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Suicide Prevention Contract
I promise not to commit suicide when I have thoughts of harming myself and to follow the plan below. I prepared this crisis plan together with my psychologist .
1.I agree to call the following people by phone when I have thoughts of harming myself.
(Please fill in by writing at least one name.)
- Name and Surname of first degree relative:
- Name and Surname of first degree relative:
- Name and Surname of a relative or friend:
2.If I still have thoughts of harming myself, I agree to go to one of the places listed below.
(Please fill in with at least one place name.)
- Somewhere near your house:
- Somewhere near your work or school:
- A favorite place:
3.If I still have thoughts of harming myself, I agree to go to the Emergency Service of the nearest hospital.