Year: 1999 Source: Journal of the American Psychiatric Nurses Association, v.5, no.1, (February 1999), p.23-28 SIEC No: 20070856

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 contracts in inpatient settings including the frequency of their use, the circumstances under which they are negotiated, and the form of contracts.

Study design: Descriptive survey.

Results: No-suicide contracts were used by 79% (n = 66) of the hospitals (N = 84). Contracts were generally negotiated after suicidal ideation was expressed (83% [n = 54] of those hospitals that use contracts), after self-harm (79%, n = 51), or after a patient who made a suicidal gesture or attempt was admitted (65%, n = 42). In all but one hospital, nurses negotiated contracts with patients. Contracts were usually verbal (74%, n = 48) or handwritten (72%, n = 47) rather than preprinted (15%, n = 10). Fifty-three percent of the respondents estimated more than 10 incidents of suicidal behavior by inpatients per year.

Conclusions: Suicidal behaviors occurred in hospital settings at a rate that is clinically significant. No-suicide contracting is a common nursing practice in psychiatric inpatient settings in Ohio. Contracts are not indiscriminately used but are negotiated when high suicide risk is assessed.