Suicide Risk Assessment an Important Part of Joint Commission Survey

Suicide contracts

Although suicide contracts are commonly used, they have not been proven to reduce suicide, said Chaput, and cannot be considered a legal document. However, if there is a positive therapeutic relationship, contracts can be helpful.

"Suicide contracts can be a very useful tool to help you determine risk and also to counsel the patient, but they do not necessarily protect you or your organization from citation or reduce liability issues," said Farrar. A suicide contract is really a method for gathering information as well as a way of measuring the patient's risk of committing suicide.

Farrar gave the example of a patient expressing depressed and suicidal thoughts. Farrar would ask that patient about her thoughts and also whether she could commit to seeking care when she has strong thoughts about hurting herself before acting on them.

"Now what I just asked her to do is, in a roundabout way, a suicide contract," said Farrar. "But it is primarily an information-gathering tool. She may say, 'Yes, Dr. Farrar, I do have these thoughts, but I don't think I'm going to act on them. They build up slowly, but I do know that if they came back, I would call you or an emergency hotline or go to an emergency room.' She has, by definition, just contracted for safety."

To read more about evaluating a patient's risk for suicide, please see the April issue of Briefings on Patient Safety, a product of Patient Safety Monitor.