BACKGROUND: Many individuals who are hospitalized on psychiatric units are at high risk of suicide. Among the strategies commonly recommended for suicide prevention is the negotiation of a no-suicide or no-harm contract. In spite of the conventional acceptance of no-suicide contracts, there is little research about this intervention.
OBJECTIVE: To describe the use of no-suicide contracts in inpatient settings including the frequency of their use, the circumstances under which they are negotiated and the form of contracts.
STUDY DESIGN: Descriptive survey.
RESULTS: No-suicidecontracts were used by 79% (n = 66) of the hospitals (N = 84). Contracts were generally negotiated after suicidal ideation was expressed (83% [n = 54]of those hospitals that use contracts), after self-harm (79%,n= 51), or after a patient who made a suicidal gesture or attempt was admitted (65%/, n = 42). In all but one hos- pital, nurses negotiated contracts with patients. Contracts were usually verbal (74%/,n = 48) or handwritten (72%,n = 47) rather than preprinted (15%,n = 10). Fifty-three percent of the respondents estimated more than 10 incidents of suicidal behavior by inpatients per year.
CONCLUSIONS: Suicidal behaviors occurred in hospital settings at a rate that is clinically significant. No-suicide contracting is a common nursing practice in psychiatric inpatient settings in Ohio. Contracts are not indiscriminately used but are negotiated when high suicide risk is assessed.
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