“Contracts for Safety”

A “contract for safety,” sometimes called a “no-suicide contract” or “no-harm contract” (hereinafter abbreviated CFS whether singular or plural), is a formal-sounding pseudoagreement between clinicians or caregivers and a person known to be at significant suicide risk. It is a pseudoagreement because, as discussed in this entry, there is no real or binding agreement, the patient is often unable to enter into a meaningful promise or contract, and, importantly, it cannot be relied on for patient safety.

CFS became popular in North America during the 1990s. Despite research and clinical experience highlighting their shortcomings, they remain common in psychiatric hospitals, emergency rooms, and outpatient counseling or psychotherapy settings. Some inpatient facilities require them for certain patients, perhaps in an effort to avoid liability should tragedy occur.

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