Safety contract
Formal Definition
A verbal or written agreement between a clinician and a patient with suicidal ideation in which the patient commits to not acting on suicidal thoughts and to contacting emergency services or the treating team if impulses become unmanageable; not a validated risk-reduction instrument and increasingly discouraged as a sole safety measure.
How It's Used on the Ward
"We safety contracted the patient" — still used in practice despite evidence that it does not reliably reduce suicide risk.
Example
""Patient denies active SI currently, agrees to return to ED or call 988 if thoughts worsen — documented safety plan reviewed. He was not appropriate for discharge on safety contract alone given prior attempts; reached out to outpatient psychiatrist for urgent appointment.""
Clinical Context
Safety contracts are NOT evidence-based for suicide prevention and are increasingly replaced by the Stanley-Brown Safety Planning Intervention, which is more structured and actionable. A safety plan includes: warning signs, internal coping strategies, social contacts for distraction, family/friends to ask for help, professional contacts, means restriction. Documentation should reflect a genuine risk assessment, not just "denied SI/HI and safety contracted." Firearm counseling and means restriction are among the highest-yield interventions.
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