Many of you are likely familiar with the venerable no-harm/no-suicide contract, also called a contract for safety.  Created in the early 1970’s, this tool was often used to prevent or delay an individual’s suicidal act.  Much has been written about this tool, both for and against it.

Originally, the oral or written no-harm/no-suicide contract was designed as a way to forge an agreement with an individual to not make a suicide attempt for a specific time period, and was based on the therapeutic relationship.  The healthcare professional asked the individual to promise to not attempt to take their life without reaching out to several individuals or organizations – typically the therapist, another individual, a suicide prevention hotline, 911, or the ED.

Over the years, the no-harm/no-suicide contract deteriorated almost to the point of an afterthought: “Hey, would you agree to not try and take your life before I see you again – I can’t let you leave until you do so.”  This may create an illusion of safety, and ignores the need for a therapeutic relationship between the patient and healthcare professional.

Problems with the no-harm/no-suicide contract include that it has no legal standing, may hurt a healthcare professional’s case if they are sued after the death of their patient, and the danger of healthcare professionals becoming complacent in its use, replacing a formal suicide risk assessment with the ‘contract’.

A “new” tool is replacing the no-harm/no-suicide contract.  The Safety Plan Initiative, or Safety Plan, is a multi-step process to assist suicidal individuals in developing a personalized plan before they need it.  Developed by Stanley & Brown, this process prompts the individual to develop an escalating series of steps for self-care.

Over the next several blogs, I’ll step you through developing a Safety Plan with individuals contemplating suicide (complete references available on request).

If you are interested in my upcoming trainings or background, or want to review my CV, please visit my website at

My last several posts have talked about resolutions or changes you may be trying to implement.  The last time, we talked about getting back on track when you lose your way.  This time, I have a couple suggestions, or ‘cheat codes,’ to assist you if you are struggling.

If you are struggling to stick with your goal(s), are you trying to change too much at one time?  If you are trying to change multiple habits at one time – like lose weight, quit smoking, get in shape – it may be helpful to focus on changing only one or two habits concurrently.  When you have succeeded at changing those first two habits, add another one or two.  Success often fuels success.

If your challenge is that your goal is too large or complex, try breaking it down into smaller ‘chunks.’  For example, writing a 15 page paper may seem overwhelming.  However, if you break this paper into smaller chunks, or goals, these smaller chunks feel easier to complete.  Divide that paper into sections – an introduction, a couple points in the body, and a conclusion.  Maybe you need a title page and a reference section or bibliography.  Now you have 7 smaller chunks.  Instead of writing “The Paper” (cue scary music), now you can focus on one small chunk at a time.

James Clear has a wealth of articles on habits and change behavior at In The 3 R’s of Habit Change: How To Start New Habits That Actually Stick, he recommends pairing a new habit with something you are already doing.  His example was starting the habit of flossing, and his tactic was to pair it with brushing his teeth, a habit he already had.  He facilitated his new flossing habit by placing flossers next to his toothbrush, making it easy to remember to floss after brushing.

If you are interested in my upcoming trainings or background, or want to review my CV, please visit my website at