What should a BIRP note for schizophrenia include?

Behavior: what the client reports about voices, beliefs, mood, sleep, medication and substance use, and your observations of speech, thought process and affect. Intervention: what you did and the goal it serves. Response: ratings, engagement, progress and current risk. Plan: practice, the next session and coordination with the prescriber or team.

How do you document hallucinations in a progress note?

Record the type (for example voices), how often they happen, what they say, whether they command the client to do anything, how distressing they are and how the client copes. Add whether the client appeared to respond to internal stimuli during the session.

How do you document command hallucinations?

Record what the voices tell the client to do, whether the client feels able to resist, any past acting on commands, and your risk judgment and safety plan. Document that you asked even when the client reports no commands.

What is CBT for psychosis?

CBT for psychosis (CBTp) is a talking therapy that helps people understand and cope with experiences such as voices and unusual beliefs, reduce distress and work toward their own goals. It is usually offered alongside medication, not instead of it.

Where does clinical assessment go in a BIRP note?

BIRP has no separate assessment section, so most clinicians record their judgment about progress and risk in Response, alongside how the client responded to the interventions.

BIRP Notes for Schizophrenia: Template + Examples (2026)

Record a session and MentalNote drafts the BIRP note for you to review and edit. No sign-up to try. HIPAA-compliant, with a BAA included on every plan. Open a sample BIRP note

Overview

This guide is part of our complete BIRP notes hub — format structure, a full clinical example, the BIRP note generator, and all 72 diagnosis-specific templates.

No sign-up needed: open a fictional BIRP note in the MentalNote editor and edit it like a real draft.

Short answer: a BIRP note for schizophrenia has four parts. Behavior: what the client reports about voices, beliefs, mood, sleep, medication and substance use, and what you observe (appearance, speech, thought process, affect). Intervention: what you did, such as CBT for psychosis, psychoeducation or relapse-prevention planning, and the goal it serves. Response: how the client responded, with ratings and your view of progress and risk. Plan: the next session, practice, and coordination with the prescriber or care team.

BIRP has no separate assessment section, so many clinicians put their clinical judgment about progress and risk in Response. Describe symptoms in the client’s words and your observations rather than labels alone.

What to document in a BIRP note for schizophrenia

Schizophrenia details to document in a BIRP note, with fictional example wording
Section	What to document	Example wording
Behavior: symptoms	Hallucinations (how often, what they say, whether they command), beliefs and how strongly held, mood, sleep	“Reports difficulty starting daily activities; no voices or unusual beliefs in the past month.”
Behavior: observations	Appearance, speech, thought process, affect, and whether the client seemed to respond to unseen stimuli	“Delayed but coherent replies; blunted affect; oriented.”
Intervention	What you did and the goal it serves	“Reviewed activity record; examined an all-or-nothing prediction and scheduled a small first step.”
Response	Distress or conviction ratings, engagement, progress and current risk	“Showered on 2 mornings (1 last week); library attendance unchanged; acute suicide risk judged low with ongoing safety planning.”
Plan	Practice, next session, prescriber or team contact and relapse signs	“Practice and record the first step on 3 mornings; coordinate with prescriber and sister with consent.”

Safety. People with schizophrenia have a higher risk of suicide than the general population, especially early in the illness, after hospital discharge and with depression, so ask directly at every session and record the answer. If a client reports suicidal thoughts, assess and record current thoughts, plan, intent, preparatory behavior, past attempts, access to means (including firearms and medications), protective factors, your risk formulation and the safety plan. Ask whether voices tell the client to do things and whether they feel they must act on them, and ask about thoughts of harming others. Contact the prescriber or care team promptly when symptoms worsen or the client stops medication. The 988 Suicide & Crisis Lifeline takes calls and texts at 988; for imminent danger, call 911 or go to the nearest emergency department.

How to Document BIRP Notes for Schizophrenia & Psychotic Disorders

Behavior

Document observable client behaviors, actions, and presentation in session

When documenting the Behavior section for schizophrenia, focus on the client’s self-reported symptoms, observable presenting concerns, potential triggers, and mood or affect changes during the session. This section captures baseline and current behavioral manifestations related to psychosis and emotional state.

Document presence and nature of hallucinations or delusions reported by the client.
Note any observable disorganized speech or behavior during the session.
Identify environmental or interpersonal triggers that may exacerbate psychotic symptoms.
Record client’s reported mood, including any signs of depression, anxiety, or irritability.
Describe affect presentation—whether flat, blunted, inappropriate, or labile.

Intervention

Record specific therapeutic interventions and techniques used

The Intervention section should detail the clinical techniques, therapeutic approaches, and observations utilized specifically to address schizophrenia symptoms during the session. Document clinician-led strategies aimed at symptom management and engagement.

Describe use of reality testing or cognitive-behavioral techniques to challenge delusional thinking.
Note implementation of psychoeducation about schizophrenia and symptom recognition.
Record any medication adherence support or monitoring conducted during the session.
Detail use of grounding or mindfulness exercises to manage hallucination-related distress.
Document clinician’s observation of client’s engagement and responsiveness to interventions.

Response

Note the client's response to interventions and observable changes

In the Response section, capture the client’s reaction to interventions, any observable changes in symptoms, and clinical impressions regarding progress or diagnostic insights. This reflects the effectiveness of the session’s therapeutic efforts.

Evaluate client’s insight into their symptoms and willingness to engage in treatment.
Note any reduction or escalation in psychotic symptoms following intervention.
Assess client’s emotional regulation and coping during or after therapeutic activities.
Record observations of improved reality orientation or cognitive clarity.
Document any emerging diagnostic considerations or need for reassessment.

Plan

Outline next steps, continued interventions, and session scheduling

The Plan section outlines the next steps in treatment for schizophrenia, including adjustments to therapeutic approaches, homework assignments, referrals, and scheduling to support ongoing symptom management and recovery.

Specify any planned medication review or psychiatric consultation referrals.
Assign homework focused on symptom tracking or coping skill practice.
Outline modifications to therapy techniques based on client’s current needs.
Schedule follow-up sessions to monitor symptom progression and treatment adherence.
Recommend community support resources or social skills training programs.