The case against no-suicide contracts: The commitment to treatment statement as a practice alternative. Journal of Clinical Psychology, 62, 243-251

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


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.

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    • "The primary characteristic that distinguishes between suicide warning signs and suicide risk factors is proximity (Rudd et al., 2006) to either a suicide attempt or a suicide. As with other conditions, like heart attack and stroke, warning signs connote imminent risk, risk that is evident over the next few minutes, hours, or days. "
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    ABSTRACT: Clinical work with suicidal patients has become increasingly challenging in recent years. It is argued that contemporary issues related to working with suicidal patients have come to pose a number of considerable professional and even ethical hazards for psychologists. Among various concerns, these challenges include providing sufficient informed consent, performing competent assessments of suicidal risk, using empirically supported treatments/interventions, and using suitable risk management techniques. In summary, there are many complicated clinical issues related to suicide (e.g., improvements in the standard of care, resistance to changing practices, alterations to models of health care delivery, the role of research, and issues of diversity). Three experts comment on these considerations, emphasizing acute versus chronic suicide risk, the integration of empirical findings, effective documentation, graduate training, maintaining professional competence, perceptions of medical versus mental health care, fears of dealing with suicide risk, suicide myths, and stigma/blame related to suicide. The authors' intention is to raise awareness about various suicide-related ethical concerns. By increasing this awareness, they hope to compel psychologists to improve their clinical practices with suicidal patients, thereby helping to save lives. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Professional Psychology Research and Practice 07/2008; 39(4):405-413. DOI:10.1037/a0012896 · 1.34 Impact Factor
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    ABSTRACT: Neuere verhaltenstheoretische Konzepte konvergieren dabei zu sog. transaktionalen Modellen, in denen eine vielfache gegenseitige Abhängigkeit von biologischen, psychologischen und sozialen Faktoren angenommen wird (z. B. Schmidtke u. Schaller 2002). Kognitive, affektive, motivationale, physiologische und behaviorale Erfahrungen können dabei zu Schemata zusammengefasst werden (Rudd 2000), die die Sensitivität für Reizbedingungen erhöhen und dadurch sowohl die Auftretenswahrscheinlichkeit suizidalen Verhaltens generell fördern, als auch dazu führen, dass dieses Verhalten immer schneller und schon bei relativ geringfügigen Auslösebedingungen emittiert wird.
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