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, particularly in adolescent populations. A legal review revealed that contracting for safety is never enough to protect against legal liability & may lead to adverse consequences for the clinician & the patient. A contract should never replace a thorough assessment of the patient’s suicide risk factors. Further empirical research is needed. (38 refs.)