MENTAL HEALTH TREATMENT PLAN

Client: [Name or ID]
Date of plan: [Date]
Plan stage: [Initial plan, or review number]
Diagnosis: [Working or established diagnosis]
Based on: [Assessment date and the measures used]
Responsible clinician: [Name, credentials]
Care team: [Psychiatrist, primary care, family, or others involved, with consent]

STRENGTHS AND PREFERENCES
Strengths: [What the client brings that the plan can use]
Preferences: [Approach, format, language, schedule, cultural or faith considerations, views on medication]

PROBLEMS
Problem 1: [What happens, how often, and its impact, in behavioral terms]
Problem 2: [What happens, how often, and its impact, in behavioral terms]

GOALS AND OBJECTIVES
Goal 1: [The long-term change for problem 1, in the client's words where possible]
Objective 1a: [Specific, measurable step: the measure, the target, and the target date]
Objective 1b: [Specific, measurable step: the measure, the target, and the target date]
Goal 2: [The long-term change for problem 2]
Objective 2a: [Specific, measurable step: the measure, the target, and the target date]

INTERVENTIONS
For goal 1: [Approach and techniques, session length and frequency, and who provides them]
For goal 2: [Approach and techniques, session length and frequency, and who provides them]
Other services: [Group, psychiatry, primary care, peer support, or none]
Safety plan: [In place, with the date last reviewed, or not indicated and why]

MEASURES AND DISCHARGE
Outcome measures: [Each measure, its baseline score, and how often it is repeated]
Discharge criteria: [What will show the client is ready to end or step down care]

REVIEW AND AGREEMENT
Client participation: [How the client shaped the plan, and their view of it]
Review date: [Date of the next plan review]
Client signature: [Signature and date]
Guardian signature: [For a minor: signature and date]

Signed: [Clinician name, credentials, date and time]