The suicide prevention contract: clinical, legal, and risk management issues.
In the managed care era, mental health professionals increasingly rely upon suicide prevention contracts in the management of patients at suicide risk. Although asking a patient if he or she is suicidal and obtaining a written or oral contract against suicide can be useful, these measures by themselves are insufficient. "No harm" contracts cannot take the place of formal suicide risk assessments. Obtaining a suicide prevention contract from the patient tends to be an event whereas suicide risk assessment is a process. The suicide prevention contract is not a legal document that will exculpate the clinician from malpractice liability if the patient commits suicide. The contract against self-harm is only as good as the underlying soundness of the therapeutic alliance. The risks and benefits of suicide prevention contracts must be clearly understood.
Simon
R I
RI
Program in Psychiatry, Georgetown University School of Medicine, Washington, DC, USA. risimon@ix.netcom.com
D006801:Humans; D016365:Liability, Legal; D017008:Negotiating; D011613:Psychotherapy / Q000331:legislation & jurisprudence*; D012308:Risk Management / Q000331:legislation & jurisprudence / Q000379:methods*; D014481:United States; D000092864:Suicide Prevention