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Contracting for safety with patients: clinical practice and forensic implications.
- Source :
-
The journal of the American Academy of Psychiatry and the Law [J Am Acad Psychiatry Law] 2009; Vol. 37 (3), pp. 363-70. - Publication Year :
- 2009
-
Abstract
- The contract for safety is a procedure used in the management of suicidal patients and has significant patient care, risk management, and medicolegal implications. We conducted a literature review to assess empirical support for this procedure and reviewed legal cases in which this practice was employed, to examine its effect on outcome. Studies obtained from a PubMed search were reviewed and consisted mainly of opinion-based surveys of clinicians and patients and retrospective reviews. Overall, empirically based evidence to support the use of the contract for safety in any population is very limited, particularly in adolescent populations. A legal review revealed that contracting for safety is never enough to protect against legal liability and may lead to adverse consequences for the clinician and the patient. Contracts should be considered for use only in patients who are deemed capable of giving informed consent and, even in these circumstances, should be used with caution. A contract should never replace a thorough assessment of a patient's suicide risk factors. Further empirical research is needed to determine whether contracting for safety merits consideration as a future component of the suicide risk assessment.
- Subjects :
- Adolescent
Adult
Child
Expert Testimony legislation & jurisprudence
Humans
Informed Consent legislation & jurisprudence
Liability, Legal
Malpractice legislation & jurisprudence
Mental Competency legislation & jurisprudence
Risk Assessment legislation & jurisprudence
Risk Management
Contracts legislation & jurisprudence
Physician-Patient Relations
Safety legislation & jurisprudence
Suicide legislation & jurisprudence
Suicide Prevention
Subjects
Details
- Language :
- English
- ISSN :
- 1093-6793
- Volume :
- 37
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The journal of the American Academy of Psychiatry and the Law
- Publication Type :
- Academic Journal
- Accession number :
- 19767501