Suicide planning type interventions as an evidence based alternative for no-suicide contracts

TL;DR

This paper compares no-suicide contracts and safety planning-type interventions, suggesting the latter may be a more effective and evidence-based approach for suicide prevention.

Contribution

The paper provides a critical analysis of evidence supporting safety planning-type interventions over no-suicide contracts.

Findings

No-suicide contracts lack sufficient quantitative evidence for clinical effectiveness.

Safety planning-type interventions are associated with reduced suicidal behaviors.

Safety planning interventions are easier to implement in various clinical settings.

Abstract

Suicidality is a common concern in psychiatric patients and one of the leading causes of death in adolescents and young adults. (Adolescent health. (2019, November 26) WHO). Some mental health professionals engage in a no-suicide contract with their patients. In this type of intervention, the patient usually agrees to not harm or kill himself/herself. There is an increasing body of evidence to support brief interventions, such as group of safety planning-type interventions (SPTIs) (McCabe et al. MC Psychiatry, 2018, May 3; 18(1)). Safety planning is derived from cognitive therapy and cognitive behavioral therapy used for suicide prevention.

Our objective was to summarize and critically analyze current evidence of effectiveness of SPTIs and no-suicide contracts in suicide prevention.

We conducted a literature review to compare no-suicide contract to safety-planning interventions in suicide prevention.

Although no-suicide contracts may work for some individuals, there is not enough quantitative evidence to support such contracts as clinically effective tools. A recent meta-analysis has shown that SPTIs were associated with reductions in suicidal behaviors although no effect was identified with frequency of suicidal thoughts (Nuij et al. (2021, April 30). The British Journal of Psychiatry, 219 (2), 419–426).

Based on the evidence and straightforward implementation of SPTIs in different clinical settings it may to be a more effective alternative to no-suicide contracts.

None Declared