Issues

Legal

Brown, G.S., Jones, E.R., Betts, E & Jingyang, W. (2003). “Improving suicide risk assessment in a managed-care environment”. Crisis, 24, pp. 49-55.

An informative paper that discusses the important role that patient assessment of suicide risk may play in clinician’s assessment and management of risk. Outlines some of the important legal and social contexts within which risk is currently managed, and provides an example of one way in which risk assessment is being managed within the US.

* Duffy, David & Ryan, Tony (Eds) (2004) New approaches to preventing suicide: A manual for practitioners. London: Jessica Kingsley Publishers.

“Written by front line professionals in the fields of nursing, mental health, prison services and the law, this text is an essential companion to the [British] government’s new suicide prevention strategy. The contributors offer a wealth of practical guidance on issues such as risk assessment and management in a range of settings, policy and the legal framework around suicide.”

Packman, W.L., O’Connor Pennuto, J.D., Bongar, B. & Orthwein, J. (2004). “Legal issues of professional negligence in suicide cases”. Behavioral Sciences and the Law, 22, pp. 697-713.

Excellent paper that outlines the types of litigation that may be brought against health care professionals in regards to suicide. Provides case examples and summarises the important role that documentation plays in mitigating against legal action.

Simon, R.I. (2000). “Taking the ‘sue’ outside of suicide: A forensic psychiatrist’s perspective”. Psychiatric Annals, 30, pp. 399-407.

Clearly outlines how risk assessment may be used to mitigate against litigation. Outlines the concept of foreseeability, and how it may be used to understand the extent to which clinician’s may be liable. Draws attention to the importance of documenting risk assessment and the need to recognise the changing status of suicide risk and the possible existence of risk without client awareness.

Media

Blood, R.W., Putnis, P., Pirkis, J., Payne, T. & Francis, C. (2001). “Monitoring media coverage of suicide: Theory and methodology”. Australian Journalism Review, 23, pp. 57-80.

Summarises much of the existing research on media influence on suicide and examines how a number of media accounts report suicide. Questions the notion of the ‘Werther Effect’, by investigating the multiple ways in which the media is received and understood. Challenges us to examine the notion of ‘copy-catting’ and suggests that it is important to further research on the Internet and suicide. Outlines how the media frames issues in particular ways and thus draws attention to or problematizes particular actions.

Coyle, J. & MacWhannell, D. (2002). “The importance of ‘morality’ in the social construction of suicide in Scottish newspapers”. Sociology of Health and Illness, 24, pp. 689-713.

Examines how suicide is represented within the news media. Explores the implications of particular moral accounts of suicide in regards to motivation and accountability which are useful for understanding how suicide is represented within society more broadly.

Pirkis, J. & Blood, R.W. (2001). Suicide and the media: A critical review. Canberra: Commonwealth Department of Health and Aged Care.

A very useful and highly informative review of the literature on the relationship between media representations of suicide and suicide behaviours themselves. Ties in with the mind frame website for use by those working in the media, and suggests productive ways for representing and reporting suicide.

Drug Use

Cottler, L. B., Campbell, W., Krishna, V.A.S., Cunningham-Williams, R.M. & Abdallah, A.B. (2005). “Predictors of high rates of suicidal ideation among drug users”. Journal of Nervous and Mental Disorders, 193, pp. 431-437.

Outlines the role that drug use plays in suicide ideation. Usefully does not focus on mental health as a correlate, and explores the gender specificity of the relation between drug use and suicide ideation. Explores the role that the depressive affect of alcohol may play in suicide ideation, and suggests that the early detection of intersections of drug use and suicide may lead to earlier treatment of suicide risk.

Dhossche, D.M. (2003). “Toxicology of suicide: Touchstone for suicide prevention?”. Medical Science Monitor, 9, pp. SR9-19.

Examines the complex role of alcohol and drugs in suicide – suggests that whilst alcohol and drugs may often not be the means to suicide, they can often leave people vulnerable to suicide.

Rivara, F.P., Mueller, B.A., Somes, G., Mendoza, C.T., Rushforth, N. & Kellerman, A.L. (1996). “Alcohol and illicit drug abuse and the risk of violence death in the home”. Journal of the American Medical Association, 278, pp. 569-575.

Outlines the extreme increase in risk for suicide within the home that results from alcohol and drug use. Suggests that this may be mediated by whether a person lives alone or with other people, but that those living with those who use alcohol and drugs may also be at increased risk not only for addiction themselves, but also interpersonal violence. Suggests that primary carers have an important role in identifying these factors and points towards the gendered nature of alcohol and drug use.

Wilcox, H.C., Conner, K.R. & Caine, E.D. (2004). “Association of alcohol and drug use disorders and completed suicide: An empirical review of cohort studies”. Drug and Alcohol Dependence, 76S, pp. s11-s19.

Briefly summarises the results from across a large number of studies of the effects of drug and alcohol use on suicide behaviour. Suggests the important of recognising the gender specificities of this relationship, and also confirms the need for a better understanding of how multiple types of substance use interact within one another and broader social factors to result in suicide.

Family and Domestic Violence

Conner, K.R., Cerulli, C., Caine, E.D. (2002). “Threatened and attempted suicide by partner-violent male respondents petitioned to family violence court”.

Violence and Victims, 17, pp. 115-125. Examines the relationship between attempted or threatened suicide and levels of violence among men. Suggests that appearances in court often precipitate suicide behaviours that perpetuate violence against others.

Dawson, M. (2005). “Intimate femicide followed by suicide: Examining the role of premeditation”. Suicide and Life-Threatening Behavior, 35, pp. 76-89.

Suggests two types of murder-suicide: 1) where the suicide is the response to guilt or fear over murder, and 2) where murder is planned before suicide in order to prevent spouse living after suicide. Outlines a number of premeditative indicators that may be useful for assessing risk of this form.

Pratt, R., Burman, E. and Chantler, K. (2004). “Towards understanding domestic violence: reflections on research and the ‘domestic violence and minoritisation’ project”. Journal of Community & Applied Social Psychology, 14, pp. 33-43.

Outlines some of the important interpretive frameworks for understanding domestic violence, and summarises the importance of understanding the role of power in the perpetuation of violent and abusive relationships.

Ullman, S.E. (2004). “Sexual assault victimization and suicidal behaviour in women: A review of the literature”. Aggression and Violent Behavior, 9, pp. 331-351.

Summarises the literature on the relationships between sexual abuse, mental health issues and suicide. Suggests that it is important to examine the shifts in gendered violence in Western societies, and the implications of this for suicide prevention, particularly for women. Proposes that a focus on ‘life meaning’ may be a potential buffer against suicide for those who have experienced sexual abuse.

Internet

Baume, P., Rolfe, A. & Clinton, M. (1998). “Suicide on the internet: A focus for nursing intervention?”. Australian and New Zealand Journal of Mental Health Nursing, 7, pp. 134-141.

Outlines some of the differing types of websites on suicide, including: 1) government and private prevention sites, 2) Tribute sites to people (particularly celebrities) who have suicided, 3) mailing lists and chat rooms, where people often talk about their suicide thoughts or behaviours, 4) online suicide notes, written by those who have suicided or attempted suicide. Suggests that those working as health professionals may be well placed to get involved in prevention work in these spaces. Examines the complex ways in which the internet may create spaces for people to talk about their feelings, but the (somewhat) public nature of it may lead people to feel committed to following through with statements of suicide intent.

Becker, K. & Schmidt, M.H. (2004). “Internet chat rooms and suicide”. Journal of the American Academy of Child and Adolescent Psychiatry, 43, pp. 246-247.

Outlines some of the pros and cons of online suicide chat rooms, the former including possibility for support and relief from suicidal feelings, the latter including discussions of reliable methods and the promotion of suicide as a ‘problem-solving strategy’. Demonstrates the potential problems for using the Internet during crisis or when at high risk, and suggests that the Internet may promote the ‘Werther effect’ even more so than print media.

Rajagopal, S. (2005). “Suicide pacts and the internet”. British Medical Journal, 329, pp. 1298-1299.

Briefly describes a seemingly new phenomenon of group suicide pacts being organised and carried out through the Internet. As opposed to such pacts made offline, which are usually between people who are very close or who are associated with extremist religions, these online suicide pacts seem to be between strangers.

Terrorism

Atran, S. (2003). “Genesis of suicide terrorism”. Science, 299, pp. 1534-1539.

Demonstrates the contingency of the term ‘terrorism’, and the relation between political oppression and resistance. Questions how moral judgements around ‘suicide terrorism’ are used to justify violent responses, and addresses the assumption that those who resist or protest in this way demonstrate psychopathology or defective personality traits. It explores some of the motivations that may inform suicide terrorism, and demonstrates that the values or social location of the people involved are not necessarily atypical from the broader culture.

Merari, A. (2005). “Suicide terrorism”. In R.I. Yufit & D. Lester (Eds) Assessment, treatment, and prevention of suicidal behaviour. New Jersey: John Wiley.

Provides summaries of the profiles of those engaged in suicide terrorism. Outlines how current theories of suicide may not be very useful in understanding suicide terrorism. Suggests that suicide terrorism is not about vendetta or fanaticism. States that suicide terrorism results not from personal loss of hope or despair, but from a social contract that centres around: 1) indoctrination, 2) group commitment, and 3) personal/public commitment to the act.

Forensic

McArthur, Morag, Camilleri, Peter & Webb, Honey (1999). “Strategies for managing suicide and self-harm in prisons”. Trends & Issues in Crime and Criminal Justice Series No. 125. Canberra: Australian Institute of Criminology.

Reports on a review of current research (Australian and international) into causes and predictability of suicide in prisons. The paper gives a summary of current issues and strategies for Australian prisons.

Dalton, Vicki (1999). “Suicide in prison 1980 to 1998: National overview” Trends & Issues in Crime and Criminal Justice Series No. 126. Canberra: Australian Institute of Criminology.

Gives a statistical breakdown of deaths by suicide in prison from 19 years’ data from the Australian Institute of Criminology’s data base.

Self Care

Barnett, R.C., Brennan, R.T. & Gareis, K.C. (1999). “A closer look at the measurement of burnout”. Journal of Applied Biobehavioral Research, 4, pp. 65-78.

Outlines the 3 factors involved in burnout (emotional exhaustion, lack of professional efficacy and cynicism) and explores how those in the health care professions are at high risk for burnout. Lists the stress factors for health care professionals that may lead to burnout and discusses some of the outcomes that may arise (increased use of alcohol and drugs, relationship breakdown, mental health problems). Proposes a reformulation of existing measures of burnout.

Dewar, Ian, Eagles, John, Klein, Susan, Gray, Nicola & Alexander, David (2000). “Psychiatric trainees’ experiences of, and reactions to, patient suicide” Psychiatric Bulletin, 24, pp 20-23 http://pb.rcpsych.org/cgi/reprint/24/1/20 A short paper describing the findings of a UK survey.

The findings suggest that the suicide of a patient can have adverse effects of trainee doctors’ personal and professional lives.

Fox, R. & Cooper, M. (1998). “The effects of suicide on the private practitioner: A professional and personal perspective”. Clinical Social Work Journal, 26, pp. 143-157.

Outlines the importance of speaking out about taboo subjects (such as feelings of not coping) among physicians. Outlines how guilt and shame may result from a patient suicide, and how the mindset of ‘protecting’ clients may not actually assist either clients or practitioners. Identifies a fourth factor in burnout (lack of social support), and suggests that high, unrealistic self expectations leads to burnout. Suggests that practitioners may experience vicarious traumatisation as a result of patient suicide. Outlines some steps that may be useful for dealing with the loss of a client, and highlights the importance of both support and a focus on positive factors (such as achievements and successes).

Frank, E. & Dingle, A.D. (1999). “Self-reported depression and suicide attempts among US women physicians”. American Journal of Psychiatry, 156, pp. 1887-1894.

Gender differences in suicide behaviour among physicians: female physicians may have higher rates than the general population of females, whilst men may be relatively the same. Lists some of the factors that may underlie this phenomenon, and highlights the role that increased access to lethal means may play.

Goldie, J.G.S. (2004). “The detrimental ethical shift towards cynicism: Can medical educators help prevent it?”. Medical Education, 38, pp. 232-238.

Identifies the need for practitioners to recognise the moral factors that underpin ethical decision making, particularly in the context of increased litigation and managed care. Explores how concerns over costs and economics may overshadow both client and practitioner risk for suicide. Suggests the need to explore how power operates in medical training, and the need for a transformative learning approach that focuses on reflexivity.

Gross, C.P., Mead, L.A., Ford, D.E. & Klag, M.J. (2000). “Physician, heal thyself? Regular source of care and use of preventive health services among physicians”. Archives of Internal Medicine, 160, pp. 3209-3214.

Emphasises that because a physician’s own health care practices will impact upon how their client views health care, it is important that we understand how physicians manage their own care. Found that a high proportion of physicians do not take advantage of a regular source of care, nor access preventive measures.

Gundersen, L. (2001). “Physician burnout”. Annals of Internal Medicine, 1135, pp. 145-148.

Suggests that self-care is not a part of medical training. Suggests that this may result in physicians denying their own emotions, in order to maintain control. What is required is increased social supports, resources and degree of control. Outlines the stressors that may lead to burnout, including the increased demand for documentation and other forms of paper work. Suggests that there is a code of silence where physicians may not report on or confront other physicians who are not coping.

McLeod, M.E. (2003). “The caring physician: A journey in self-exploration and self-care”. The American Journal of Gastroenterology, 98, pp. 2135-2138.

Highlights the contrast between a caring physician (one who looks after themselves as well as others) and a traditional physician (one who may fail to examine their own needs and problems). Outlines how reflexivity is not taught in training, and what this may lead to, and explores some of the stressors that may lead to burnout. Demonstrates the importance of pre-emptive work (eg support groups) and the need for physicians to make conscious change in their work style.

Pietila, M. (2002). “Support groups: A psychological or social device for suicide bereavement?”. British Journal of Guidance and Counselling, 30, pp. 401-414.

Excellent article highlighting the cultural and moral specificity of how we grieve. Suggests that particular types of grieving are normalised or promoted, and that other forms are disavowed. This is particularly applicable to how practitioners may feel able to grieve, and the gender specificity of which types of grieving are publicly possible. Suggests that there is a gap between the utility of support groups as a shared space of understood meaning, and the prohibition of certain types of public grief.

Torre, D.M., Wang, N., Meoni, L.A., Hunter Young, J., Klag, M.J. & Ford, D.E. (2005). “Suicide compared to other causes of mortality in physicians”. Suicide and Life-Threatening Behavior, 35, pp. 146-153.

Findings suggest that physicians have a lower rate of mortality than the general population, but a higher rate of suicide, but that this is gender specific. Suggests that this may partly result from higher access to more lethal means.