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Template library · Treatment plans

Self-Harm Safety Plan template

Builds alternatives to self-harm and reduces access to means, with clear support contacts.

  • 16 fields across 5 sections
  • Included with MyWellOps
  • Edit it, or save your own version

What’s in it

  • Client NameText
  • Date CompletedDate
  • ClinicianText

Urges & Triggers

  • Urges & TriggersText
  • Completed by: Client

Warning Signs

  • Warning SignsText
  • Completed by: Client

Alternative Coping Actions

  • Hold ice / cold water on skinTick box
  • Intense exerciseTick box
  • Draw / snap a rubber band on wristTick box
  • Call a support personTick box
  • Completed by: Client

Means Restriction / Environmental Safety

  • Means Restriction / Environmental SafetyText
  • Completed by: Shared

Support Contacts & Clinician Review

  • NameText
  • RelationshipText
  • PhoneText
  • Support Contacts & Clinician ReviewText
  • Client SignatureSignature
  • Clinician SignatureSignature
  • Completed by: Shared

When to use it

Write a treatment plan once assessment is done, to agree goals, the approach and when you will review progress — and revisit it at each review.

How it works in MyWellOps

  1. Start from the template and fill in the goals and interventions for this client.
  2. Share it with the client if you want them to see or sign it.
  3. Keep it on their record and update it at each review.

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