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.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.     

社会救助制度的道德风险及防范

道德风险普遍存在于社会生活的各个领域,社会救助制度的环境决定了社会救助制度道德风险的特殊性.社会救助制度的道德风险主要体现在救助依赖、"贫困陷阱"等方面.社会救助制度道德风险的规避策略包括:构建合理的社会救助责任主体的关系;强化社会救助的激励和约束机制;降低社会救助参与各方的信息不时称程度;坚持政府责任与个体责任的统一,实现社会救助制度中个体德性与制度正义的伦理生态.     

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.     

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.