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Contracting for safety with patients: clinical practice and forensic implications
Keelin A Garvey1, Joseph V Penn, Angela L Campbell
1University of California Davis Medical Center, Division of Psychiatry and the Law, 2230 Stockton Blvd, Sacramento, CA 95817, USA. keelin_garvey@ucdmc.ucdavis.edu
The Journal of the American Academy of Psychiatry and the Law
|September 22, 2009
Summary
The contract for safety, used in managing suicidal patients, lacks strong empirical evidence, especially for adolescents. Legal reviews show it offers insufficient protection against liability and should be used cautiously, never replacing thorough risk assessments.
Area of Science:
- Psychiatry
- Clinical Psychology
- Medical Law
Background:
- The contract for safety is a clinical procedure for managing suicidal patients.
- It carries significant implications for patient care, risk management, and medicolegal outcomes.
Purpose of the Study:
- To assess the empirical support for the contract for safety procedure.
- To examine its legal implications and effect on patient outcomes through a review of legal cases.
Main Methods:
- A literature review was conducted using PubMed searches.
- Included studies comprised opinion-based surveys and retrospective reviews.
- Legal cases involving the contract for safety were also analyzed.
Main Results:
- Empirical evidence supporting the contract for safety is very limited, particularly in adolescent populations.
- Legal review indicated that contracts for safety do not sufficiently protect against legal liability.
- Adverse consequences for clinicians and patients may arise from its use.
Conclusions:
- The contract for safety should only be used with patients capable of informed consent and with caution.
- It must never substitute a comprehensive suicide risk assessment.
- Further empirical research is necessary to validate its role in suicide risk assessment.
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