Commitment to Living » current events

Interesting qualitative study about military mental health professionals on deployment

Anthony Pisani — Mon, 11 Jul 2011 16:17:18 +0000

A group of US and UK colleagues have published an interesting qualitative study about the challenges and resiliency of military mental health professionals (MMHPs). They had a small non-representative sample of British MMHPs who had completed a period of deployment in Iraq between 2003-2005. For the study, they participated in detailed interviews about their experiences practicing in a deployment setting. The authors did a nice job pulling together themes from the interviews in order to develop a conceptual model for the goals, challenges, and resources, and to draw out some recommendations about training and planning. Recommended:

McCauley, M., Liebling-Kalifani, H., & Hughes, J. H. (2011). Military Mental Health Professionals On Operational Deployment: An Exploratory Study. Community Mental Health Journal. doi:10.1007/s10597-011-9407-8

New on the Web: Suicide Prevention News and Comment

Anthony Pisani — Fri, 09 Jan 2009 17:18:19 +0000

Franklin Cook has started a suicide prevention news blog that looks very promising. Suicide Prevention News and Comment (SPNAC) is still young– less than a month old–but already has some valuable information and insights. As the site’s name suggests, most of the posts (several each week) are stimulated by news in the suicide prevention arena which Mr. Cook passes on, along with helpful and thoughtful commentary. The webiste has a three-column newspaper-style format, which could be welcoming and familiar to readers who are less experienced with blogs. I have added SPNAC to my blogroll, and look forward to reading more from this site.

Clinical reflections on Army’s approach in interactive suicide prevention video

Anthony Pisani — Wed, 22 Oct 2008 17:21:38 +0000

A colleague pointed me to a Washington Post articl e describing an interactive suicide prevention video the Army has produced and will make mandatory for all soldiers. I experimented with the online demo of Beyond the Front, which shows scenes from the life two soldiers and allows the viewer to make choices that either lead toward or away from help and survival. The demo portion I reviewed focuses on the decision a distressed soldier faces in deciding to talk with the chaplain or not. I was impressed with the quality of the video and interested by the approach.

I am not expert enough in public awareness and mass media approaches to prevention to comment or speculate about how effective this video might be in preventing suicide in the Army. But I would like to comment on some intersections between the approach this video takes and some ideas about clinical practice.

To me, one of the most powerful aspects of this video is the way in which it leads the soldier-viewer to see him/herself as potentially at risk for suicide. The video gives the message “If you don’t get help, your life could be in danger.” Since the video is interactive, the viewer can actually make decisions (like keeping the distress or suicidal thoughts secret) that eventually lead to death.

From a clinical perspective, I have found that putting in front of a person–sometimes in a dramatic way–the danger he or she is in can actually help to kick in the person’s survival instinct. It sounds strange to warn someone of danger when the danger is from oneself. But a question like this one can be sobering: “If there were nothing we could do to move life be more livable, how likely would you be to die?” I worked with someone who could not name a single reason why life could have worth or meaning and who could identify no chance for things to get better, but who, when asked that question, started talking about his son and two other people he wouldn’t want to leave behind. Recently, I was pleased to hear a similar question encouraged in the ASIST approach to suicide prevention and intervention. An advanced variation of this question might even embed the prospect of hope within the danger question: “If there were nothing we could to help life be more livable–I think there are things, but let’s say we didn’t pursue them–If things continue like this, how likely would you be to die?”

It is strange and surprising to some clinicans that most people who are suicidal (and I would venture to say some who actually kill themselves) don’t want to die. Many people who have survived near lethal suicide attempts have reported that. A participant in a workshop I gave several months ago illustrated this for me in a compelling way. This participant had, at an earlier point in her life, attempted suicide. She had since recovered and pursued education in the mental health field. In sharing her subjective experience of the suicidal wish, she said, “I never wanted to kill myself. I just wanted to kill the pain.” What a gift. Clinicians should be aware of this and look for ways to simultaneously connect with the suffering and activate the part of every person that desires life.

Description of Golden Gate Bridge Barrier

Anthony Pisani — Tue, 21 Oct 2008 15:12:03 +0000

My last two posts focused on means restriction–the aim of preventing suicide by reducing a person’s access to a quick and lethal suicide method. The Golden Gate Bridge Physical Suicide Deterrent Project has been a highly publicized (and controversial) state effort to determine out the best way to balance the imperative of saving lives by erecting a physical barrier on the bridge and the desire to protect the beauty and touristic appeal of this national landmark. On October 10, Board of Directors voted to pursue the construction of an steel net that would extend 20 feet on either side of the bridge. Today I came across a post at PsychCentral by Dr. John M. Grohol describing how this proposed net would work. I found the article interesting and thought I’d pass it on.

Means restriction and impulsivity in fantastic NY Times piece

Anthony Pisani — Mon, 08 Sep 2008 16:48:48 +0000

I have mentioned quite a few NY Times articles in this blog because I think they cover suicide really well. Last month they published a piece in the NY Times Magazine that I keep recommending to people in informal and clinical discussions, so I thought I’d link to it here. Many thanks to my colleague Bill Watson for first alerting me to the article.

The Urge To End It, by Scott Anderson, is a stunning piece. Well-written, and well-researched, it challenges the stereotype that suicide is always well thought out, carefully planned, and the result of a conscious and un-ambivalent decision. He focuses on the impulsivity and momentary desperation involved in many suicide attempts, and raises awareness about means restriction as a potent intervention.

For clinicians, there are several important take-home points and cautions:

Expressed suicidal ideation is only one part of an assessment of risk for suicide; impulsivity, high intensity stressors, and agitated emotional pain signal as much about risk as suicidal ideation.
We need to ask about available means and seek to disable lethal means whenever possible.
We need to advocate for public policy that promotes means restriction–this may save the life of someone in our care (or in our lives).
Ambivelance runs deep. Even in the moment of jumping, survivors report feeling regret, not wanting to die. We are built for living, and those who help distressed individuals have a powerful force on our side.
We need to ask about how bad the pain is and how intense the desire for escape, even (especially) with individuals who have not previously expressed suicidal ideation.

There are probably other lessons from Anderson’s excellent article, including understanding more about the subjective experience of someone who attempts suicide. The article is not short, but you’ll be rewarded for the time spent to read it all the way through.

Possible contagion effect in Nantucket

Anthony Pisani — Tue, 18 Mar 2008 12:11:35 +0000

The small island of Nantucket, MA has seen 3 teen suicides in a short period of time, according to the New York Times. Very sad. Statistically, three suicides in a high school of 400 represents a meaningful cluster, and a possible contagion effect. Whether it is or it isn’t contagion in Nantucket (it is impossible to know for sure and the article suggests some disagreement in this case), the key thing for clinicians to know is that vulnerability to contagion has been documented in adolescents. Clinicians working with adolescents at risk at the time of a public or peer suicide should consider reassessing their clients’ risk for suicide when news of a peer death becomes public.

NY Times: Making Sense of the Great Suicide Debate

Anthony Pisani — Mon, 11 Feb 2008 13:09:59 +0000

N.Y. Times has done it again. A nice article taking a step back from the current flurry of news and discovery about the relationship between anti-depressants and suicide.

Word is getting out about suicide and antidepressants

Anthony Pisani — Tue, 08 Jan 2008 13:09:43 +0000

We’re seeing more public awareness of the nuances in the research about suicide and antidepressants, which I’ve posted about before. This NEW YORK TIMES article is an example.

Caution, Not Panic, Seen After Drug Warnings

New York Times article about elder suicide

Anthony Pisani — Tue, 27 Nov 2007 13:45:49 +0000

The New York Times does a good job raising public awareness about suicide prevention. Today, they’ve published an article bout suicide in older adults. Read the full article here.

Newsmap illustrates power of mapping/visualization

Anthony Pisani — Mon, 19 Nov 2007 14:25:20 +0000

This is a bit far afield from suicide, but I think worth mentioning here because it illustrates how maps and visualization can present a different, more contextually-sensitive view of a phenomenon, as compared to that which lists and other linear formats can achieve.

I recently became aware of a project called Newsmap, which takes a traditional news feed (Google News) and maps it so that you can see the news landscape in a different way. The program purports to “to divide information into quickly recognizable bands which, when presented together, reveal underlying patterns in news reporting across cultures and within news segments in constant change around the globe.” In the quick scans I’ve done, I’ve been impressed with how much information can be presented this way, and with how much more context one apprehends from this visual view.