No-suicide contracts, no-suicide agreements and no-suicide assurances: an exploratory study of their nature, utilization and perceived effectiveness

Stephen Edwards

Research output: ThesisDoctoral Thesis

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The research examined mental health practitioners' attitudes towards, satisfaction with and use of suicide prevention contracting (SPC) techniques. Survey respondents comprised consultant psychiatrists, clinical psychologists, occupational therapists, mental health nurses, psychologists, registered medical officers and social workers. A self-report questionnaire was mailed to 1347 potential respondents, together with three follow-up letters sent out at two-week intervals. There was a 31% response rate, producing 420 valid questionnaires. The results of the research re-confirm the historical trajectory of SPC, from its early beginnings as a relationship-based suicide-risk assessment technique to one that is used in contemporary practice by practitioners to meet a range of objectives. The research focused on three SPC techniques in operation in clinical practice: verbal no-suicide assurances, no-suicide agreements, and written no-suicide contracts. Analysis of the data suggests a number of important findings. The first of these is that practitioners perceive different utility among these three techniques. Secondly, the least experienced practitioners were significantly less likely to use no-suicide contracts, despite seeing more suicidality and having more formal training in the use of the technique. Thirdly, a practitioner's gender, and formal training were significant in the perception and application of SPC techniques. Finally, suicidal behaviours and completed suicide was a clinical outcome in some situations irrespective of the use and non-use of SPC. The findings of this research are used to provide an emerging conceptual framework and associated nomenclature that inform clinical decision-making in relation to SPC. In addition, a conceptual model is presented which demonstrates that the potential for injudicious use of SPC techniques is as much precipitated by individual factors as it is by broader environmental factors. Key words: no-suicide contracts, suicide prevention contracts, no-suicide agreements, no-suicide decisions, contingency contracting.
Original languageEnglish
QualificationDoctor of Philosophy
Publication statusUnpublished - 2008


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