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Letter to the EditorFull Access

No Suicide Decision

Published Online:18 Nov 2005https://doi.org/10.1176/pn.40.22.0036e

Thank you for the article in the July 1 issue in which Robert Simon, M.D., was interviewed: “Several Signs Should Alert Clinicians to Suicide Risk.

I have one small addition to make. Dr. Simon comments that there are no data to support the use of no-suicide contracts to prevent suicide. However, as Marcia Goin, M.D., pointed out in the July 18, 2003, issue, these contracts seem to have evolved from the no-suicide decision procedure published by me, Robert L. Goulding, M.D., and Mary E. Goulding M.S.W., in the February 1973 American Journal of Psychiatry in the article “No-Suicide Decisions: Patient Monitoring of Suicidal Risk.”

This procedure, which is not a contract, has been used for more than 30 years internationally with only four reported fatalities. These data were reported at a workshop at APA's 2004 annual meeting in New York in which Dr. Simon was kind enough to participate. He said he agreed that this procedure was different and professionally sound.

I should emphasize that I entirely agree with Dr. Simon's cautions against contracts in general.

Tempe, Ariz.