARD HEALTH AND HOPE H 24

Advocating for Others to Support Your Recovery

When you’re feeling stronger, you may find that helping others who are facing suicide can help you, too. 

Sharing your experiences and wisdom might save other lives. And saving lives can be a source of pride and 

accomplishment for you. Speaking about your experience also helps to break the guilt and shame that can be 

associated with suicide and lets others know they’re not alone.

You should give serious consideration to whether you’re ready to talk openly about your suicide attempt before 

deciding to advocate for others. It’s important to ensure that you’ve given yourself enough time to heal and learn 

from your experience before using it to help others. Some questions you might ask yourself include:

• Am I ready to speak? Have I healed enough to speak?

• Am I prepared for my family’s reactions to going public?

• Am I prepared for the possible social effects of going public with my story?

• Am I familiar with the resources available to help others?

• How will I take care of myself?

The American Association of Suicidology has a helpful guide, “Special Considerations for Telling Your Own Story: 

Best Practices for Presentations by Suicide Loss and Suicide Attempt Survivors.” You may want to read the entire 

article before making the decision to share your story.

For more information, visit: http://www.suicidology.org/suicide-survivors/suicide-attempt-survivors

Some Ways to Help others When 

the Time is right include:

• Becoming a member of a national organization that advocates for suicide 

prevention

• Helping raise funds for suicide prevention

• Participating in a suicide prevention walk

• Volunteering at a crisis hotline

• Organizing an attempt survivors’ support group

• Writing or talking with others about your journey to raise public awareness 

about suicide and recovery
A JOURNEY TOWARD HEALTH AND HOPE H 25

Hopes for a Safe Journey

The time after your suicide attempt is an important 

one. It can be a turning point in your life. Often, your 

suicide attempt can break the silence that surrounded 

the problems you were experiencing and your suicidal 

thoughts. Making a choice to be open about how you’re 

feeling and seeking help, when you’re ready, can be the 

first step on the path to a more fulfilling life.

As discussed, recovering from your suicide attempt 

is a process. It will likely have its ups and downs. 

You may feel overwhelmed or sad at times, and you 

may experience suicidal thoughts again. However, it’s 

important to remember that feelings change. Finding 

ways to cope with those negative feelings while staying 

alive will give you a chance to enjoy the positive things life 

has in store for you. The stories and tools in this booklet 

can help you feel better. They’ve worked for other people, 

and they may work for you, too.

The survivors, researchers, SAMHSA and Lifeline 

staff, and many others who contributed to this booklet 

sincerely hope it will help you. We ask you always to 

remember our message:

• You are not alone.

• You matter.

• Life can get better.

• It may be difficult, but the effort you invest in your 

recovery will be worth it.

There is Hope

“Everything will feel different if we 

just live long enough to see and be 

the difference.”

—Cathy Singer

“You may think things will never get 

better, but you never know. You may 

think you know, but you don’t know. 

And you may think nobody cares 

about you or that you’re worthless, 

but that’s not true. This is just your 

disease talking, and you can’t listen 

to it. It will pass and eventually, 

sometimes longer than other times, 

it will get better.”

—Heidi Bryan

“If I were to sum up my life today, the 

word that I would use to describe it 

is fulfilling. I live a very enriched life.”

—Terry Wise

“You are not ‘crazy’ or lessened in 

any way by your experience. Many 

more people than you can imagine, 

even among people you know, have 

had suicide attempts or suicidal 

thinking themselves. You have a 

lot of company from people of all 

backgrounds, even if the majority of 

that company may be too scared to 

admit it. Be strong. Don’t let yourself 

get pushed around. You can move on.”

—Cara Anna
A JOURNEY TOWARD HEALTH AND HOPE H 26

SAMPLE SAFETY PLAN 1

STEP 1: Warning signs:

1. 

2. 

3. 

STEP 2: Internal coping strategies–Things I can do to take my mind off my problems without 

contacting another person:

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 I can ask for help: 

1. Name: Phone #: 

2. Name: Phone #: 

3. Name: Phone #: 
A JOURNEY TOWARD HEALTH AND HOPE H 27

STEP 5: Professionals or agencies I can contact during a crisis:

1. Clinician Name: Phone #: 

Clinician Pager or Emergency Contact #: 

1. Clinician Name: Phone #: 

Clinician Pager or Emergency Contact #: 

3. Suicide Prevention Lifeline: 1-800-273-TALK (8255)

4. Local Emergency Service: 

Emergency Services Address:

Emergency Services Phone:

STEP 6: Making the environment safe: 

1. 

2. 

3. 

4. 

The one thing that is most important to me and worth living for is: 

 

Adapted from Stanley and Brown (2011)
A JOURNEY TOWARD HEALTH AND HOPE H 28

KEEPING YOURSELF SAFE

SAMPLE SAFETY PLAN 2

Step 1: Know the warning signs

Many suicide attempt survivors indicate that their suicidal thinking became almost automatic over time. When 

something negative occurred, they started to have negative thoughts. These thoughts included, “Nobody cares 

about me,” “I can’t take it anymore. I wish I were dead.” These warning signs can include personal situations, 

thoughts, images, thinking styles, moods, or behaviors and can help you know when to use your plan.

What triggers your suicidal thoughts?

Step 2: Internal coping strategies

One way to take your mind off your suicidal thoughts is to do something that helps you feel better. What can you 

do when you’re alone and you start to have thoughts of suicide? What can you do to take your mind off your 

problems and help yourself feel better? Examples include reading a book, playing computer games, exercising, 

playing with your dog, shopping, or writing down your thoughts and feelings in a journal. 

Step 3: External coping strategies

Another way to take your mind off your suicidal thoughts is through external strategies like talking to certain people 

or visiting places that improve your mood. Finding places that make you feel better or people who cheer you up 

are good ways to keep your thoughts from escalating. Where can you go to be around other people in a safe 

environment? Who can you be around that makes you feel positive? Examples include the coffee shop, the gym, 

your place of worship, friends, or family.

Step 4: Who can you ask for help?

It can be helpful to have someone with whom you feel comfortable sharing your thoughts of suicide.

Ideally, this is a supportive person who already knows about your suicidal thoughts before a crisis occurs and is 

aware of his/her role as a resource in your plan. Having several people listed here, if possible, is best in case your 

primary support person is unavailable. Who do you feel comfortable talking to when you’re in crisis?

Name: Phone #: 

Name: Phone #: 
A JOURNEY TOWARD HEALTH AND HOPE H 29

Step 5: Professional resources

What professionals or agencies can offer assistance if the other parts of this plan don’t seem to be helping you 

stay safe? Ideally, you want to have resources that are available 24 hours a day, 7 days a week.

Clinician’s Name: Clinician’s Phone #: 

Local Emergency Dept.: Phone #: 

Local hotline:

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Step 6: A safer environment

At times, you may forget to use your plan or it doesn’t make you feel better. Having items close to you that you 

could use to harm yourself can create a dangerous situation. It’s important to remove items that you may use 

impulsively.

What items do you have nearby that you could use to harm yourself? How can you safely remove them for the time 

being? Examples include pills, guns, knives, poison, or rope. To whom can you give them?

Reminders of hope and reasons for living

Things that are important to me and give me hope include:

Adapted from Stanley and Brown (2011) by the Didi Hirsch Suicide Prevention Center.
A JOURNEY TOWARD HEALTH AND HOPE H 30

Places to get more Information

If you’re in crisis anytime, day or night

National Suicide Prevention Lifeline: 1-800-273-8255. Live chat: www.suicidepreventionlifeline.org

Veterans Crisis Line and Military Crisis Line: 1-800-273-8255 (press 1). Text to 838255.

Live chat: http://www.veteranscrisisline.net/

The Trevor Project: 1-866-488-7386 (For LGBTQ young people, their friends, and allies)

http://www.thetrevorproject.org/

Warm Lines

National Consumer Self-Help Clearinghouse: Technical assistance center that includes several resources for locating 

warm lines. http://www.mhselfhelp.org/

National Empowerment Center: NEC maintains a webpage on peer-run warm lines. http://power2u.org/

Suicide Attempt Survivor Websites

The National Suicide Prevention Lifeline’s With Help Comes Hope website has information for survivors, friends 

and family, and clinicians. It also includes a therapist and support group finder, videos, and a timeline of the attempt 

survivor movement. http://lifelineforattemptsurvivors.org

The American Association for Suicidology’s (AAS) Suicide Attempt Survivor webpage: This website includes up-todate links, resources, personal stories, support groups, videos, and more for suicide attempt survivors and those 

who care about them. AAS is a professional organization with an “Attempt Survivor/Lived Experience” division where 

attempt survivors have a collective voice in the field of suicide prevention.

http://www.suicidology.org/suicide-survivors/suicide-attempt-survivors

Suicide Prevention Information/Organizations

National Action Alliance for Suicide Prevention: Public-private partnership that advances the National Strategy for 

Suicide Prevention (http://store.samhsa.gov/product/PEP12-NSSPGOALS) in areas requiring coordination and 

leverage at the national level. Its Suicide Attempt Survivor Task Force wrote The Way Forward (see below).

http://actionallianceforsuicideprevention.org

Suicide Prevention Resource Center: Federally funded national resource center that provides technical assistance, 

training, and materials to increase knowledge about preventing suicide, and promotes collaboration within the field 

of suicide prevention. Excellent website for cutting-edge information about suicide and suicide prevention.

http://www.sprc.org/

National Council for Suicide Prevention: Coalition of national organizations working to prevent suicide.

http://www.thencsp.org/

Mental Health and Mental Illness Websites

Substance Abuse and Mental Health Services Administration: A part of the federal Department of Health and Human 

Services (HHS), SAMHSA’s mission is to reduce the burden of substance abuse and mental illness on America’s 

communities. http://www.samhsa.gov/
A JOURNEY TOWARD HEALTH AND HOPE H 31

National Institute of Mental Health: A part of HHS and the National Institutes of Health, NIMH’s vision is to 

transform the understanding and treatment of mental illnesses. www.nimh.nih.gov. For information about mental 

health medications, see http://www.nimh.nih.gov/health/publications/medications-listing.shtml.

Depression and Bipolar Support Alliance: Provides hope, help, support, and education to improve the lives of 

people who have mood disorders. http://www.DBSalliance.org

Mental Health America: Dedicated to helping all Americans achieve wellness by living mentally healthier lives. 

http://www.mentalhealthamerica.net/

National Alliance on Mental Illness: Dedicated to building better lives for the millions of Americans affected by 

mental illness. http://www.nami.org/

Therapists and Support Groups

Behavioral Health Treatment Locator: SAMHSA’s on-line tool for persons seeking treatment facilities in the United 

States or U.S. territories for substance abuse/addiction and/or mental health problems. 

https://findtreatment.samhsa.gov/

Known Attempt Survivor Support Groups: http://attemptsurvivors.com/support-groups/

Depression and Bipolar Support Alliance Support Groups: 

http://www.dbsalliance.org/site/PageServer?pagename=peer_support_group_locator

Psychiatric Advance Directives

Psychiatric advance directives are legal documents that can be prepared in advance by people who are concerned that 

they might be subject to involuntary psychiatric treatment or commitment in the future. The National Resource Center on 

Psychiatric Advance Directives has more information. http://www.nrc-pad.org

Peer Mentoring and Peer Specialists

ASHA International: Peer specialists provide support, encouragement, and specialized services. 

http://www.myasha.org/programs/peer-mentoring/

Directory of Consumer Organizations National Mental Health Consumer Clearinghouse:

http://www.cdsdirectory.org/

Certified peer specialist programs: Compilation of peer specialist training and certification programs. 

http://tucollaborative.org/community-inclusion/resources/peer-supportconsumer-run-servicespeer-specialists/

International Association of Peer Supporters: http://www.inaops.org

Apps

MY3 Safety Planning App: Available in the Apple App Store and Google Play, free of charge. 

Virtual Hope Box: Available in the Apple App Store and Google Play, free of charge.

Suicide Safe: Designed by SAMHSA for health care providers to assist patients at risk of suicidal ideation and 

behaviors. Available in the Apple App Store and Google Play, free of charge.
A JOURNEY TOWARD HEALTH AND HOPE H 32

Publications and Videos

The Way Forward: Pathways to hope, recovery, wellness with insights from lived experience. Written by the 

Suicide Attempt Survivors Task Force of the National Action Alliance for Suicide Prevention, this report has 

groundbreaking recommendations for supporting anyone who has been suicidal. It includes a comprehensive 

resource section. 

http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/The-Way-ForwardFinal-2014-07-01.pdf

Order these free from the SAMHSA Store (http://store.samhsa.gov/home or call 1-877-SAMHSA-7): 

• Stories of Hope And Recovery: A Video Guide for Suicide Attempt Survivors. DVD of three people who tell 

about their journeys from attempting suicide to lives of hope and recovery. 

 http://store.samhsa.gov/product/Stories-Of-Hope-And-Recovery-A-Video-Guide-for-Suicide-Attempt-Survivors/

SMA12-4711DVD. Order No. SMA12-4711DVD.

• A Guide for Taking Care of Yourself After Your Treatment in the Emergency Department. 

 http://store.samhsa.gov/product/A-Guide-for-Taking-Care-of-Yourself-After-Your-Treatment-in-theEmergencyDepartment/SMA08-4355. Order No. SMA08-4355

• A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department. 

http://store.samhsa.gov/product/A-Guide-for-Taking-Care-of-Your-Family-Member-After-Treatment-in-theEmergency-Department/SMA08-4357. Order No. SMA08-4357

• Shared Decision Making in Mental Health: Considering the Role of Antipsychotic Medications in your Recovery 

Plan. CD-ROM and online tool to help people make choices about treatment and mental health services, 

including an interactive decision aid on medication-assisted therapy. 

http://store.samhsa.gov/product/Shared-Decision-Making-in-Mental-Health-Decision-Aid/SMA12-4696

Order No. SMA12-4696

• Taking Action: A Mental Health Recovery Self-Help Educational Program. Introduces a recovery educational 

curriculum that offers self-help concepts, skills, and strategies for adults with mental illness, including those 

dealing with substance use disorders. Promotes wellness, stability, recovery, and life transformation. 

http://store.samhsa.gov/product/Taking-Action-A-Mental-Health-Recovery-Self-Help-Educational-Program/

SMA14-4857. Order No. SMA14-4857
A JOURNEY TOWARD HEALTH AND HOPE H 33

REFERENCES

Bryan, H., and Cunningham, A. (2009). Now what do I do? Surviving a suicide attempt. Retrieved from 

http://www.heidibryan.com/uploads/NOW_WHAT_DO_I_DO_04.2011.pdf.

Gould, M.S., Kalafat, J., Harrismunfakh, J.L., & Kleinman, M. (2007). An evaluation of crisis hotline outcomes. 

Part 2: Suicide callers. Suicide and Life-Threatening Behavior, 37(3), 338–352.

National Suicide Prevention Lifeline (2007). Lifeline service and outreach strategies suggested by suicide 

attempt survivors: Final report of the attempt survivor advisory summit meeting and individual interviews. 

http://lifelineforattemptsurvivors.org/connect-to-resources.

Stanley, B., and Brown, G.K. (2011). Safety planning intervention: A brief intervention to mitigate suicide risk. 

Cognitive and Behavioral Practice, 19, 256–264.
A JOURNEY TOWARD HEALTH AND HOPE H 34

Appendix—Additional Acknowledgments

SAMHSA is grateful to Ms. Heidi Bryan and Amy Cunningham, Psy.D., whose booklet Now What Do I Do? Surviving 

a Suicide Attempt provided the inspiration for SAMHSA’s booklet, and who graciously allowed SAMHSA to borrow 

both their concepts and some of their words. SAMHSA would also like to thank Ms. Shari Sinwelski (Associate 

Project Director, National Suicide Prevention Lifeline), and members of Lifeline’s Consumer Survivor Subcommittee 

and the Didi Hirsch Suicide Prevention Center’s Suicide Attempt Survivor Support Group, whose lived experience, 

along with that of Ms. Bryan, helped shape this booklet and infuse it with the voices of attempt survivors.
SMA-15-4419

First printed 2015