About no-suicide contracts
Phillip J. Resnick, MD (“Recognizing that the suicidal patient views you as an adversary,” Jan), emphasizes when treating suicidal patients that monitoring mood, behavior, social circumstances, and communications with relatives must be done to assess suicidality. Patient reports to therapists alone are inadequate.
No-suicide contracts alone are, as Dr. Resnick says, hazardous. But when used in conjunction with his recommendations, they can offer patients another avenue for discussing their conflicts about suicide. It is not uncommon for a patient to say: “Doctor, you know that no-suicide contract I made with you? I tore it up last week.” It may be easier for some patients to say they destroyed their no-suicide contract than to proceed immediately to “I am going to kill myself.” When confronted with this situation, therapists can aggressively assess and plan accordingly.
Clinicians should not take Dr. Resnick’s comments and summarily conclude that no-suicide contracts are worthless.
Gary Waltz, MD
Cleveland Heights, Ohio
Dr. Resnick responds:
I agree that no-suicide contracts are not worthless. My point is to convey to therapists that they should not allow such contracts to create a false sense of security.