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OF mental health care and mentally ill

Suicide Prevention Strategies

Preventing suicide

A wealthy college student was single, pregnant and suicidal, with a clearly formed plan. The only solution she could think of besides suicide was never to have become pregnant, even to be virginal again.

I took out a sheet of paper and began to widen her blinkers (sic). I said something like, ‘Now, let’s see: You could have an abortion here locally.’ She responded, ‘I couldn’t do that.’ I continued, ‘You could go away and have an abortion.’ ‘I couldn’t do that.’ ‘You could bring the baby to term and keep the baby.’ ‘I couldn’t do that.’ ‘You could have the baby adopted.’ Further options were similarly dismissed. When I said, ‘You can always commit suicide, but there is no need to do that today’, there was no response. ‘Now,’ I said. ‘Let’s look at this list and rank them in order of your preference, keeping in mind that none of them is optimal.’

Just drawing up the list had a calming effect. The student’s drive to kill herself receded, and she was able to rank the list even though she found something wrong with each item. But an important goal had been achieved:she had been pulled back from the brink.

The example is similar in approach to the example and draws on a cognitive method for helping such people examine, in an objective way,their ideas and feelings about suicide.

Currently, there is a focus on the reduction of suicide. The present Governmenthas set a target that has developed into a climate of ‘risk assessment and management’within clinical settings. This has culminatedin the doctrine of ‘close observation’ as the preferred method within such clinicalsettings. Close observation or ‘continuous observation’ means that the person is observed at all times until an assessment is made that determines whether the riskof suicide has been reduced. The benefit of such close observation is that it providesan opportunity for the carer to develop a therapeutic relationship with the client;however, the experience reported by clients is that such observation is restricting,punishing, humiliating and far from therapeutic. Methods have to bedeveloped that allow an individual who is suicidal to be cared for without compromisingtheir autonomy. Close observation is still to be used in emergencies wherethe risk of self-killing is imminent. An alternative to this is what Cutcliffe andBarker  call ‘engagement and inspiring hope’. They define ‘close observation’as limiting the role of the carer to that of a custodian with little therapeutic value.They describe this process as one of forming a relationship, conveying acceptanceand tolerance, listening and understanding. They point out that if a sense of beingvalued is conveyed by the carer the client will respond by opening up to the carerand a therapeutic relationship can begin. This process of ‘engagement’ can inspirehope and expectation in the client, something that they may have been lackingduring their illness. In a study of what relatives found hope-inspiring, Talseth et al. outlined six themes:

1. being seen as a human being

2. participating in an I–you relationship

3. trusting staff, treatment and care

4. feeling trusted by staff

5. being consoled

6. entering into hope.

These can apply equally to the client or their relative. It will be important forthe carer to listen and to accept that the person who is feeling this way may beangry and frustrated; the carer’s task is to help the client explore their feelings andto gain a more positive outlook on their future.

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