Managing Elder Suicide: A Profile of American and Canadian Crisis Prevention Centers

Suicides among older adults in the United States and Canada in the last decade have accounted for an increasing share of all suicides. In both countries the use of firearms among older adults has steadily increased. Despite these trends, little is known about the extent to which crisis centers are prepared to prevent elder suicide. A survey of AAS-listed crisis prevention centers examined the training, knowledge, and current practices relevant to elder suicide among personnel in 321 crisis prevention centers in both countries. Results revealed insufficient training, a lack of familiarity with recent suicide trends, and limited outreach to older adults.     

A History of Physician Suicide in America

Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900–1970), an expendable deviant, represents the antithesis of that era’s image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era’s frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians’ limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.     

A Survey of Telephone Answering Services in Suicide Prevention and Crisis Intervention Agencies*

ABSTRACT: The telephone service established by directors of suicide prevention and crisis intervention services is generally given little careful consideration. Many agencies take their telephone systems for granted, assuming that almost any system will function adequately if an operator is available and a crisis worker is on call. There are a number of important issues at stake that should be carefully considered before a program is established that uses any system other than full-time coverage by the trained crisis worker at a permanent location. In order to investigate just what really happens under the various systems in use, a series of 76 calls was placed to 19 different emergency crisis services in the southeastern United States. Times were recorded to show how much time elapsed, through what various systems, to get an actual crisis worker on the line. There were marked differences across the eight different systems identified. The results clearly indicate that crisis services are in danger of unknowingly providing inferior and dangerously low quality service unless they maintain maximum control over their own telephone answering system 24 hours a day.     

Suicide Prevention in a Treatment Setting

Reducing the suicide rate through treatment depends on the development of new knowledge and new technology with emphasis on early intervention and continuing lowintensity contact for many troubled suicidal people, rather than the current preoccupation with detecting and hospitalizing the “highest risk.” I anticipate that sophisticated interactive computer programs will be effective in improving screening and case finding, thus bringing many more suicidal persons into contact with primary care physicians and outpatient mental health services for the purpose of relieving psychological pain. Computer programs will be invaluable in improving training for both primary care providers and outpatient mental health workers. Improved communication networks will prove to be useful resources for maintaining continuity of care and consultation, which is important in long-term treatment. Other technical developments include simplifying and making explicit various treatment approaches, in both psychotherapy and drug therapy, so that research can proceed to clarify what type of treatment helps which type of suicidal patient.     

Out of Its Mind: Psychiatry in Crisis

The Psychological Record -     

基督教“道德金律”与康德的道德律令

康德为道德寻求客观依据而确立的"道德律令"继承了基督教传统"道德金律"的普世性、律法及上帝观念,同时又从实践理性角度赋予了这种基督教传统文化思想以新的时代意义。这种新的解释具有现代科学理性及人文性特征,从而对后之学者在道德问题上的探寻有着深远的影响。     

The Effectiveness of Suicide Prevention Centers: A Review

This article reviews 14 studies examining whether suicide prevention centers have a preventive effect on suicide rates. Seven studies were identified that provide some support for a preventive effect, one found an increase in the suicide rates, and six failed to find any significant effects (either preventive or facilitative). The studies' different methodologies are reviewed, and limitations on the authors' conclusions pointed out. The conclusion of this article is that the evidence provides support for a preventive effect from suicide prevention centers, albeit small and inconsistently found.     

Temporal Fluctuations in Suicide Calls to a Crisis Intervention Service

Suicide-related calls received by a crisis intervention center were analyzed for temporal variations. The overall number of calls, calls concerning personal suicidal ideation, and calls concerning third-person suicide potential varied by both month and day of the week. Ideation calls and calls involving a suicide attempt varied by day of the month. Month and day of the week variation in third-person calls paralleled variations in completed suicides. Fluctuations were large enough to be useful in scheduling crisis center staff. The possibility that third-person calls represent a greater suicide threat than first-person calls is discussed.     

Suicide Prevention from a Public Health Perspective

The public health approach to health problems provides a strong framework and rationale for developing and implementing suicide prevention programs. This approach consists of health-event surveillance to describe the problem, epidemiologic analysis to identify risk factors, the design and evaluation of interventions, and the implementation of prevention programs. The application of each of these components to suicide prevention is reviewed. Suggestions for improving surveillance include encouraging the use of appropriate coding, reviewing suicide statistics at the local level, collecting more etiologically useful information, and placing greater emphasis on analysis of morbidity data. For epidemiologic analysis, greater use could be made of observational studies, and uniform definitions and measures should be developed and adopted. Efforts to develop interventions must include evaluating both the process and the outcome. Finally, community suicide prevention programs should include more than one strategy and, where appropriate, should be strongly linked with the community's mental health resources. With adequate planning, coordination, and resources, and the public health approach can help reduce the emotional and economic costs imposed on society by suicide and suicidal behavior.     

Chronic Callers to a Suicide Prevention Center

ABSTRACT: Records of 67 chronic callers to the Cleveland Suicide Prevention Centers over the past 9 years are reviewed. Of this group, 51% were diagnosed as drug or alcohol dependent. It was also noted that 4 of the 67 were known to have committed suicide and that another 37 (55%) had made suicide attempts. A surprising finding was that 47% of the group was eventually referred to an ongoing treatment resource. Agency strategies for dealing with the chronic caller are discussed.     

Psychotherapy as Moral Encounter: A Crisis of Modern Conscience

Psychotherapy can no longer be understood as a morally neutral or value-free practice. Many have argued that psychology is implicitly and inevitably laden with moral assumptions and has a significant impact on the moral and ethical fabric of its clients and surrounding society (Browning 1987; Doherty 1995; Dueck and Reimer 2003; Kelly and Strupp 1992; Rieff 1987, 2006). In this work, the authors highlight the profound identity crises within the field of psychology around the place of morality/ethics in its theories and practices. Chronicling some of the shifts between modern and postmodern theory will allow for a meaningful engagement with this issue. The postmodern shifts in the field have left clinicians ideologically hampered in their ability to attend to the moral dimensions of their clients’ lives. In conclusion, the authors posit a virtue ethics and consider avenues of holistically and meaningfully infusing clinical practice with moral sensibilities.     

Testing an App-Assisted Treatment for Suicide Prevention in a Randomized Controlled Trial: Effects on Suicide Risk and Depression

Suicide is a global public health problem and effective psychological interventions are needed. The objective of the present study was to evaluate the effect of an app-assisted suicide prevention treatment on suicide risk and depression. One hundred twenty-nine participants were randomized to treatment as usual (TAU), consisting of psychotherapy adhering to the framework of Collaborative Assessment and Management of Suicidality (CAMS), with (TAU + APP, N = 60) or without (TAU, N = 69) access to a mobile application (i.e., LifeApp’tite). Suicide risk and symptoms of depression were assessed pre- and posttherapy, and at 4-month follow-up. The TAU + APP group showed a smaller decrease on self-reported suicide risk at the end of treatment, corresponding to a medium between-group effect size (p = .008, d = 0.46). At the 4-month follow-up this was the case only at the trend level, where the effect size was also of a smaller magnitude (p = .057, d = 0.30). No differences between the treatment groups were observed on self-reported depressive symptoms, either immediately following treatment (p = .732, d = 0.05) or at follow-up (p = .467, d = 0.11). The unexpected negative effect concerning suicide risk points to crucial consideration of issues pertaining to timing, dosing, and content when adding new technology to existing treatments both in this and other populations.     

The University and the Moral Imperative of Fair Trade Coffee

This paper examines the relationship between the university and fair trade coffee campaigns in North America. In recent years, fair trade coffee sales internationally have increased substantially but have still not grown large enough to meet the needs of fair trade producers in the South. In consequence, fair trade activists have sought to expand the market by pressuring public institutions to adopt fair trade purchasing policies. In North America, the university has emerged as a central focus of fair trade coffee campaigns. Thus far, university administrators have been reluctant to support fair trade. This paper explores this reluctance and asserts that the university has a moral responsibility to support fair trade. However, it also argues that the potential exists for administrators to employ fair trade as an ethical fig leaf to mask the growing corporatization of the university under the weight of neoliberal reforms. This has become a common strategy of many neoliberal institutions in the North. Contrary to the assumptions of much of the emerging literature, it cannot be assumed that the impact of fair trade will necessarily be beneficial in the North unless activists work to ensure fair trade does not become employed as an ethical fig leaf.     

A Follow-up Study of 53 Suicides Known to a Suicide Prevention Center

ABSTRACT: The operation of the Cleveland Suicide Prevention Center is reviewed, and 53 known suicides during the Center's first four years of operation are discussed. A suicide rate of 288 per 100,000 suggests that persons contacting the Center represented a high suicide risk group. Of the suicides, 57 percent were women. This high proportion of females was statistically significant when compared to the smaller percentage of female suicides for Cuyahoga County, Ohio. Of the persons who committed suicide, 26 percent initiated direct contact with the Center themselves, and none recontacted the Center just prior to death. The question is raised whether contact initiated by another may in itself be suggestive of greater suicidal risk. Some of the practical problems in evaluation and referral are discussed.