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. Al-though 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 insuf-ficient. "No harm " contracts cannot take the place of formal suicide risk assess-ments. 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. In the managed care era, mental health professionals increasingly rely upon sui-cide prevention contracts in the manage-ment of patients at suicide risk. ' In both outpatient and inpatient settings, patients are being treated for shorter periods of time. For example, in acute care psychi-atric units or hospitals, the average length of stay is usually less than six days. How-ever, only the sickest patients are hospital-i ~ e d. ~ The purpose of hospitalization is rapid stabilization of the patient and early discharge. Admission requirements for in-Dr. Simon is Clinical Professor of Psychiatry and Di