A call for change from impersonal risk assessment to a relational approach: professionals’ reflections on the national guidelines for suicide prevention in mental health care in Norway

Espeland, Kristin; Hjelmeland, Heidi; Knizek, Birthe Loa

doi:10.1080/17482631.2020.1868737

Cited by 17 publications

(14 citation statements)

References 52 publications

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“…In recent years, several experts have argued that new approaches in clinical suicide prevention are needed [ 35 , 36 , 37 , 38 ]. The insight is growing that current practices will not get us any further in significantly reducing suicide.…”

Section: The Limitations Of Theoretical Suicide Modelsmentioning

confidence: 99%

Suicide Models and Treatment Models Are Separate Entities. What Does It Mean for Clinical Suicide Prevention?

Michel

2021

IJERPH

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Theoretical models of suicide are based on risk factors associated with suicide, such as psychiatric pathology, genetics, epigenetics, functional brain disorders, and impaired decision making. In current clinical practice, the predominant risk model is the medical model, which posits that treating suicide risk is primarily a matter of treating psychiatric disorders. However, even comprehensive risk factor models cannot overcome the basic problem that, by their nature, they cannot accommodate the suicidal person’s psychological experience of suicidality. Risk factor models do not translate into effective treatment models. Suicide risk is highly personal and fluid, and is related to individual vulnerabilities and to person-specific events triggering suicidal thoughts and actions. Clinicians need treatment models that are meaningful to suicidal patients. Understanding the single person’s suicidality requires a patient-centered approach. Therapeutic interventions that effectively reduce the risk of suicidal behavior have been developed from general principles of psychotherapy. Therapy process factors associated with effective therapies are working alliance, validation of the individual patient’s thoughts and feelings, active treatment engagement. Psychological therapies need patients who are active participants in a collaborative working relationship between therapist and patient. The goal must be to jointly develop a meaningful understanding of the suicidal crisis. In view of the limited personal resources in health care systems it is important that effective therapies are brief and effective. Future research must aim to improve our understanding of the factors involved in effective therapies in order to optimize treatments for individuals at risk. This may also include the integration of biological risk factors in psychological treatment models.

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Section: The Limitations Of Theoretical Suicide Modelsmentioning

confidence: 99%

Suicide Models and Treatment Models Are Separate Entities. What Does It Mean for Clinical Suicide Prevention?

Michel

2021

IJERPH

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“…Such approaches, however, divest suicide of meaning, intent and agency and limit efforts to understand suicidal experiences. A relational view of ethics that emphasises notions of trust, mutuality, reciprocity and solidarity to foster open discussion and reflection destabilises current practices of risk assessment, surveillance, detention and coercive treatment; and in doing so, broadens the possibilities by which practitioners engage with suicidal persons (Espeland et al, 2021). This, in turn, has led to an increasingly critical stance by some scholars towards the moralising rhetoric of prevention that seeks to safeguard life at all cost; silence the voices of suicidal individuals, and subject persons to harmful environments and consequences (Baril, 2017; Tack, 2019).…”

Section: Ethicsmentioning

confidence: 99%

Critical suicide studies, between methodology and ethics: Introduction

2021

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“…Some researchers and clinicians have explicitly identified a potential conflict for therapists regarding where to focus their attention: on the obligatory risk assessment or on patient's experience (Espeland et al, 2021;Schechter et al, 2013). The assessment situation is at worst more therapist-centered than patient-centered because the standardized procedures may be prioritized at the expense of patient's perspective.…”

Section: Theoretical Concepts and Procedures For Handling The Risk Of Suicidementioning

confidence: 99%

“…Many clinicians experience a tension between protecting themselves from legal liability and maintaining an empathic, patient-centered position (Espeland et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…In suicide prevention programs and national guidelines, the priority of employing standardized risk assessment scales is maintained-even though the sensitivity and specificity of such instruments are low (Espeland et al, 2021). In Norway, as in many other countries, National Guidelines for Suicide Prevention include procedures for assessing suicide risk, descriptions of risk factors that should be examined, which health professionals are qualified to assess patients, and the situations in which risk assessment should be completed (Norwegian Directorate of Health, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Assessments in Psychotherapy with Suicidal Patients: The Precedence of Alliance Work

Østlie

Stänicke

Haavind

2021

J Contemp Psychother

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In this article the aim was to explore how therapists handle suicide risk assessment in connection with patient’s experience of alliance in psychotherapy. In a naturalistic, longitudinal study, 19 suicidal patients were interviewed three times: just before they started in therapy (T1), during the early phase (T2), and again after one year (T3). 17 therapists were interviewed separately at T2 and T3. The interviews explored the personal experiences of both patients and therapists, including their handling of suicidality and the quality of their relationships. An interpretative-phenomenological approach was used to analyze the research interviews case by case, as seen from the perspective of both therapist and patient in each dyad. Because of their duties within the Norwegian Healthcare System, all therapists are obliged to follow the National Guidelines in suicide risk assessment. The results indicate that there are two pitfalls for therapists: to avoid the topic of suicidality and using the suicide risk assessment in a rigid way. Both pitfalls have disturbing effects on the working alliance between therapist and patient. Most of the therapists were able to integrate personalized assessment procedures in the running dialogue. Our argument here is that in order to integrate assessment with therapeutic work, it is important for the therapist to establish ethical responsibility with patient. A modern philosophical perspective on ethics of closeness is discussed.

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A call for change from impersonal risk assessment to a relational approach: professionals’ reflections on the national guidelines for suicide prevention in mental health care in Norway

Cited by 17 publications

References 52 publications

Suicide Models and Treatment Models Are Separate Entities. What Does It Mean for Clinical Suicide Prevention?

Suicide Models and Treatment Models Are Separate Entities. What Does It Mean for Clinical Suicide Prevention?

Critical suicide studies, between methodology and ethics: Introduction

Assessments in Psychotherapy with Suicidal Patients: The Precedence of Alliance Work

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