Annemiek Huisman

Psychopathology and suicide method in mental health care

BACKGROUND Not all suicide methods are evenly distributed among different psychiatric disorders. METHODS In a nationwide sample of 505 suicides by persons in mental health care, the relationship between psychiatric diagnosis and suicide method was examined with chi(2) tests, logistic regression analyses and multinomial logistic regression analysis, including interactions with age, gender and treatment status. RESULTS Psychotic disorders were associated with jumping from heights, and substance-related disorders were associated with self-poisoning. Depressive disorders were not associated with any particular suicide method. Male patients preferred hanging, female patients self-poisoning. Inpatients preferred jumping before a train, outpatients self-poisoning. Bipolar patients preferred jumping before a train over hanging. LIMITATIONS Psychological mechanisms for selection of suicide methods are still unknown. CONCLUSIONS Possible means of suicide prevention suggested by this study include limiting access to tall buildings or structures to patients with psychotic disorders; careful prescription of medication to female patients and particularly to patients with substance-related disorders; and limiting easy access to railways near clinical settings to patients with bipolar and psychotic disorders. Limiting access to means of suicide may be less effective for suicidal patients with depressive disorders who may switch to other available methods.

An examination of the Dutch Health Care Inspectorate's supervision system for suicides of mental health care users.

OBJECTIVE This study examined characteristics of suicides among mental health care users reported between 1996 and 2006 to the Dutch Health Care Inspectorate and the inspectorates follow-up responses. The aims were to determine whether follow-up was associated with particular characteristics and whether the responses could be improved in accordance with guidelines for treatment of suicidal patients. METHODS Information about patient and treatment characteristics was collected from a sample of 505 of the 5,483 suicide notifications between 1996 and 2006. The 1996-2005 sample included an equal number of cases to which the inspectorate did and did not respond. The 2006 sample included the first 205 notifications in that year. RESULTS For 2006 notifications the response rate was 37%. The responses most frequently addressed how and whether the suicide was evaluated and the adequacy of treatment for the psychiatric disorder. A follow-up response was more likely when the suicide involved a young patient or a patient treated in a mental health care setting for less than a year or when the notification was accompanied by the mental health institutions plans for improving its policies. A response was less likely when the patient was discharged from inpatient care in the three months before the suicide. Since 2002 responses have more frequently emphasized the importance of suicide risk assessment, in accordance with guidelines. CONCLUSIONS The inspectorate might improve its supervision system by placing greater emphasis on addressing suicidal impulses and treating older and chronically suicidal patients and patients soon after inpatient discharge.

Suicides in Users of Mental Health Care Services: Treatment Characteristics and Hindsight Reflections

The current study aims to describe the patient and treatment characteristics of a sample of 505 suicides by mental health care patients, and to determine how clinicians view the care provided and what they learned. The results indicate that the quality of mental health care for suicidal patients could be improved by focusing on communication among clinicians, continuity of care, suicide risk assessment procedures, and the involvement of relatives.

Mental Health Reforms in Europe: Further Evaluation of the Dutch Supervision System for Suicides of Mental Health Care Users

Until recently, suicides of mental health care users in the Netherlands had to be reported to the Health Care Inspectorate by treating clinicians and medical directors. Interview data from 38 clinicians who reported a suicide and directors of the 28 facilities where they worked indicated ambivalence about the procedures usefulness, especially about the blame implied by the required reporting procedure. No interviewee reported that a suicide could have been prevented. In May 2011 the national policy was changed so that most suicides can be reported in a blame-free manner within the facility and fewer suicides must be reported to the inspectorate.

Treatment of Intrusive Suicidal Imagery Using Eye Movements

Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions.

Signaleren van suïcidaliteit bij jongeren met de VOZZ-vragenlijst

SamenvattingDe Vrije Universiteit Amsterdam ontwikkelde een signaleringsinstrument voor suïcidaliteit onder jongeren, ‘Vragen over Zelfdoding en Zelfbeschadiging’ (VOZZ) met 39 items en een screeningsvariant met tien items (VOZZ-SCREEN). De vragenlijst is ontwikkeld in een pilotstudie (n = 319) onder jongeren die in behandeling zijn bij de Geestelijke GezondheidsZorg (jeugd-GGZ) (43) en onder leerlingen van het middelbaar beroepsonderwijs (276) en in een vervolgonderzoek (n = 744) onder jongeren van 18 tot 21 jaar. De psychometrische kwaliteiten van de VOZZ en de VOZZ-SCREEN zijn goed. De VOZZ is geschikt voor gebruik op scholen en in de jeugdhulpverlening als inventarisatie-instrument van risico- en beschermende factoren van suïcidaliteit, op basis waarvan een gesprek aangegaan kan worden. De VOZZ-SCREEN is geschikt voor zowel algemene populatiescreeningsdoeleinden als voor selectieve screening, zoals door de GGD. Meer onderzoek naar de VOZZ en de VOZZ-SCREEN is nodig om de psychometrische eigenschappen bij jongeren onder de 18 jaar vast te stellen.

Results and experiences of 113 Online: a comprehensive Dutch online suicide prevention platform

The emergence of new information and communication technologies has led to the development of Internet based “e-mental health” interventions including e-therapy, online screening, tele-consultation and online information and education services. These developments can benefit the field of suicide prevention by increasing the availability, accessibility, and acceptability of care to suicidal individuals, being often emotionally vulnerable and ambivalent help seekers (McGinty et al., 2006 ; Krysinska & de Leo, 2007; Sarchiapone et al., 2009; Lester, 2008; Luxton et al., 2011; Barak, 2007). This chapter presents the Dutch online suicide prevention platform which provides several complementary services over the Internet. We first present the general background, introducing the potential contribution of e-mental health for suicide prevention. We then describe the organization of 113Online, the principles and key services they provide. Third, we present data on the characteristics of 113Online service users and their usage, as well as some outcomes, using data recorded during the first three years of operation. The final section summarizes and discusses our experiences to date and research findings. Plans for future developments will be presented and a research agenda will be proposed.

Richtlijnen voor de behandeling van suïcidale patiënten

Uitgaande van de beste ervaringen in de behandeling van suicidale patienten en op grond van wetenschappelijk onderzochte effectieve behandelingen zijn internationale richtlijnen geformuleerd die een handvat geven voor de praktijk van de hulpverlening. Ook in Nederland is in 2012 zo’n multidisciplinaire richtlijn geformuleerd. De belangrijkste elementen van een behandeling volgens de richtlijn worden hier beschreven.

16 Algemene preventie van suïcide in GGZ-instellingen

Individuele hulpverleners richten zich vaak op het voorkomen van individuele suicides van hun patienten. Het is de taak van de GGZ-instellingen om hun beleid in overeenstemming met algemene voorwaarden voor suicidepreventie en met wetenschappelijke ontwikkelingen vorm te geven. Voorbeelden van effectieve, algemene preventiemaatregelen bij de verkeersveiligheid zijn de verplichting om bromfietshelmen te dragen of om veiligheidsgordels te dragen in auto’s. Bij suicidepreventie kunnen ook algemene maatregelen getroffen worden die de veiligheid van patienten verhogen.

4 Richtlijnen voor de behandeling van suïcidale patiënten

Dit hoofdstuk geeft een overzicht van de belangrijkste richtlijnen die nationaal en internationaal zijn verschenen voor de behandeling van suicidale patienten. Het is een weergave van wat momenteel als optimale zorg wordt gezien.