Contract For Safety Agreement

Contract For Safety Agreement

Security contracts may have developed from the concept of therapeutic contracts. The idea of a treaty implies shared responsibility and decision-making shared by competent and rational people (Miller, 1999). Miller also pointed out that therapeutic contracts with suicidal people may not be feasible or valid, since contracting involves choice for both parties. The patient`s choice may be “limited or suppressed” if it is a suicidal idea, especially if the physician feels that steps are needed to protect the patient (Miller 1999, p. 466). The issue of freedom from restriction is always a concern. In addition, physicians do not want to be found guilty of failing to protect patients from the damage caused to them (Bongar, Maris, Berman, Litman, Silverman, 1993). Damage contracts involve an often signed obligation on the client to do nothing before a specific date to harm himself or someone else. Often, this date is the next time the client and therapist meet, so that the client can be reassessed and the contract can be reviewed and renewed if necessary.

Some non-injury contracts include certain steps the customer should take before participating in harmful behaviours. Another area of research focused on measuring the views of experts and patients on the usefulness of safety contracts. Davidson and his colleagues12 interviewed a group of psychologists about their views on non-suicide agreements and found that these agreements were generally considered useful for moderately suicidal patients and less useful for mildly or severely suicidal patients. The results also showed that psychologists thought contraction was appropriate with adults and adolescents, but not with children. Davis and his colleagues17 took a different approach and interviewed 135 patients interned in a psychiatric hospital to reflect on their views on the use of non-suicide contracts. Most patients rated agreements positively, regardless of age, gender, social desirability, presence or absence of axis II disorder or risk of suicide at admission. A history of suicidal behavior, including the number of trials, influenced patients` assessments of the availability of these contracts, however, with several attempts finding them less useful than patients without trials. The authors suspected that, given the seriousness of psychopathology found in several trials, their views on each intervention may be more negative than that of less seriously ill patients. In addition, previous experiences with safety contracting and subsequent suicidal behaviour may have contributed to the doubt that these patients felt the usefulness of this intervention.

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