No-suicide contracts, no-suicide agreements, and no-suicide assurances: A study of their nature, utilization, perceived effectiveness, and potential to cause harm

Background: Suicide prevention contracting (SPC) procedures are often afforded clinical practice validity in the absence of evidence attesting to their efficacy and validity. Aims: This study sought to develop a contemporary profile of SPC, identifying factors associated with utilization, perceived effectiveness, and to describe potentially detrimental factors when activating SPC. Methods: A questionnaire was mailed to a sample […]

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

This article reviews the literature on the use of Òno-suicide contractsÓ 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 […]

Chinese workers Foxconned.

The suicide nets are still there. Foxconn, the giant electronics manufacturing subcontractor, installed them in 2010, a year when fourteen workers died after jumping from the ledges and windows of crowded dormitories. In addition to the wide mesh nets, stretched low over the streets of Foxconn’s company towns, the corporation has twenty-four-hour “care centers,” “no […]

No-Suicide Contracts (IN: Assessment, Treatment, and Prevention of Suicidal Behavior, edited by R I Yufit & D Lester)

This chapter describes no-suicide contracts, places them in context, details the existing research on no-suicide contracts, & makes some recommendations about their use. Appendices include examples of no-suicide contracts for use with outpatients, inpatients, children aged 6-8 years, children aged 9-11 years, youth aged 12-17 years, & 2 versions of a verbal agreement. (52 refs.)

Suicidal Behaviours Among Polish Youth in Light of the Following Papers: Suicidal Behaviour in Children and Adolescents. Parts 1 and 2

In this letter to the editor, the author observes that literature reviews by Steele & Doey (2007) seem to indicate that in both America & Europe a broad definition of attempted suicide prevails. This term is used interchangeably with deliberate self-harm which is not informative as to whether or not suicidal intent accompanied the self-harm. […]

Chronic Suicidality and Borderline Personality

This article compares acute suicide ideation with chronic suicide ideation, specifically their different meanings, relationships with Axis I & Axis II disorders, intrapsychic functions, approaches to assessment, & interventions. The potential risks of acute hospitalization of the chronically suicidal borderline personality disorder patient are discussed as well as a longitudinal, multidimensional treatment strategy for the […]

In Session With Jan Fawcett, MD: Diagnosis, Treatment, and Management of Suicide

In this interview, Dr. Fawcett answered the following questions: How common is suicide among patients seen by health care professionals? In what settings are patients most at risk? What can physicians do in cases where the patient is chronically suicidal? What are the indicators that most predict a suicide attempt? Have the demographics of suicide […]

The Efficacy of No-Suicide Contracts With Clients in Counseling on an Outpatient Basis

Clients at 2 outpatient facilities who self-identified as having expressed suicidal thoughts or engaged in suicidal behaviours during some point in their counselling treatement were invited to participate in a survey to assess their perception of the relative effectiveness of 22 treatment methods in order to determine the perceived efficacy of no-suicide contracts as compared […]

Contracting for Safety With Patients: Clinical Practice and Forensic Implications

A literature review was done to assess empirical support for contracts for safety. Legal cases in which this practice was employed are reviewed to examine its effect on outcome. Studies were obtained from a PubMed search. Overall, empirically based evidence to support the use of the contract for safety in any population is very limited, […]

About No-Suicide Contracts

In this letter to the editor, the author comments on an article by Resnick on the assessment & treatment of suicidal patients, including the use of no-suicide contracts. Waltz states clinicians should not conclude from Resnick’s comments that no-suicide contracts are worthless. Resnick’s response, in which he reiterates his point clinicians should not allow these […]

Effectiveness of Close Watch Precautions in Suicidal Patients

In this letter to the editor, Aldrich comments on an article by Busch et al (2003) on inpatient suicide. He discusses the apparent ineffectiveness of close watch precautions & no-suicide contracts for suicidal patients. He asserts the frequent failure of these procedures is due in part to their self-fulfilling prophecy that suicidal patients have already […]

Book Review-Assessment, Treatment, and Prevention of Suicidal Behavior, edited by R I Yufit & D Lester

This book is said to be a “well-referenced & comprehensive book about the assessment of & psychotherapeutic approaches to the individual at risk of suicide”. The book is deemed useful for clinicians who want to learn about various psychotherapeutic approaches, with the understanding the recommendations come from case studies & not controlled studies. (2 refs.)

No-Suicide Agreements: Current Practices and Opinions in a Canadian Urban Health Region

This study determined the extent to which no-suicide agreements are used by outpatient mental health therapists in a Canadian urban health region. Therapists’ perceptions & practices surrounding their use are described. 312 therapists completed surveys. No-suicide agreements were used by 83% although 43% had no formal training in their use. Among those who had used […]

Recognizing That the Suicidal Patient Views you as an ‘Adversary’


College Student Suicide: a Call to Action

The nature & extent of suicide among American college students is examined in this article. Risk & protective factors are discussed as are responses to suicide in this population, legal issues & training issues. The importance of college student suicide & its prevention is emphasized as is the importance of protective factors. (68 refs.)

No-Harm Contracts: a Review of What we Know


Making Stone Soup: Evidence-Based Practice for a Suicidal Youth With Comorbid Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder

Crisis intervention for suicidal youth with comorbid attention-deficit/hyperactivity disorder (ADHD)/major depressive disorder (MDD) presents special challenges for evidence-based practitioners. This article reviews the treatment literature on suicide and comorbid ADHD/MDD. The findings are applied to a clinical case vignette. A 2-phase intervention based on expert consensus guidelines is introduced as a way of addressing both […]

Borderline Personality Disorder: Suicidality and Self-Mutilation

This article includes a discussion between J Mann and J G Gunderson.

Assessment and Treatment of the Youthful Suicidal Patient

This article includes a discussion between D Shaffer and D A Brent.

No-Suicide Contracts to Prevent Suicidal Behavior in Inpatient Psychiatric Settings

Background: Many individuals who are hospitalized on psychiatric units are at high risk of suicide. Among the strategies commonly recommended for suicide prevention is the negotiation of a no-suicide or no-harm contract. In spite of the conventional acceptance of no-suicide contracts, there is little research about this intervention. Objective: To describe the use of no-suicide […]

Assessing and Treating Suicidal Behaviors: a Quick Reference Guide

Please see SIEC #2004-0132 for the full version of this document.

The Effects of the use of “No-suicide Contracts” in Community Crisis Situations: the Experience of Clinicians and Consumers

Gestalt Therapy Approaches to Crisis Intervention With Suicidal Clients