This research examines the importance of assessing motivations that crisis patients attribute for considering a suicide attempt. For 251 consecutive patients attending a crisis unit, suicide attempters and ideators indicated agreement with each of 14 reasons for attempting suicide. Principal components analysis of these agreement ratings yielded two factor scales of motives: Extrapunitive/Manipulative Reasons and Internal Perturbations. Scores for internal perturbations correlated significantly with patients' wishes to die, clinicians' ratings of patients' suicidal desire and preparation for suicide, and clinicians' overall evaluation of patients' suicidal risk. Associations between internal perturbations and these suicide measures were nonredundant with hopelessness. It is concluded that evaluating a suicidal person's internal reasons for attempting suicide has unique assessment value.

Mental health diversion is a process where alternatives to criminal sanctions are made available to persons with mental illness (PMI) who have come into contact with the law. One form of mental health diversion is pre-arrest, in which the police use their discretion in laying charges. Concomitant with the growth of pre-arrest diversion programs is a growing body of research devoted to the phenomenon. The purpose of this paper is to review the existing literature of pre-arrest diversion, and to report the results of an international survey of pre-arrest diversion programs we conducted to identify evidence-based practices. On the basis of our review and survey, we note that successful pre-trial programs appear to integrate relevant mental health, substance abuse and criminal justice agencies by having regular meetings between key personnel from the various agencies. Often, a liaison person with a mandate to effect strong leadership plays a key role in the coordination of various agencies. Streamlining services through the creation of an emergency drop-off center with a no-refusal policy for police cases is seen as crucial. While there is some indication that mentally ill offenders benefit from their participation in this form of diversion, the evaluative literature has not yet achieved the "critical mass" necessary to create generalizable, evidence-based knowledge. The absence of generally agreed-upon outcomes could lead to the inequitable application of basic principles of diversion. We suggest that indicators, benchmarks, and outcomes must be agreed upon if a comprehensive understanding of pre-arrest programs is to emerge.

A 27-month prospective study was conducted of patient assaults on nurses in a Canadian psychiatric hospital. Rates were low (4% of the patients committing an assault) and the injuries mostly trivial. Schizophrenics accounted for 43% of attacks, but when allowance was made for the disproportionate number of patients in the hospital with this diagnosis, individuals with mental retardation or dementia were approximately twice as likely to be assaultive as schizophrenics. Repeat assaulters (greater than 4 attacks) were more likely to be suffering from paranoid schizophrenia.

This research examines the importance of assessing motivations that crisis patients attribute for considering a suicide attempt. For 251 consecutive patients attending a crisis unit, suicide attempters and ideators indicated agreement with each of 14 reasons for attempting suicide. Principal components analysis of these agreement ratings yielded two factor scales of motives: Extrapunitive/Manipulative Reasons and Internal Perturbations. Scores for internal perturbations correlated significantly with patients' wishes to die, clinicians' ratings of patients' suicidal desire and preparation for suicide, and clinicians' overall evaluation of patients' suicidal risk. Associations between internal perturbations and these suicide measures were nonredundant with hopelessness. It is concluded that evaluating a suicidal person's internal reasons for attempting suicide has unique assessment value. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 569-576, 1998. Why is it that for two equally hopeless persons, one will attempt or complete suicide whereas another will not? The purpose of the current study is to address this question by assessing the attributions that patients in crisis give for attempting to end their lives.The identification of psychological antecedents of suicidal intent represents an important avenue to pursue in the prediction and therapeutic prevention of self-destructive behavior. To date, arising from the cognitive research of Aaron T. Beck and his colleagues, hopelessness,

This study evaluated counseling procedures for reducing anxious vocational indecision. Thirty-two university students with this problem were identified and randomly assigned to five training conditions: anxiety management, problem solving, a combination of the two, a placebo procedure, and a notreatment condition. The same counselor group-administered the treatment and placebo procedures. The experimental design consisted of pre-and postassessment of vocational, anxiety-related, and problem-solving variables. The main finding was that a combination of anxiety-management and problem-solving training was effective and resulted in significantly greater gains than either method alone with respect to vocational exploratory behavior, awareness of career plans, and problem-solving behavior. Within the theoretical framework of D'Zurilla and Goldfried, it was concluded that vocational indecision as used in this study appears to be due to deficiencies in problem solving and execution of chosen alternatives.