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).