Suicidality–Medical Care and Treatment in a Legal Perspective-A Question of Suicide Prevention (original) (raw)
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The Israel Medical Association journal : IMAJ, 2011
Suicide is universal within the range of human behaviors and is not necessarily related to psychiatric morbidity, though it is considerably more prevalent among psychiatric patients. Considering the limitations of medical knowledge, psychiatrists cope with an unfounded and almost mythical perception of their ability to predict and prevent suicide. We set out to compose a position paper for the Israel Psychiatric Association (IPA) that clarifies expectations from psychiatrists when treating suicidal patients, focusing on risk assessment and boundaries of responsibility, in the era of defensive medicine. The final draft of the position paper was by consensus. The IPA Position Paper established the first standard of care concerning expectations from psychiatrists in Israel with regard to knowledge-based assessment of suicide risk, elucidation of the therapist's responsibility to the suicidal psychotic patient (defined by law) compared to patients with preserved reality testing, cap...
Suicide and mental disorder: the legal perspective
The Medical journal of Australia
Suicide is a problem for society. On examination, current medical/legal concepts of suicide and responsibility rely on imprecise definitions and neglect aspects of suicide which are social rather than medical. A non-medical approach to those cases of people at risk who do not suffer a mental disorder is suggested, along with factors to be considered when the actions of mental health professionals are being evaluated.
BMJ Open, 2019
ObjectivesThe overall aim of this study was to aggregate the conclusions of all investigations conducted after suicides reported to the supervisory authority in Sweden in 2015, and to identify deficiencies in healthcare found in these investigations; the actions proposed to deal with the deficiencies; the level of the organisational hierarchy (micro–meso–macro) in which the deficiencies and actions were situated; and outcomes of the supervisory authority’s decisions.Design and settingThis is a retrospective study of all reports from Swedish primary and secondary healthcare after suicide to the regulatory authority in Sweden in 2015.ResultsIn 55% (n=240) of cases, healthcare providers reported healthcare deficiencies that contributed to suicide; these deficiencies were primarily in ‘suicide risk assessment’ and ‘treatment’. Actions aimed at preventing new suicides were proposed in 80% of cases (n=347). By far, the most frequent actions were ‘education and competence’, present in 52% ...
FP06-1 The Medicalization of Suicide
Asian Journal of Psychiatry, 2011
Medicalisation is the misclassification of non-medical problems as medical problems. A common form of medicalisation is the misclassification of normal distress as a mental disorder (usually a mood disorder). Suicide is medicalised when it is considered a medical diagnosis per se, when it is considered to be secondary to a mental disorder when no mental disorder is present, and when no mental disorder is present but the management of suicidal behaviour associated with distress is believed to be the sole responsibility of mental health professionals. In the West, psychological autopsies have led to the belief that all or almost all suicide is the result of mental disorder. However, there are reservations about the scientific status of such studies. The actions of psychological autopsy researchers, coroners/magistrates, police, policy writers, and grieving relatives all contribute. Medicalisation of suicide has the potential to distort research findings, and caution is recommended.
Suicide in Europe: an on-going public health concern
Socijalna psihijatrija, 2017
Every 40 seconds, somewhere in the world someone dies by suicide, with certain groups such as youth and men being most at risk. Research abounds as to the risks and protective factors, but there is still a huge gap in our knowledge as to what leads one person to act on suicidal ideation and another to refrain. Risks factors vary by country, culture, gender and class, and represent a complex and potentially synergistic interplay between biological, psychological, social, environmental and personal factors. These will be discussed in this paper. Many prevention programmes have been established, but no one intervention stands out. At a minimum, country-wide efforts raising awareness of suicide and deliberate self-harm, highlighting risk and protective factors and identifying and treating mental health problems early, particularly in youth, are essential. Targeted methods include public education and media campaigns, providing training for front-line staff in early recognition and, in the case of primary care clinicians, appropriate referrals for treatment of mental illness, generating policies on restricting easy access to lethal means or substances such as alcohol which disinhibit behaviour and reducing the stigma of, and promoting, help-seeking. These efforts should go some way towards slowing what might otherwise become a self-destructive epidemic. We all have a role to play. / Svakih 40 sekundi negdje na svijetu netko počini samoubojstvo pri čemu su određene skupine, poput mladih i muškaraca pod većim rizikom. Istraživanja ukazuju na brojne kako rizične, tako i zaštitne čimbenike, ali i dalje postoji veliki nedostatak u znanju što neku osobu vodi da djeluje prema svojim suicidalnim idejama, a drugu da se suzdrži od počinjenja suicida. Rizični čimbenici variraju ovisno o državi, kulturi, spolu, klasi i predstavljaju kompleksno, potencijalno sinergističko međudjelovanje bioloških, psiholoških, društvenih, okolišnih i osobnih činitelja o čemu raspravlja ovaj članak. Utemeljeni su mnogi preventivni programi, ali ni jedna intervencija se posebno ne ističe svojom većom učinkovitošću. Potreban minimum treba uključivati: napore na nacionalnoj razini u podizanju svjesnosti o suicidu i namjernom samoozljeđivanju, ukazivanje na rizične i zaštitne čimbenike, rano identificiranje i tretman problema duševnog zdravlja, osobito u mladih. Ciljane metode prevencije uključuju: javnu edukaciju i medijske kampanje, provođenje edukacije i treninga stručnjaka prve linije u ranom prepoznavanju, u slučaju primarne zdravstvene skrbi adekvatno upućivanje na liječenje mentalnih poremećaja, stvaranje politike restriktivnog pristupa smrtonosnim sredstvima ili supstancijama poput alkohola koji dezinhibira ponašanje, reduciranje stigme i promoviranje traženja pomoći. Sve bi ove aktivnosti trebalo smanjiti ono što bi u suprotnom moglo postati epidemija autodestruktivnog ponašanja. Svi mi u ovome imamo svoju ulogu.
Epidemiology of Suicide and the Psychiatric Perspective
International Journal of Environmental Research and Public Health, 2018
Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low-and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating-and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.
Suicide prevention: a task for public health and a role for public health ethics
Journal of Public Mental Health, 2009
Suicide is primarily conceptualised as an event with causes relating to individual lives. However, we argue that it is impor tant not to lose sight of the fact that not all causes of suicide are related simply to individual action and circumstances. Clear evidence exists for some risk factors for suicide being visable at the population level or related to membership of various social groups. Strategies to prevent suicide, therefore, ought to focus on such causes (eg. injustice, discrimination, mental illness in general), not just on causes relating to individuals. In turn, this means that suicide prevention should not merely focus on trying to reduce access to the means of suicide by individuals (eg. shotguns in rural areas, pesticides in India, means of strangulation in prisons etc) but should expand to include such things as socio-economic determinants and other population influences on mental health. We argue that suicide ought to be thought of as being, in an impor tant sense, a public health problem, and that the resources of public health ethics are one impor tant element in seeking to address this impor tant issue.