Self-harm Contract

I _____________________________________, agree to not harm myself in any way or attempt to kill

myself.

In order to help myself know when I feel like self-harming, I will recognize these warning signs.
1. Watching movies with self-harm.
2. Seeing people with self-harm marks.
3. When my depression kicks in.

When I start having thoughts of self -harm, I will:

1. Listen to positive, uplifting music.
2. Take a bath.
 With timer set so I don’t fall asleep.
3. Go for a drive with caution*.
 Driving is only acceptable when not extremely upset or crying.

I will go to my three favorite places to go for a distraction.

1. The mall.
2. The park.
3. A lake.

The people I can contact when I feel like self-harming are:

1. Momma Hen: 801-643-0120
2. Tori: 765-398-8208

If I do all of the steps above and I still feel like self-harming I will contact:
1. Acacia: 765-432-7963
2. St. Vincent Hospital: 765-236-8457
3. Suicide Prevention Hotline: 1-800-273-8255

I agree to make my environment at home safe by:

1. Removing sharps.
2. Going to hang out with my roommates.
3. Getting to a safe space without isolating.

The one thing that is important to me and worth living for is:
 Ohana, friends and my life

Signature ______________________________Date_____________________________

Signature ______________________________Date_____________________________

Signature ______________________________Date_____________________________