Contracting for safety: a concept analysis

The concept of contracting for safety, although a popularly accepted method for managing suicidal patients, has no scientific evidence to support its effectiveness. There are questions regarding the clinical justification. This article provides a concept analysis of contracting for safety to evolve and clarify exemplary criteria of the concept within psychiatric nursing practice. At times in clinical practice, contracting is often the primary factor in clinical decision-making, justifying a lower level of intervention. If a patient is inebriated or psychotic, he or she cannot enter into a legal contract. There may be undue reliance on the patient's apparent willingness to contract for safety. There may be little opportunity to establish a therapeutic relationship with the concomitant rapport and trust necessary for contracting. If it is used at all, contracting for safety should be used judiciously.