Dyadic death: murder-suicide.

Twenty homicide-suicides, drawn from death records of three major eastern United States cities, were analyzed in comparison to prior studies and samples of homicide offenders and suicide victims. Results indicated a lower incidence for this event than reported previously and several distinguishing characteristics of the murderer who subsequently commits suicide. Two primary types, from the perspective of ego fusion, are discussed.     

Suicide Risk Assessment and Risk Formulation Part II: Suicide Risk Formulation and the Determination of Levels of Risk

The suicide risk formulation (SRF) is dependent on the data gathered in the suicide risk assessment. The SRF assigns a level of suicide risk that is intended to inform decisions about triage, treatment, management, and preventive interventions. However, there is little published about how to stratify and formulate suicide risk, what are the criteria for assigning levels of risk, and how triage and treatment decisions are correlated with levels of risk. The salient clinical issues that define an SRF are reviewed and modeling is suggested for an SRF that might guide clinical researchers toward the refinement of an SRF process.     

Changing the Direction of Suicide Prevention in the United States

It is axiomatic that the goal of suicide prevention is the prevention of suicide. Yet in spite of significant efforts to this end since the middle of the last century, and most notably in the last decade, the rate of suicide in the U.S. has not declined; rather, it has increased. To address this issue, Suicide Awareness Voices of Education (SAVE) brought together leading prevention specialists from other public health problems where successes have been achieved, representatives from countries where suicide rates have declined, and U.S. based suicide prevention researchers and program directors, to “think outside the box” and propose innovative, scalable approaches that might better drive success in achieving desired results from U.S. suicide prevention efforts. The recommendations should challenge our preconceptions and force us outside our own mental constraints to broaden our perspectives and suggest catalysts for real change in suicide prevention.     

Evaluation of the Recognizing and Responding to Suicide Risk Training

Changes in attitudes, confidence, and practice behaviors were assessed among 452 clinicians who completed the training, Recognizing and Responding to Suicide Risk, and who work with clients at risk for suicide. Data were collected at three time points. Scores on measures of attitudes toward suicide prevention and confidence to work with clients at risk for suicide improved over time. Clinical practice behaviors improved for assessing and formulating suicide risk, developing suicide prevention treatment plans, and responding to vignettes. Results suggest training can improve clinicians’ attitudes toward suicide, confidence to work with clients at risk for suicide, and, most importantly, clinical practice skills.     

Inpatient Treatment Planning

The inpatient treatment plan is the essential guide to coordinate the nursing and adjunctive therapeutic staff's approach to the multiple needs of hospitalized patients. The written plan, formulated within days of admission, articulates to the community of caregivers the link between the patient's presenting problems and those services available to alleviate them. As illustrated in the case of Steve, the complexities of patients and of care-giving systems require careful thought in arriving at a workable approach.