No-suicide agreements: Current practices and opinions in a Canadian urban health region

Abstract

Objective: To determine the extent to which no-suicide agreements (NSAs) - one method of intervening with people at risk of suicide - are used by a population of outpatient mental health therapists in a Canadian urban health region, and to describe therapists' perceptions and practices surrounding their use. Method: The survey was mailed to 516 therapists, including psychiatrists, psychologists, nurses, social workers, and occupational therapists. Results: Completed surveys were returned by 312 therapists (response rate = 60.5%). NSAs were used by 83%, although 43% had no formal training in their use. Among those who had used NSAs, 31% reported having had at least one patient attempt or complete suicide while an agreement was in place. Therapists from nonmedical disciplines were most likely to have used these agreements. Most therapists believed NSAs communicated care and concern to patients. Respondents were divided in their perceptions of whether NSAs afforded liability protection in the event of a patient suicide. Contextual factors associated with the perceived degree of suicide risk, the patient-therapeutic relationship influenced a therapist's use of NSAs. Most therapists attempted to have patients admitted to hospital if the patient refused to enter into an NSA. Conclusions: Use of NSAs is prevalent in this population of outpatient psychotherapists, suggesting that these therapists believe they are a useful intervention in the management of suicidal patients. Practitioners might benefit from increased formal training opportunities in the use and legal implications of NSAs.