No-Suicide Contract

By Ofer Zur, Ph.D.

 

It has been a common practice to ask patients to sign an agreement not to commit suicide, the “no-suicide” contract or what also has been called, “Agreement not to self-harm.” The practice started in the 1970s where detailed questionnaires were indented to be a suicide assessment. In future writings they have turned to a “no-suicide contract.” The main concern with this pseudo-legal agreement is that not only is it alien to our best practices, but also there is no reliable or valid data to confirm its effectiveness or usefulness. In fact there is a serious concern that such contracts may cause harm if it gives therapists a false sense of security that the client would not harm him or herself. In the words of Dr. Goin (2003), “What originated as a guide to evaluation has dramatically and dangerously been transposed into a ‘contract’ that some believe will control and/or prevent suicide.” While the contract may give the client the sense that the clinician is concerned, it should not be considered a substitute for a careful clinical assessment and a thorough suicide risk management intervention.

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No-Suicide Contract

Your Letterhead Here

(Note: This is not a legal document, it is just a sample of an agreement. Clinicians should adapt it according to each client, setting and therapeutic work and seek consultation as necessary.)

Agreement not to self-harm

I, _____________________________________, agree that I will not take any action to harm myself or others. If I feel an impulse to hurt myself or others, I will call Dr. xx at (xxx) xxx-xxxx and/or the police at 911 and/or County Mental Health at (xxx) xxx-xxxx or the hotline (xxx) xxx-xxxx, according to the severity of the situation.

I am aware that Dr. xx may not respond to my call right away, and I then will need to contact one of the other numbers mentioned above or other emergency services. I also have read, signed and have had explained to me the limits of confidentiality outlined in the Office Policies form, especially in regard to clients who pose a danger to themselves or others.

If I choose to retract this contract, I will discuss it first with Dr. xx in person.

Date: ______________

Client’s Signature: __________________________________

Therapist: _________________________________