Behavioral Contracting for Repeated Suicide Attempts

Abstract

A behavioral contract was used to decrease the frequency of repeated suicide attempts and to increase adaptive behavior of a chronic schizophrenic patient hospitalized on a locked psychiatric ward. The behavior therapist left the patient's unit a few months after the contract ended. A follow-up at one year after termination of the contract showed no suicide attempts, suicidal ideas only once, and good adjustment on an unlocked psychiatric ward for the previous nine months. Just before completion of this article, 18 months after the contract, the patient committed suicide. A psychological autopsy showed the patient had continued without suicidal behavior for 14 months after the contract ended. When faced with possible discharge from the hospital and a return to the interpersonal conditions the contract had corrected earlier, the patient increased self-injurious and suicidal behavior and finally killed himself. This temporary success, followed by longer-term failure, is presented to illustrate certain clinical and methodological issues in the behavioral treatment of suicidal patients.