Face to face with the suicidal

Morgan, Gethin; Buckley, Carole; Nowers, Mike

doi:10.1192/apt.4.4.188

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Accurate clinical sensitivity to the patient's inner world is probably of paramount relevance in the approach to suicide risk (Morgan et al, 1998). Suppression of the active symptoms of mental illness, reduction of access to alcohol and drugs and treatment of substance misuse, supportive approaches to sources of stress and removal of the means of committing suicide should significantly reduce suicides in secure locations.…”

Section: Prevention Of Suicide In Secure Psychiatric Facilitiesmentioning

confidence: 99%

Suicide in secure psychiatric facilities

Gordon¹

2002

Adv. psychiatr. treat

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Many people can understand pictures better than words.Books Beyond Words is a series of picture books that has been developed to make communicating easier for people with learning or communication difficulties -and to enable discussion about difficult topics. Supporting text and guidelines are provided for carers, supporters and professionals.d are best dealt with by solitary confinement e may be reduced if other prisoners help in the management of prisoners who are suicidal.

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Section: Prevention Of Suicide In Secure Psychiatric Facilitiesmentioning

confidence: 99%

Suicide in secure psychiatric facilities

Gordon¹

2002

Adv. psychiatr. treat

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Section: Psychiatric Servicesmentioning

confidence: 99%

“…Attempts have been made to identify diagnoses with greater predictive risk of self-harm (Owens & House, 1995; Morgan et al, 1998), but reliability remains low. Depression is one high-risk diagnosis, particularly in subjects of male gender, older age, with previous acts of deliberate self-harm and persistent insomnia (Morgan et al, 1998). Schizophrenia has a 10% lifetime risk, highest in subjects with depressive symptoms, a more serious illness, recurrent relapses, and fear of deterioration, especially in those of high intellectual ability (Morgan et al, 1998).…”

Section: Psychiatric Servicesmentioning

confidence: 99%

Evidence-Based Prevention Strategies of Suicide Behavior in the World: Implications for Slovenia

Henderson¹,

Dazzan²,

Dernovšek

et al. 2002

Crisis

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In this review we consider how Slovenia could consider tackling its high rate of suicide (overall 29 per 100,000, 46 in males, 13 in females). First, we consider the evidence for risk factors that may contribute to Slovenia's high rate of suicide. Second, we describe the interventions to try to reduce the impact of these factors and the evidence for such interventions. We categorize interventions in terms of their operation at either the population level or that of high-risk groups. However, it should be borne in mind that settings often assumed to provide access to population groups, such as general practice and schools, do not reach some people who are likely to be at high risk; for example those who have dropped out of school or who have been excluded from a GP's list. We focus particularly on those for high-risk groups, as a number of East-European countries with high suicide rates such as Slovenia, Hungary, and the Baltic republics are currently considering a shift toward more community-based mental health services. The provision of community mental health services in Slovenia would provide an opportunity to study their impact on the suicide rate. However, we conclude that their development should be accompanied by other initiatives operating at population levels. This multilevel approach acknowledges the complexity of the etiology of suicide, the impossibility of reaching all those at risk through services and the lack of strong evidence for any one intervention.

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“…This is important because how doctors and other professionals ask questions, i.e., the words and phrasing that they use, influences the patient’s response [20]. Some guidance recommends asking neutral or non-leading questions [21] and/or direct questions (e.g., “Have you had any thoughts about killing yourself?) [22].…”

Section: Introductionmentioning

confidence: 99%

How do healthcare professionals interview patients to assess suicide risk?

McCabe

Sterno²,

Priebe

et al. 2017

BMC Psychiatry

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BackgroundThere is little evidence on how professionals communicate to assess suicide risk. This study analysed how professionals interview patients about suicidal ideation in clinical practice.MethodsThree hundred nineteen video-recorded outpatient visits in U.K. secondary mental health care were screened. 83 exchanges about suicidal ideation were identified in 77 visits. A convenience sample of 6 cases in 46 primary care visits was also analysed. Depressive symptoms were assessed. Questions and responses were qualitatively analysed using conversation analysis. χ 2 tested whether questions were influenced by severity of depression or influenced patients’ responses.ResultsA gateway closed question was always asked inviting a yes/no response. 75% of questions were negatively phrased, communicating an expectation of no suicidal ideation, e.g., “No thoughts of harming yourself?”. 25% were positively phrased, communicating an expectation of suicidal ideation, e.g., “Do you feel life is not worth living?”. Comparing these two question types, patients were significantly more likely to say they were not suicidal when the question was negatively phrased but were not more likely to say they were suicidal when positively phrased (χ 2 = 7.2, df = 1, p = 0.016). 25% patients responded with a narrative rather than a yes/no, conveying ambivalence. Here, psychiatrists tended to pursue a yes/no response. When the patient responded no to the gateway question, the psychiatrist moved on to the next topic. A similar pattern was identified in primary care.ConclusionsPsychiatrists tend to ask patients to confirm they are not suicidal using negative questions. Negatively phrased questions bias patients’ responses towards reporting no suicidal ideation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1212-7) contains supplementary material, which is available to authorized users.

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Face to face with the suicidal

Cited by 7 publications

References 8 publications

Suicide in secure psychiatric facilities

Suicide in secure psychiatric facilities

Evidence-Based Prevention Strategies of Suicide Behavior in the World: Implications for Slovenia

How do healthcare professionals interview patients to assess suicide risk?

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