Suicide

“Epictetus’ smoky chamber: a study on rational suicide as a moral choice”

by Evangelos Protopapadakis

“Epictetus’ smoky chamber: a study on rational suicide as a moral choice”

by Evangelos Protopapadakis

Coming Home by Catherine Gorey

by Feminism and Religion

Originally published in the Feminism and Religion project

It speaks to me often when I am in the midst of interior conflict roused by change, growth, transition, disappointment... more It speaks to me often when I am in the midst of interior conflict roused by change, growth, transition, disappointment etc. Each personal encounter causes a shift in my interior landscape which in turn requires me to find my center again. Sometimes the homecoming takes longer, depending on the cause of the axis shifting.

March 15th, 2012 will mark the 3 year anniversary of my mother’s death. A day that caused me much turmoil within and a life event from which I continue to search for my center. I would never have thought that this life event would shake me to the core as it did, causing me to question everything I ever thought to have known about my mother.

The interpersonal theory of suicide

by Kim Van Orden

Absurdamente, más vale persistir. Onetti frente al suicidio

by Catalina Quesada Gómez

Published in Revista Letral, 2 (2009), pp. 39-51. ISSN 1989-3302

'Suicide and insanity in post-Famine Ireland' in Culture of Care in Irish Medical History, 1750-1950, C. Cox & M. Luddy (eds) (Palgrave, 2010).

by Georgina Laragy

'Narratives of poverty in Irish suicides between the Great Famine and the First World War, 1845-1914', in Andreas Gestrich, Elizabeth Hurren and Steven King (eds), Poverty and Sickness in Modern Europe: Narratives of the Sick Poor, 1780-1938 (Continuum Press, 2012), pp.143-59.

by Georgina Laragy

forthcoming

Jones, T. and Hillier, L. (2012). Sexuality education school policy for Australian GLBTIQ students. Sex Education, ifirst http://www.tandfonline.com/doi/abs/10.1080/14681811.2012.677211 Accessed 10.05.12.

by Tiffany Jones

Education is state-run in Australia, and within each of the eight states and territories there are both government and... more Education is state-run in Australia, and within each of the eight states and territories there are both government and independent schooling systems. This paper details the position of gay, lesbian, bisexual, transgender, intersex and queer (GLBTIQ) students within Australian education policy documents nationally, focusing on the three largest states and educational sectors in Australia. Survey data are used to report on the schooling experiences of over 3000 Australian GLBTIQ young people aged 14–21 years. Data from interviews with key policy informants identify both the obstacles to implementing policies, and how such obstacles have been overcome. Much official policy sees sexuality education as promoting inclusive, protective and affirming messages around GLBTIQ students. There exist significant correlations between policy and a variety of well-being and psycho-social outcomes for GLBTIQ students, including lowered incidence of homophobic abuse and suicide, and the creation of supportive school environments. Ideal policy visions are outlined, along with practical recommendations of relevance to a variety of stakeholders.

The Role of Medico-Legal Systems in Producing Geographic Variation in Suicide Rates

by Joshua Klugman

Co-authored with Gretchen Condran and Matt Wray.  Resubmitted to Social Science Quarterly.

Objectives.  In this analysis we ask whether there is systematic variation in the reporting of suicide by... more Objectives.  In this analysis we ask whether there is systematic variation in the reporting of suicide by medico-legal system and if this biases estimated effects of social correlates on suicide.  Methods.  With cause of death records (1999-2002) and 2000 Census data, we use negative binomial regression to analyze the effects of medico-legal system on suicide and non-suicide mortality aggregated at county of occurrence.    Results.  We find that elected coroners have slightly lower official suicide rates than medical examiners (all of whom are appointed) and appointed coroners.  In addition, we find that omitting medico-legal system does not bias estimates of the social determinants of suicide.  Conclusion. Contrary to arguments that medical examiners’ greater scientific training makes them more likely to underreport suicides, we conclude that appointed death investigators (medical examiners and appointed coroners) underreport suicide to a lesser degree than elected coroners, who are subject to greater public pressures that result in the misclassification of suicides. 

PRACTICAL COUNSELING SKILLS AND APPROACHES

by Daniel Keeran MSW

By Daniel Keeran, MSW, President, College of Mental Health Counselling

This is a convenient list of practical counseling articles with clickable hypertext to access the full version. Topics... more This is a convenient list of practical counseling articles with clickable hypertext to access the full version. Topics include:

What To Say When Dying,
Working With Anger,
Counseling Depression,
Counseling Domestic Violence,
Healing Childhood Loss of Caring,
Healing Grief,
Healing Sexual Abuse,
Effective Counseling Skills,
Solving Issues in Marriage,
Solving Problems,
Steps To Prevent Suicide,
Steps for Healing Adultery

A comparison of venlafaxine and SSRIs in deliberate self-poisoning

by Christopher Ryan

Chan, Agnes N., Naren Gunja, and Christopher J. Ryan. 2010. A comparison of venlafaxine and SSRIs in deliberate self-poisoning. Journal of Medical Toxicology 6: 116-121.

To compare the clinical features of deliberate self- poisoning with venlafaxine and selective serotonin reuptake... more To compare the clinical features of deliberate self- poisoning with venlafaxine and selective serotonin reuptake inhibitors (SSRIs) presenting to the emergency department of an Australian tertiary referral hospital. A retrospective cohort study comparing all 36 patients who presented with venlafaxine self-poisoning with 44 randomly selected patients with SSRI self-poisoning between 1997 and 2006. Patients who had overdosed on venlafaxine were older (mean age 37.4 versus 28.8 years (p ≤ 0.001) and generally exhibited a higher degree of suicidal intent (p≤0.017). Median venlafaxine dose taken was 35 defined daily doses (DDDs) compared with SSRIs 19.4 DDDs. Those who ingested venlafaxine were more likely to become confused (25% versus 0%; p = 0) and have mydriasis (19.4% versus 2%; p ≤ 0.02), than those who took SSRIs. One patient from the venlafaxine group died. Compared with SSRI self-poisoners, patients who deliberately ingested venlafaxine were more likely to exhibit serious suicide intent. They were also more likely to be older, take a higher DDD of the drug, and have confusion and mydriasis. This has implications for management of severely depressed and suicidal patients.

Helpful and unhelpful risk assessment practices [Letter]

by Christopher Ryan

Large, Matthew M., Christopher J. Ryan, and Olav B. Nielssen. 2010. Helpful and unhelpful risk assessment practices [Letter]. Psychiatric Services 61 (5): 530.

Snowden and associates’ (1) report in the November 2009 issue on a validation study of the Classification of Violence... more Snowden and associates’ (1) report in the November 2009 issue on a validation study of the Classification of Violence Risk (COVR) is an example of a worrying trend toward the promotion of unhelpful risk assessment practices in mental health services (2).

Clinical decisions in psychiatry should not be based on risk assessment

by Christopher Ryan

Ryan, Christopher, Olav Nielssen, Michael Paton, and Matthew Large. 2010. Clinical decisions in psychiatry should not be based on risk assessment. Australasian Psychiatry 18 (5): 398-403.

Objective: Risk assessments that place patients in high or low risk categories have been widely adopted by mental... more Objective: Risk assessments that place patients in high or low risk categories have been widely adopted by mental health services in an attempt to reduce the harms associated with psychiatric disorders. This paper examines the effects of categorization based on the results of a risk assessment.

Methods: The violence prediction instrument derived from the MacArthur Study of Mental Disorder and Violence was used to illustrate the nature and effects of risk assessment and the consequent categorization of patients.

Results: The majority of patients categorized as being at high risk will not commit any harmful acts.

Conclusions: Patients who are classified as high risk share the cost of efforts to reduce harm in the form of additional treatment and restrictions, although the majority will not go on to commit a harmful act. Clinical decisions made on the basis of risk assessment also divert resources away from patients classified as low risk, even though a significant proportion do go on to a commit harmful act. We argue that psychiatric professionals should discuss the risks of treatment and of non-treatment with patients (or with their substitute decision-makers) and should maintain a duty to warn about the consequences of not having treatment. However, assessment of risk of harm should not form the basis for clinical decision making. We should aim to provide optimal care according to the treatment needs of each patient, regardless of the perceived risk of adverse events.

Legal and ethical aspects of refusing medical treatment after a suicide attempt: the Wooltorton case in the Australian context

by Christopher Ryan

Ryan, Christopher J., and Sascha Callaghan. 2010. Legal and ethical aspects of refusing medical treatment after a suicide attempt: the Wooltorton case in the Australian context. Medical Journal of Australia 193: 239-242.

• When a patient presents to hospital after a suicide attempt and appears to refuse treatment, clinicians should first... more • When a patient presents to hospital after a suicide attempt and appears to refuse treatment, clinicians should first assess if he or she should be treated under mental health legislation, regardless of competence to refuse treatment.

• When it is not possible or is inappropriate to treat under mental health legislation, the person’s competence to refuse treatment should be assessed. If the patient is definitely competent, his or her decision to refuse treatment should probably be honoured.

• If an incompetent patient carries a document refusing treatment, clinicians must determine the validity of that document as an advance care directive — including whether or not the patient was competent at the time it was written.

• The law around the right to refuse treatment after a suicide attempt remains unclear and, if uncertain of what to do, clinicians should provide urgently required life-saving treatment and simultaneously seek an urgent court order to clarify how they should proceed.

• In all but extraordinary circumstances, a patient who refuses treatment after a suicide attempt can and should be given life-saving treatment, under either mental health legislation or the common law concept of necessity.

Refusing medical treatment after attempted suicide: Rethinking capacity and coercive treatment in light of the Kerrie Wooltorton case

by Christopher Ryan

Callaghan, Sascha, and Christopher James Ryan. 2011. Refusing medical treatment after attempted suicide: Rethinking capacity and coercive treatment in light of the Kerrie Wooltorton case. Journal of Law and Medicine 18: 811-819.

The inquest into the death of Kerrie Wooltorton in Norfolk, England, ignited extensive public debate on the scope of... more The inquest into the death of Kerrie Wooltorton in Norfolk, England, ignited extensive public debate on the scope of the common law right to refuse medical treatment where a patient is distressed, depressed or actively suicidal. In Australia, a patient’s wishes need not be honoured if the patient is not legally competent, if he or she falls within the ambit of the compulsory treatment provisions in the mental health legislation, and possibly also if there is a recognised public interest in preventing suicide which is sufficient to  override the patient’s choice. This article argues that decisions about whether to give medical treatment despite an apparent refusal should be based solely on a determination of the patient’s competence to make their own choice. However, the test for legal competence must take into account the person’s agency in making the decision, and decisions which will effectively end the person’s life must be shown to be thought through.

The validity and utility of risk assessment for inpatient suicide

by Christopher Ryan

Large, Matthew, Christopher Ryan, and Olav Nielssen. 2011. The validity and utility of risk assessment for inpatient suicide. Australasian Psychiatry 19 (6): 507-512.

Objective: It is widely assumed that identifying clinical risk factors can allow us to determine which patients are at... more Objective: It is widely assumed that identifying clinical risk factors can allow us to determine which patients are at high risk of suicide while in hospital, and that identifying those patients can help prevent inpatient suicide. We aimed to examine the validity and utility of categorizing psychiatric patients to be at either high or low risk of committing suicide while in hospital.

Method: The assumption that high-risk categorizations are valid was examined by comparing factors included in high-risk models derived from individual studies of inpatient suicide with the results of a meta-analysis of factors associated with inpatient suicide. A valid high-risk model was then applied to a hypothetical clinical setting in order to test the assumption that high-risk categorizations are useful.

Results: The existing models for assessing whether inpatients are at high risk of suicide all include one or more factors that were not found to be associated with inpatient suicide by meta-analysis and were probably chance associations. Depressed mood and a prior history of self-harm are the only well-established independent risk factors for inpatient suicide. Using these risk factors to classify patients as being at high or low risk would prevent few, if any, suicides, and would come at a considerable cost in terms of more restrictive care of many patients and the reduced level of care available to the remaining patients.

Conclusions: Risk categorization of individual patients has no role to play in preventing the suicide of psychiatric inpatients.

Risk factors for suicide within a year of discharge from psychiatric hospitals: a systematic meta-analysis

by Christopher Ryan

Large, Matthew, Swapnil Sharma, Elizabeth Cannon, Christopher Ryan, and Olav Nielssen. 2011. Risk factors for suicide within a year of discharge from psychiatric hospitals: a systematic meta-analysis. Australian and New Zealand Journal of Psychiatry 45 (8): 619-628.

Background: The increased risk of suicide in the period after discharge from a psychiatric hospital is a... more Background: The increased risk of suicide in the period after discharge from a psychiatric hospital is a well-recognized and serious problem.

Objective: The aim of this study was to establish the risk factors for suicide in the year after discharge from psychiatric hospitals and their usefulness in categorizing patients as high or low risk for suicide in the year following discharge.

Method: A systematic meta-analysis of controlled studies of suicide within a year of discharge from psychiatric hospitals.

Results: There was a moderately strong association between both a history of self-harm (OR  3.15) and depressive symptoms (OR  2.70) and post-discharge suicide. Factors weakly associated with post-discharge suicide were reports of suicidal ideas (OR  2.47), an unplanned discharge (OR  2.44), recent social difficulty (OR  2.23), a diagnosis of major depression (OR  1.91) and male sex (OR  1.58). Patients who had less contact
with services after discharge were signifi cantly less likely to commit suicide (OR  0.69). High risk patients were more likely to commit suicide than other discharged patients, but the
strength of this association was not much greater than the association with some individual risk factors (OR  3.94, sensitivity  0.40, specificity  0.87).

Conclusions: No factor, or combination of factors, was strongly associated with suicide in the year after discharge. About 3% of patients categorized as being at high risk can be expected to commit suicide in the year after discharge. However, about 60% of the patients who commit suicide are likely to be categorized as low risk. Risk categorisation is of no value in attempts to decrease the numbers of patients who will commit suicide after
discharge.

Suicide risk assessment: reply to Draper.

by Christopher Ryan

Large, Matthew, Christopher Ryan, and Olav Nielssen. 2012. Suicide risk assessment: reply to Draper. Australian and New Zealand Journal of Psychiatry 46: 387.

Draper raises issues following our recent meta-analysis of factors associated with suicide in the year after discharge... more Draper raises issues following our recent meta-analysis of factors associated with suicide in the year after discharge from psychiatric hospitals. First, he suggests that suicide risk assessment “personalized to the individual” is less likely to suffer from the shortcomings in prediction we found in our meta-analysis. Second, he asserts that a suicide risk assessment is likely to be more valid over the short-term than over a period of up to one year. Neither assertion can be supported.

Problems And Solutions For A Hypothetical Right Not To Exist

by Manolito Gallegos

In this paper I will describe and attempt to resolve one of the main problems of David Benatar’s text "Better... more In this paper I will describe and attempt to resolve one of the main problems of David Benatar’s text "Better Never To Have Been: The Harm of Coming Into Existence": whether it is possible for a right not to exist to be posited without there ever being a person in existence to hold such a right. I will conclude that this is indeed possible given an experience oriented view of personhood that I shall outline, and what other conclusions might be drawn from such a view.

Jones, T. (2012). Data Brief: the Tasmanian Education Context. Report submitted to Rodney Croome of the TGLRG and the Tasmanian Department of Education, Hobart.

by Tiffany Jones

The Data Brief was submitted to Rodney Croome for viewing by The Tasmanian Department of Education and Training by... more The Data Brief was submitted to Rodney Croome for viewing by The Tasmanian Department of Education and Training by Tiffany Jones, on the 4th of April, 2012. It provided a short overview of data relevant to the Tasmanian education context, collected for a PhD research project.This research was based on a mixed methodology, including legal and policy analysis (over 80 national, state and sector education policies), key informant interviews and cross-analysis of new data on the education context for 3,134 Australian GLBTIQ students. The overview was intended to assist in underscoring the need for a distinct Tasmanian education policy that explicitly focusses on GLBTIQ student issues, which would ideally provide detailed guidance around these issues for Tasmanian schools.