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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information, including your last name, first name, middle initial, and contact details such as street address, city, state, zip code, and phone number. This information is crucial for identification and communication.
Next, provide your date of birth (DOB), age, marital status, and emergency contact details. Ensure that the emergency contact's phone number is accurate for immediate assistance if needed.
Proceed to the agreement sections. For each agreement listed (one through four), clearly write your name in the designated space to acknowledge your commitment to abstain from self-harm and seek help when necessary.
Finally, sign and date the form at the bottom. A witness should also sign and date the document to validate the agreement.
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Signs of self-harm If you think a friend or relative is self-harming, look out for signs, including: unexplained cuts, bruises or cigarette burns - usually on the wrists, arms, thighs and chest. keeping themselves fully covered at all times, even in hot weather. pulling out their hair.
How do you not cut yourself when chopping?
Never cut toward yourself Always make sure the knife edge is facing and moving away from you. Its good practice to keep the blade facing away from you at all times. Also, never cut anything while holding it in your hand, such as a bagel or piece of fruit.
What are harm minimization techniques for self-harm?
The aim of harm minimisation is to: prepare for self-harm for example by having clean implements and first aid materials easily available. try to slow down the process to have as much control as possible. think about what wound or other care you might need afterwards.
How to treat non-suicide self injury?
Several interventions appear to hold promise for reducing NSSI, including dialectical behaviour therapy, emotion regulation group therapy, manual-assisted cognitive therapy, dynamic deconstructive psychotherapy, atypical antipsychotics (aripiprazole), naltrexone, and selective serotonin reuptake inhibitors (with or
What are the signs of self-destructive behavior?
Examples of Self-Destructive Behavior Self-harm such as cutting. Lack of hygiene. Drug or substance abuse. Dating disorders, such as binge eating or restrictive eating. Being consistently late for work. Self-sabotage in work or relationships. Uncontrolled compulsions, like excessive gambling or shopping. Risky sexual behavior.
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Talking therapies The types of talking therapy recommended if you self-harm include: Cognitive behavioural therapy (CBT) Dialectical behaviour therapy (DBT)
What are the alternatives to cutting yourself?
What Should I Do When I Feel the Urge to Cut? Call or text a friend or play with a pet. Make a warm drink, like tea or hot chocolate. Take a shower or bath (make sure there arent razors nearby). Wrap yourself up in a cozy blanket and listen to soothing music, watch a funny show, or read a book.
What are warning signs of someone that may harm themselves?
Warning signs include: Scars, often in patterns. Fresh cuts, scratches, bruises, bite marks, or other wounds. Excessive rubbing of an area to create a burn. Keeping sharp objects on hand. Wearing long sleeves or long pants, even in hot weather. Frequent reports of accidental injury.
Related links
Self-Harm and Cutting Fact Sheet
Generally, cutting is done with sharp objects, such as razors knives, pins/ needles, sharp stones, and broken glass. However, when these types of items aren
Oct 17, 2023 What is self-harm? Cutting yourself (such as using a razor blade, knife, or other sharp object to cut your skin) Punching yourself or punching
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