Konrad Michel

Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide

Background:u2002National suicide statistics show remarkable differences in the frequencies of various methods used for completed suicide. The WHO/EURO Multicentre Study on Parasuicide makes possible for the first time an international comparison of the frequencies of methods used in attempted suicide, because the data are based on geographical catchment areas of medical institutions. Method: Ongoing standardized monitoring of attempted suicide in all medical institutions serving the catchment areas was performed in 14 centres in 12 European countries. The data analysis is based on 20,649 events involving 15,530 persons, recorded between 1989 and 1993. Results: The comparison of rates per 100,000 shows striking differences between the centres. The highest rates for drug overdoses were found for female attempters in Oxford (347/100,000), Helsinki (238/100,000) and Stockholm (221/100,000). Guipuzcoa had the lowest rates (61/100,000). The differences were most prominent in the age group 15–24, with outstanding rates for women in Oxford (653/100,000), which was mainly due to the frequent use of analgesics. Szeged had outstandingly high rates for pesticides and solvents. In some centres the use of multiple methods was frequent. Conclusions: There is a need, especially for areas with high frequencies for certain methods, to understand the factors involved and to develop new and specific prevention projects and to monitor their effects. The WHO/EURO Multicentre Study on Parasuicide has proved to be a useful and reliable instrument for continuous monitoring of trends in parasuicide.

Building a therapeutic alliance with the suicidal patient.

In this book, editors Konrad Michel and David A. Jobes have enlisted an elite group of clinicians and researchers to explore what has become known as the “Aeschi approach” to clinical suicide prevention. According to this view, mental health professionals working with patients at risk for suicide must recognize a fundamental conflict at the heart of good clinical practice: while they are experts in the assessment and treatment of disorders of mental health, when it comes to the patient’s suicidal story, the patient is the expert. Successful interventions with suicidal patients must therefore be empathic and honor the very personal perspective of the patient.

Self-confrontation interview with suicide attempters

Psychiatric and psychological assessment after parasuicide is characterized by a number of difficulties. The interview is a strategically complex task for the patients trying to accommodate the wishes of the psychiatrist/psychologist and their own goals. The psychiatrist/ psychologist on the other hand needs to gain information about the event and the patients mental state, has to assess the risk of further suicidal behaviour, and has to motivate the patient for treatment. In our experience a routine video prompted recall or self-confrontation interview, can be a helpful means of talking with the patient about his or her feelings and cognitions during the interview. Furthermore, it allows clarification of the processes leading to parasuicide. The procedure of administering a self confrontation interview is described, the theoretical background for interpreting the results is outlined and some examples of patient interviews are presented. It is demonstrated that this method allows access to additional information on the patients thinking and emotions during the interview and that it also provides more details of the suicidal process.