Health services, suicide, and self-harm: patient distress and system anxiety

Smith, Michael J.; Bouch, Joe; Bradstreet, Simon; Lakey, Trevor; Nightingale, Anne; O’Connor, Rory C.

doi:10.1016/s2215-0366(15)00051-6

Cited by 33 publications

(33 citation statements)

References 28 publications

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“…This research suggests that it is important to encourage counselors to look for support in the child's immediate network and promote use of potential supports with all children who are considering suicide. This research also supports the notion that effective interventions depend on the helper's engagement and empathy with the help‐seeking client (Smith et al., ).…”

Section: Discussionsupporting

confidence: 82%

“…However, when we examined these sessions, we found numerous examples where the counselor seemed to reject the child's appeal because the counselor assessed the child as being too suicidal to continue the dialogue. In these cases, it seems that risk assessment gets in the way of engagement and containment of distress, as previous research on health care professionals’ interactions with suicidal patients has indicated (Smith et al., ). A rejection of the help‐seeking child could also be a result of the practitioner's feelings of powerlessness when engaging with suicidal children (Smith et al., ).…”

Section: Discussionmentioning

confidence: 90%

“…In these cases, it seems that risk assessment gets in the way of engagement and containment of distress, as previous research on health care professionals’ interactions with suicidal patients has indicated (Smith et al., ). A rejection of the help‐seeking child could also be a result of the practitioner's feelings of powerlessness when engaging with suicidal children (Smith et al., ). In other instances, the counselor expressed that the child provided too little information for the dialogue to be productive, indicating that some counselors could benefit from special training in handling text sessions with quieter and less responsive children.…”

Section: Discussionmentioning

confidence: 90%

See 2 more Smart Citations

Texting for Help: Processes and Impact of Text Counseling with Children and Youth with Suicide Ideation

Sindahl

Côte

Dargis

et al. 2018

Suicide & Life Threat Behav

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Objective To explore: (1) how children contacting a child helpline with suicide ideation differ from children discussing other topics, (2) whether text messaging effectively helps, and (3) which counselor behaviors are most effective. Method Of 6,060 text sessions at the Danish national child helpline, 444 concerned suicidality, of which the 102 sessions that included self‐rated, end Session ratings were selected for content analysis. Results Twenty‐six percentage of suicidal children had severe suicidality. The suicide sample had significantly more girls, was older than the nonsuicide sample, and more often recontacted the helpline in the 2 weeks prior to follow‐up. 35.9% of suicidal children felt better immediately and over half ended the session with a plan of action. At follow‐up, 23.9% of suicidal children reported feeling better; however, 37.0% reported feeling worse. Talking about emotions, expressing empathy, and encouraging the child to talk to someone were associated with positive impacts. Setting boundaries was associated with negative impacts. Conclusions Texting with suicidal children can be helpful, but should be considered a first step toward obtaining more sustainable help. Research is needed to determine how to better help children who felt worse or did not improve in the 2 weeks after contacting the helpline. Suggestions to further training of counselors are discussed.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

Texting for Help: Processes and Impact of Text Counseling with Children and Youth with Suicide Ideation

Sindahl

Côte

Dargis

et al. 2018

Suicide & Life Threat Behav

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“…If there is an underlying expectation within the health care system that all suicides among psychiatric patients can be prevented, this may lead to maladaptive responses on the part of the individual clinician [34]. Involuntary care contrasts starkly with concepts of service user involvement and joint decision making, which are stressed in clinical guidelines [35].…”

Section: Discussionmentioning

confidence: 99%

Psychiatrists’ experiences of suicide assessment

2016

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BackgroundClinical guidelines for suicide prevention often stress the identification of risk and protective factors as well as the evaluation of suicidal intent. However, we know very little about what psychiatrists actually do when they make these assessments. The aim was to investigate psychiatrists’ own accounts of suicide assessment consultations, with a focus on their behaviors, attitudes and emotions.MethodSemi-structured in depth interviews were carried out with a purposive selection of 15 psychiatrists.ResultsThematic analysis revealed three main themes: understanding the patient in a precarious situation, understanding one’s own reactions, and understanding how the doctor-patient relationship impacted on risk assessment and management decisions. Emotional contact and credibility issues were common subthemes that arose when the respondents talked about trying to understand the patient. The psychiatrists stressed the semi-intuitive nature of their assessments. Problems related to the use of risk factor assessments and rating scales were apparent. Assessment consultations could evoke physical and emotional symptoms of anxiety, and concerns about responsibility could lead to repressive management decisions. In situations of mutual trust, however, the assessment consultation could kick-start a therapeutic process.ConclusionThis study highlights psychiatrists’ experiences in clinical suicide assessment situations. Findings have implications for professional development as well as for service delivery.

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“…Subsequently, staff working to support people with self-harm and suicidal behaviour, are particularly at risk of providing maladaptive responses, such as negative feelings and a focus on diagnosis and risk assessment, potentially impairing more adaptive responses such as containment of distress and safety planning (Smith et al, 2015). Positive attitudes, personcentred care and hope have all been found to be central to improvement in mental illness (Cleary et al, 2013).…”

mentioning

confidence: 99%

The PARALLEL Study (imPAct of expeRiencing Another’s seLf harm and suicidaL bEhaviour in hospitaL)

Hargate

Howden

Tarpey

et al. 2017

JFP

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Purpose-This study aims to explore the experiences of both staff and patients in a medium-secure mental health unit of the self-harm and/ or suicidal behaviour of others. Suicide and self-harm is highly prevalent in forensic settings and evidence suggests that experiencing other people's self-harm and suicidal behaviour can lead to negative outcomes, both for staff and patients. This is particularly important in hospitals where patients are highly dependent on staff for support. Design/methodology/approach-Semi-structured interviews were conducted with five staff members and six patients in a medium-secure male mental health unit in the North of England. Data was analysed following Interpretative Phenomenological Analysis (IPA) guidelines. Findings-Three dominant themes were identified during analysis: the impact of suicide and self-harm; the role of others; and the importance of understanding and experience. Various impacts were discussed including desensitization, negative emotions and the desire to help. Other people played an important role in protecting against negative impacts, with shared experiences and peer support reported as the biggest benefits. Experiences of selfharm and suicide were found to increase understanding resulting in more positive attitudes. Additionally, the importance of training and education was highlighted. Originality/value-This paper provides an insight into the experiences of staff and patients in medium-secure male mental health unit, which has benefits to practitioners when considering support mechanisms.

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Health services, suicide, and self-harm: patient distress and system anxiety

Cited by 33 publications

References 28 publications

Texting for Help: Processes and Impact of Text Counseling with Children and Youth with Suicide Ideation

Texting for Help: Processes and Impact of Text Counseling with Children and Youth with Suicide Ideation

Psychiatrists’ experiences of suicide assessment

The PARALLEL Study (imPAct of expeRiencing Another’s seLf harm and suicidaL bEhaviour in hospitaL)

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