No-harm Safety Contract

A no-harm safety contract is a written or verbal agreement between you and a mental health professional to promote safety. It contains specific actions and promises you agree to. The agreement also includes instructions from the therapist or doctor. The instructions will help prevent you from harming yourself or harming others. Harm can be as mild as pinching yourself, but can increase in intensity to actions like burning or cutting yourself. The extreme level of self-harm would be committing suicide. No-harm safety contracts are also sometimes referred to as a no-suicide contract, suicide prevention contract, no-harm agreements or decisions, or a safety contract.

REASONS FOR NO-HARM SAFETY CONTRACTS

Safety contracts are just one part of an overall treatment plan to help keep you safe and free of harm. A safety contract may help to relieve anxiety, restore a sense of control, state clearly the alternatives to harm or suicide, and give you and your therapist or doctor a gauge for how you are doing in between visits.

Many factors impact the decision to use a no-harm safety contract and its effectiveness. A proper overall treatment plan and evaluation and good patient understanding are the keys to good outcomes.

CONTRACT ELEMENTS

A contract can range from simple to complex. They include all or some of the following:

Action statements. These are statements you agree to do or not do.

Example: If I feel my life is becoming too difficult, I agree to do the following so there is no harm to myself or others:

  • Talk with family or friends.

  • Rid myself of all things that I could use to harm myself.

  • Do an activity I enjoy or have enjoyed in the recent past.

Coping strategies. These are ways to think and feel that decrease stress, such as:

  • Use of affirmations or positive statements about self.

  • Good self-care, including improved grooming, and healthy eating, and healthy sleeping patterns.

  • Increase physical exercise.

  • Increase social involvement.

  • Focus on positive aspects of life.

Crisis management. This would include what to do if there was trouble following the contract or an urge to harm. This might include notifying family or your therapist of suicidal thoughts. Be open and honest about suicidal urges. To prevent a crisis, do the following:

  • List reasons to reach out for support.

  • Keep contact numbers and available hours handy.

Treatment goals. These are goals would include no suicidal thoughts, improved mood, and feelings of hopefulness.

Listed responsibilities of different people involved in care. This could include family members. A family member may agree to remove firearms or other lethal weapons/substances from your ease of access.

A timeline. A timeline can be in place from one therapy session to the next session.

HOME CARE INSTRUCTIONS

  • Follow your no-harm safety contract.

  • Contact your therapist and/or doctor if you have any questions or concerns.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition. Noticing any mood changes or suicidal urges.

  • Will get help right away if you are not doing well or get worse.