The case against no-suicide contracts: The commitment to treatment statement as a practice alternative

Department of Psychology & Neuroscience, Baylor University, TX 97334, USA.
Journal of Clinical Psychology (Impact Factor: 2.12). 02/2006; 62(2):243-51. DOI: 10.1002/jclp.20227
Source: PubMed

ABSTRACT This article reviews the literature on the use of "no-suicide contracts" in clinical practice, including conceptual discussions, patient and clinician surveys, and a few empirical studies on clinical utility. Our primary conclusion is that no-suicide contracts suffer from a broad range of conceptual, practical, and empirical problems. Most significantly, they have no empirical support for their effectiveness in the clinical environment. The authors provide and illustrate the commitment to treatment statement as a practice alternative to the no-suicide contract.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This column is the fourth in a series describing a model for therapeutic risk management of the suicidal patient. Previous columns presented an overview of the therapeutic risk management model, provided recommendations for how to augment risk assessment using structured assessments, and discussed the importance of risk stratification in terms of both severity and temporality. This final column in the series discusses the safety planning intervention as a critical component of therapeutic risk management of suicide risk. We first present concerns related to the relatively common practice of using no-suicide contracts to manage risk. We then present the safety planning intervention as an alternative approach and provide recommendations for how to use this innovative strategy to therapeutically mitigate risk in the suicidal patient. (Journal of Psychiatric Practice 2014;20:220-224).
    Journal of Psychiatric Practice 05/2014; 20(3):220-4. DOI:10.1097/01.pra.0000450321.06612.7a · 1.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: One of the more controversial issues in working with people who self-injure is whether counselors should use no-harm contracts. Important therapeutic considerations include the efficacy of such contracts or agreements in preventing self-injury, the emotional and behavioral responses of clients, and the perceived protection these contracts or agreements may offer counselors. The authors weigh potential benefits and pitfalls and make recommendations for working collaboratively with clients to meet their individual needs.
    01/2011; 89(1). DOI:10.1002/j.1556-6678.2011.tb00069.x
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Primary care is a critical setting for suicide prevention because it is often the first and only source of mental health care for the U.S. general population. It is also important because suicidal patients report a greater number of somatic complaints and make more frequent medical visits compared to nonsuicidal patients. Models for managing suicide within primary care have recently arisen, yet no models have been proposed for use within the patient-centered medical home (PCMH), a primary care model that integrates behavioral health into its practice. The authors suggest a chronic disease model for the management of suicide risk in the PCMH along with collaborative strategies that may include suicide screening and targeted assessment, warm hand-offs, cognitive-behavioral interventions, routine collaborative medication management, and means restriction counseling. The current paper advises how those within the PCMH can adapt and implement evidence-based practices to manage suicide. Finally, the authors discuss a case example illustrating these evidence-based and collaborative methods.
    Cognitive and Behavioral Practice 08/2014; 21(3). DOI:10.1016/j.cbpra.2014.04.006 · 1.33 Impact Factor


Available from