Brief Strategic Family Therapy and the Management of Adolescent Indian Parasuicide Patients in the General Hospital Setting

Abstract

This article describes a model for brief strategic family intervention for use with adolescent parasuicides in a general hospital setting. A rationale and structured therapeutic procedure for intervention are provided. The intervention uses a systemic, time and cost-effective approach which attempts to use the crisis to facilitate resolution of a developmental impasse within the family as a whole. The approach incorporates elements of crisis intervention theory and strategic family therapy. While no formal outcome study was conducted, a three-year follow- up period suggested a zero parasuicide readmission rate for cases receiving family intervention.

Attendance at Psychological Consultations following Non-Fatal Suicidal Behaviour: An Ethical Dilemma

“…After recognising the benefits of the psychological service to their patients over the years, physicians and other medical staff appear to have developed an unwritten policy of requesting a psychological consultation for every NFSB patient as soon as he or she has been physically and medically stabilised (Wassenaar, 1987). This usually occurs within 48 to 72 hours after admission for the NFSB.…”

“…This approach was also motivated by concerns about maximising immediate therapeutic benefits and patient attendance at such services. It is standard clinical and risk-management practice in several countries to conduct the first mental health consultation while the individual is an in-patient (Bongar, 1992;Boyce et aI., 2003;Hawton, 2000;Piacentini, et aI., 1995;Runeson, et aI., 2000;Wassenaar, 1987). However, the process of referring the NFSB patients to our general hospital psychological clinic has been somewhat different, as described below.…”

Psychological Intervention, Spontaneous Remission, Hopelessness, and Psychiatric Disturbance in Adolescent Parasuicides

“…In addition, adjustment disorders are also prevalent and may be understood in the context of life events and individual reactions. In general, South African studies of suicidal Indian adolescents have noted an absence of severe psychiatric disturbance (Pillay & Schlebusch, 1987;Wassenaar, 1987). Interestingly, in a comparison of Asian (mainly Indian) and White parasuicides in Britain, Merrill and Owens (1986) found significantly lower levels of psychiatric disturbance in their Asian sample.…”

“…Hopelessness is believed to be the most predominant feeling preceding a suicidal gesture and is probably of greater significance in causing this behavior than depression on its own (Beck, Steer, & Brown, 1993;Beck, Steer, Kovacs & Garrison, 1985;Pfeffer, 1986). The more hopeless individuals feel about their life situation, the more likely they are to give up trying and use suicidal behavior as a means of escaping the situation (Shneidman, 1993) or as a way of communicating their state of distress (Wassenaar, 1987). The level of hopelessness has also been found to be an important predictor of future suicide in individuals with suicidal ideation (Beck et al, 1985).…”

“…If the session is satisfactory the adolescent is discharged and at least two follow-up family sessions are arranged. This approach has been more fully described elsewhere (Wassenaar, 1987). Due to a number of practical difficulties, a strict family therapy regime could not be adhered to on an ongoing basis.…”