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Template — Safety and no harm agreement (client signature) (Associate Handbook)

Audience: Associates / clients
Use: When clinically appropriate as an adjunct to safety planning and risk assessment.

Associate reference (not client-facing copy): A Safety & No-Harm Agreement aligned with BCACC / CCPA / CRPO ethical language and current best practices (non-coercive, trauma-informed, not a “no-suicide contract”).

Important: This agreement is not a substitute for suicide risk assessment, safety planning, or escalation to emergency services. It does not guarantee safety. Use professional judgment and follow ethical and legal obligations.

Safety and no harm agreement

Client name: ___________
**Date of birth**: __________
**Date**: _____________
**Therapist name**: __________

Shared Understanding

I understand that counselling may involve emotionally challenging material and that distress can fluctuate during the therapeutic process.

I understand that my therapist’s role is to provide clinical care within scheduled sessions, and that they may not be available outside of those times unless explicitly agreed upon.

I understand that confidentiality has limits. If there is imminent risk of serious harm to myself or others, my therapist may take steps consistent with ethical and legal obligations to protect safety.

Client Commitments

I agree that:

If I experience thoughts, urges, or impulses related to self-harm or suicide, I will:

  • bring this into therapy as soon as reasonably possible, and/or
  • use the supports identified in my Safety Plan if risk increases outside of session time.

I understand that having suicidal thoughts does not mean I have failed or that therapy has failed. It signals a need for additional support.

I agree to participate collaboratively in safety planning and risk assessment as needed.

Therapist Commitments

My therapist agrees to:

  • respond to safety concerns in a respectful, non-judgmental, and collaborative manner.
  • engage in ongoing risk assessment consistent with professional standards.
  • discuss openly with me when they believe additional supports or emergency intervention may be necessary.
  • use the least intrusive interventions appropriate to the level of risk.

Crisis & Emergency Supports (Canada)

If I am in immediate danger, I will contact 911 or go to the nearest emergency department.

I am aware of the following crisis resources:

  • Canada Suicide Crisis Helpline: call or text 988 (24/7)
  • Crisis Services Canada: talksuicide.ca

These services are available outside of therapy hours.

Limits of This Agreement

This agreement does not remove my right to access emergency services at any time.

This agreement does not replace clinical judgment or legal obligations.

This agreement does not guarantee safety, but supports shared responsibility and transparency.

Acknowledgement

I confirm that:

  • this agreement has been explained to me.
  • I understand its purpose and limitations.
  • I am entering into it voluntarily.

Client Signature: _____________

Date: _______________

Therapist Signature: __________

Date: _______________

Storage instruction (clinic)

  • Please store the signed agreement in the client’s JaneApp record (documents/forms area) so it is accessible if escalation is needed.