Client Document Template:
The document created from this template can be given or sent to a client at risk after their therapy session. It is a copy of a safety plan made with the client during that session.
It follows the same format as the Lifeline Suicide Safety Plan available at: https://www.lifeline.org.au/get-help/beyond-now/create-your-beyond-now-suicide-safety-plan-online/
Hi Client’s Name,
Thanks for speaking with me today.
Session Summary
Provide a clear and concise, but compassionate summary of the main issues discussed by the clinician and the client in today’s session. Highlight key topics, any insights the client gained, and any emotions or themes that stood out. Focus on the client’s emotional state and concerns. Use validating language to acknowledge the client’s feelings and efforts.
Professional assessment of identified risk (suicidal ideation, self-harm, or harm from others), contributing psychosocial stressors, and protective factors. Frame risk as manageable with appropriate support while avoiding alarmist language.
Safety Plan
My warning signs:
Describe the feelings, thoughts, behaviour, situations that might signal to the client that they are struggling.
Make my space safe:
Describe practical steps the client could take to make their environment safe (e.g., removing harmful items, avoiding isolation).
My reasons to live:
Describe the positive things in the client’s life, things that the client is looking forward to, and things that potentially bring joy to the client (e.g., a pet, a hobby, an upcoming event).
My coping strategies:
Describe healthy, practical ways that the client can manage distressing thoughts and feelings (e.g., grounding techniques, distraction, relaxation exercises).
Places and people I can connect with:
Describe positive places that the client can go in order to potentially feel uplifted (e.g., walk in the park, exercise at the gym). Describe those people that the client can connect with in a social way (e.g., meet someone for a coffee, invite a friend over for dinner).
Trusted people I can talk to:
Describe people in the client’s life who are a positive influence, who can be contacted by the client to have a meaningful discussion with, and who are potentially able to provide support to the client if needed. List their contact details if specified in the transcript.
My professional support:
Describe the professional help potentially available to the client if needed in an emergency (e.g., GP, counsellor, Lifeline). List their contact details if specified in the transcript.
Next Steps
List details of any appointments mentioned, including appointments between the clinician and the client; and including time, date, and location. Describe any actions agreed to by the client (e.g., going to the emergency department at the local hospital) or the clinician (e.g., agreed time to ring the client).
Provide a final affirming, empowering statement in a calm, warm, and hopeful tone, reinforcing the message that the client has strengths, support, and options. The statement should remind the client that safety is possible, and that they have steps they can take to help themselves.
If you have any queries or concerns, please reach out to me!
Hi Emma,
Thanks for speaking with me today.
Session Summary
Today we talked about the overwhelming feelings you’ve been experiencing after your recent job loss and relationship breakdown. You shared feeling increasingly isolated and having thoughts about “not wanting to be here anymore,” which has been frightening for you. We discussed how these feelings have intensified over the past two weeks and explored some immediate strategies to help you stay safe.
You’ve been experiencing thoughts of suicide triggered by financial stress and feelings of worthlessness following these major life changes. The combination of losing your support network, moving to a new suburb, and struggling to find employment has created a perfect storm of stressors. However, your love for your dog Max, your desire to see your niece grow up, and your willingness to reach out for help are important protective factors.
Safety Plan
My warning signs:
- Feeling overwhelmed by small tasks that wouldn’t normally bother me
- Not answering calls or messages from friends
- Sleeping more than 10 hours or having trouble sleeping at all
- Thinking “I can’t do this anymore” or “Everyone would be better off without me”
- Increased alcohol use to numb feelings
- Cancelling plans and isolating myself
Make my space safe:
- Give my medication to my sister for safekeeping
- Remove alcohol from my home for the next few weeks
- Make sure I’m not alone overnight if I’m feeling very low
- Delete my ex-partner’s number when I’m feeling triggered to contact them
- Set a timer if I find myself scrolling negative content online
My reasons to live:
- My dog Max who depends on me
- My niece Lily’s upcoming 5th birthday party next month
- Finding a job that better matches my skills and values
- The possibility of feeling better and enjoying life again
My coping strategies:
- Taking Max for a walk around the lake
- Practising the 5-4-3-2-1 grounding technique when anxious
- Having a shower when feeling overwhelmed
- Listening to my “mood lift” playlist
- Using the Calm app for guided meditation
Places and people I can connect with:
- The local dog park in the morning when other regular dog owners are there
- My weekend pottery class
- Having coffee with Sam on Thursday mornings
- Community garden volunteer group on Saturdays
Trusted people I can talk to:
- Kate (sister)
- Sam (friend)
- Online support group (7pm Wednesdays)
My professional support:
- Dr. Sarah Mitchell (Clinical Psychologist)
- Dr. Jane Thompson (GP)
- Lifeline: 13 11 14
- Mental Health Line: 1800 011 511
- Local Hospital Emergency Department: Royal Hospital, Reserve Rd, St Leonards
Next Steps
- Next appointment with me: Tuesday, 19 May at 3:00pm
- GP appointment to review medication: Thursday, 21 May at 10:15am
- You’ll call your sister Kate tonight to arrange staying with her this weekend
- I’ll check in with you via phone on Friday, 15 May at 4:30pm
Remember Emma, these difficult feelings won’t last forever, and you’ve shown incredible strength by reaching out for support. Each small step you take to keep yourself safe is an important achievement. You have people who care about you and resources to help you through this challenging time.
If you have any queries or concerns, please reach out to me!
Dr. Sarah Mitchell
Clinical Psychologist
- Template Type
- Client Document
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