INTEGRATED RECOVERY PLAN /
ATTACH LABEL OR RECORD PATIENT DETAILS
LOCAL UR / MH UR
NAME
ADDRESS
TELEPHONE / DOB / SEX M/F

My Integrated Recovery Plan

The purpose of this meeting is for me to think about the things that are important for me and my recovery and how staff can help me to stay well.

Our Details

My Name:……………………………………………………………………………………………………………………..

My supports

Family, friends & other / Workers
Name:
Relationship:
Phone: / Name:
Relationship:
Phone:
Name:
Relationship:
Phone: / Name:
Relationship:
Phone:
Name:
Relationship:
Phone: / Name:
Relationship:
Phone:
Please place a tick in the box next to the people who are meeting together about my recovery plan. / Date of meeting ___/___/____

Our Agreement to Work Together

All the people involved in creating this recovery plan have an important role in supporting me to achieve my goals. Everyone agrees to work together to ensure:

  • we have good communication
  • respect is upheld for each person
  • achievement of my goals becomes the focus

My overall goal is ………………………………………………………………………

My Plan

What is the most important thing to me? / What do I want to do about it? / How might I do it? / How can you help me do it? / Date of completion
What is the thing most important to me? / What do I want to do about it? / How might I do it? / How can you help me do it? / Date of completion
What is the thing most important to me? / What do I want to do about it? / How might I do it? / How can you help me do it? / Date of completion
At some point things may change in my life or with my health that interfere with me achieving my goals.
If this occurs I would like the following to occur:
For Mental Health issues Monday to Friday 9am-5pm / For Mental Health issues After Hours
contact: Ph: / contact: Ph:
Green Light – Things you may notice when I am well and strategies to build on / Things that help me to stay well – Daily Maintenance Plan
Yellow Light – Things you may notice when I am becoming unwell / Things I need to do to stay well
Red Light –Things you may notice that I am unwell / Crisis Response/Actions to be taken

What I want to happen when I am unwell:

Dependents
Action to be taken:
Person responsible: / Pets
Action to be taken:
Person responsible:
(Other)
Action to be taken:
Person responsible: / (Other)
Action to be taken:
Person responsible:

People I want to have involved when I am unwell:

Person 1: / Relationship to consumer: / Contact Details: / Person 2: / Relationship to consumer: / Contact Details:

Monitoring and Next Catch Up

My supports and I will monitor my progress and update each other via any of these methods - phone or email

We will catch up again on ____/____/_____ to review my progress towards my goals

My signature______Date ____ / ____ / _____

My supports

Name: / Name:
Signature: / Signature:
Name: / Name:
Signature: / Signature:
Name: / Name:
Signature: / Signature:
NAME (PRINT) / SIGNATURE / DESIGNATION / DATE