Research question In patients using psychiatric services, does the implementation of observation or no-suicide contracts increase patient safety? The use of various observation methods, including non-suicide contracts (NSCs), in the treatment of patients using psychiatric services is currently the standard of care. The use of no-suicide contracts became common in the United States in 1973 when Drye, Goulding, and Goulding published a report reflecting data from their own practice. McMyler and Pryjmachuk (2008) explain Drye's study: Firstly, within a 5 year period in the authors' practice, NSCs had been carried out with 600 service users and none had resulted in suicide. Second, as part of the study, Drye et al. interviewed 31 therapists who used NSCs and found that, in the 609 cases in which NSCs were used according to their instructions, no suicides had occurred. (p. 513) A no-suicide contract is an agreement between a provider and a patient who uses psychiatric services. This agreement is “sometimes verbal but usually written, under which the service user agrees not to harm themselves… commonly including a statement of consent, details of the duration of the agreement and a contingency plan in case where the service user feels unable to maintain the agreement” (McMyler & Pryjmachuk, 2008, p. 513). Different levels of observation have also been used in the treatment of psychiatric patients. These levels of observation include: “routine or general observation, 30 to 15 minute checks, and constant or continuous observation” (Manna, 2009, p. 268). While a mental health professional such as a licensed professional counselor, a licensed clinical social worker, a psychiatrist, or an Advance...... at the heart of the document ......111/j.1365-2850.2008.01286.xMurphy , E. , Kapur, N., Webb, R., & Cooper, J. (2011). Risk assessment following self-harm: comparison between mental health nurses and psychiatrists. Journal of Advanced Nursing, 67(1), 127-139. doi:10.1111/j.1365-2648.2010.05484.xNational Institute of Mental Health. (2014).Puskar, K., & Urda, B. (2011). Examining the effectiveness of no-suicide contracts in inpatient psychiatric settings: Implications for psychiatric nursing. Issues in Mental Health Nursing, 32(12), 785-788. doi:10.3109/01612840.2011.599476QSEN Quality and safety education for nurses. (n.d.). QSEN Quality and safety education for nurses. Retrieved February 1, 2014, from http://www.qsen.org.Range, L., Campbell, C., Kovac, S., Marion-Jones, M., Aldridge, H., Kogos, S., & Crump , Y. (2002). Anti-suicide contracts: overview and recommendations. Studies on death, 26(1), 51-74.