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How Effective are Suicide Contracts in Clinical Practice?

Psychiatrists and psychologists often "contract for safety" with suicidal patients; these patients avoid hospitalization based on their assurances that they will contact their clinicians if the inclination to commit suicide overwhelms them. Most clinicians assume that these contracts have clinical utility, but no previous studies have examined the issue. This investigator conducted a mail survey of 514 psychiatrists in Minnesota on their use of "no-suicide contracts" and obtained responses from 267 (52 percent).

Of the respondents, 152 (57 percent) used no-suicide contracts; of these, 94 (62 percent) used verbal contracts only, and 58 (38 percent) used both verbal and written contracts. Within this group, 62 (41 percent) had patients who committed suicide or made serious attempts after entering into the contract. Psychiatrists in practice for longer periods of time were less likely than younger colleagues to contract with their patients for safety.

Comment: Before we can know whether contracting for safety has any clinical efficacy, we need data on the rates of attempted and completed suicide among ambulatory suicidal patients who do not have such contracts and among those who do. Such data currently do not exist. Still, these findings should caution psychiatrists who take excessive comfort from the fact that their suicidal patients agree to contract for safety. No medicolegal protection is conferred by a no-suicide contract, and it is easy to see why. At least some of these contracts may not be worth the words that are spoken or the paper that they are written on.

— J Yager

Published in Journal Watch Psychiatry November 14, 2000

Citation(s):

Kroll J. Use of no-suicide contracts by psychiatrists in Minnesota. Am J Psychiatry 2000 Oct 157 1684-1686.

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