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The legendary rap star and cofounder of Run D.M.C. speaks out about his battle with depression and overcoming suicidal thoughts-- one of the most devastating yet little known health issues plaguing the black community today.

PURPOSE.  This article identifies the types of environmental safeguards within psychiatric facilities that can be implemented to protect suicidal individuals from harming themselves. The history and variety of safeguards are discussed, as well as recommendations for administrators regarding making their units safer. CONCLUSION.  The use of environmental safeguards is one of the first steps in decreasing inpatient suicides. PRACTICE IMPLICATIONS.  Inpatient nurses need to be aware of the environmental dangers in their units and of the safeguards that should be implemented. Recommendations include training programs, environmental tours, and effecting indicated structural changes.

Clinical work with suicidal people is a demanding area. Little is known about health professionals’ practices when faced with suicidal patients. The aims of this study were to: (1) describe the practices most likely to be adopted by professionals facing a suicidal patient and (2) analyze the differences according to professional characteristics (group, specific training on suicide, and experience with suicidal patients). A self-report questionnaire that was developed for this study was filled out by 239 participants. Participants were psychologists, psychiatrists, and general practitioners who work in different contexts: hospitals, public health centres, schools or colleges, and community centres. Principal components analysis, analyses of variance, and t-tests were used. Four components were identified: (1) Comprehensive risk assessment; (2) protocols, psychotherapy and connectedness; (3) multidisciplinary clinical approach; and, (4) family, explaining a total of variance of 44%. Positive associations between suicide-related variables (training and experience) and practices were found. In general, health professionals’ practices are evidence-based, however a relevant percentage of professionals can benefit from training and improve their practices.

Suicide management is attended with ethical dilemmas. Philosophical positions like respect for life (which generally accords with the theological position), autonomy, duty to others, and utilitarianism; as well as legal requirements provide a context for ethical decision making. Ethical principles involved are duty to others, autonomy (including informed consent and confidentiality), beneficence and non-maleficence. The application of these principles are considered in various clinical situations related to acute care (advanced directives, withdrawal of or withholding life-sustaining treatments, surrogate decision makers, informed consent, no-suicide contracts, involuntary hospitalization) as well as long-term care in mental health settings (acutely and chronically suicidal patients, patients with suicidal behavior who are not in a suicidal crisis, and therapeutic relationship). Organizational issues (legal statutes, institutional preparedness) and cultural issues (family ties, religiosity) relevant to ethics related to suicidality are also discussed. It is emphasized that professional bodies should appreciate the difficulties faced by health-care professionals in the ethical decision making related to suicide and develop instruments to support them.

Background The Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that has been shown to reduce suicidal ideation and overall symptom distress. CAMS has not been previously evaluated in a standard acute inpatient mental health care setting with only short treatment times for suicidal patients. In this randomized controlled trial (RCT) we are investigating whether CAMS is more effective than Enhanced-Treatment as Usual (E-TAU) in reducing suicidal thoughts as primary outcome variable. We are also investigating depressive symptoms, general symptom relief, and the quality of the therapeutic alliance as secondary outcomes. Methods/Design This RCT is designed as a single-center, two-armed, parallel group observer-blinded clinical effectiveness investigation. We are recruiting and randomizing 60 participants with different diagnoses, who are admitted as inpatients because of acute suicidal thoughts or behaviors into the Clinic for Psychiatry and Psychotherapy, Ev. Hospital Bethel in Bielefeld, Germany. The duration of treatment will vary depending on patients’ needs and clinical assessments ranging between 10 and 40 days. Patients are assessed four times, at admission, discharge, 1 month, and 5 months post-discharge. The primary outcome measure is the Beck Scale for Suicide Ideation. Other outcome measures are administered as assessment timepoints including severity of psychiatric symptoms, depression, reasons for living, and therapeutic relationship. Discussion This effectiveness study is being conducted on an acute ward in a psychiatric clinic where patients have multiple problems and diagnoses. Treatment is somewhat limited, and therapists have a large caseloads. The results of this study can thus be generalizable to a typical inpatient psychiatric hospital settings. Trial registration This clinical trial has been retrospectively registered with the German Clinical Trials Register; registration code/ DRKS-ID: DRKS00013727 (on January 12, 2018). In addition, the study was also registered with the International Clinical Trials Registry Platform of the World Health Organization (identical registration code). Registry Name: „Evaluation von CAMS versus TAU bei suizidalen Patienten – Ein stationärer RCT“.

Background Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that appears promising to reduce suicidal ideation and suicidal cognition. CAMS has not previously been evaluated in a standard specialized mental health care setting for patients with suicidal problems in general. In this pragmatic randomized controlled trial (RCT) we will investigate if CAMS is more effective than treatment as usual (TAU) in reducing suicidal thoughts and behaviors. Effects will also be investigated on mental health and symptom relief in general and upon readmissions to inpatient units. Methods/design The study is a multicenter, observer-blinded, superiority, two-armed RCT which will include patients from four clinical departments at Vestre Viken Hospital Trust, Norway. We aim to include 100 patients with moderate to strong suicidal problems, as defined by a score of 13 or more on Beck’s Scale for Suicide Ideation - Current. Patients are included regardless of diagnosis. Randomization will be performed using a stratified four-block procedure with treatment unit as the stratification variable. The duration of treatment will vary depending on patients’ needs and clinical assessments. Patients are interviewed by research staff at four checkpoints: baseline, 2 weeks, 6 months, and 12 months. Central outcome measures are the Beck Scale for Suicide Ideation - Current, Outcome Questionnaire – 45, and Suicide Attempt Self-Injury Count. Discussion This pragmatic trial is effectuated within the Public Health Care System in Norway, where patients have multiple problems and diagnoses and therapists have a high work load. Results from this trial are highly generalizable to a typical everyday clinical setting, and one should expect similar results if CAMS is implemented in the future as a standard component in specialized mental health care systems. Trial registration Open Science Framework: DOI 10.17605/OSF.IO/JHRM2 . Registered 5 July 2015. ClinicalTrials.gov: NCT02685943 . Registered on 8 February 2016.

This is a commentary on two articles on assessing mental capacity in everyday practice and in the case of the suicidal patient. It explores some of the conceptual problems with capacity, including the lack of a ‘right’ answer and the value-laden nature of capacity assessments in suicidal patients. In England and Wales, in addition to the Mental Capacity Act 2005 clinicians must also consider their duty of care as part of the European Convention on Human Rights as enacted in the Human Rights Act 1998.

Background Clinicians working with patients at risk of suicide often experience high stress, which can result in negative emotional responses (NERs). Such negative emotional responses may lead to less empathic communication (EC) and unintentional rejection of the patient, potentially damaging the therapeutic alliance and adversely impacting suicidal outcomes. Therefore, clinicians need training to effectively manage negative emotions toward suicidal patients to improve suicidal outcomes. Methods This study investigated the impact of virtual human interaction (VHI) training on clinicians’ self-awareness of their negative emotional responses, assessed by the Therapist Response Questionnaire Suicide Form, clinicians’ verbal empathic communication assessed by the Empathic Communication and Coding System, and clinical efficacy (CE). Clinical efficacy was assessed by the likelihood of subsequent appointments, perceived helpfulness, and overall interaction satisfaction as rated by individuals with lived experience of suicide attempts. Two conditions of virtual human interactions were used: one with instructions on verbal empathic communication and reminders to report negative emotional responses during the interaction (scaffolded); and the other with no such instructions or reminders (non-scaffolded). Both conditions provided pre-interaction instructions and post-interaction feedback aimed at improving clinicians’ empathic communication and management of negative emotions. Sixty-two clinicians participated in three virtual human interaction sessions under one of the two conditions. Linear mixed models were utilized to evaluate the impact on clinicians’ negative emotional responses, verbal empathic communication, and clinical efficacy; and to determine changes in these outcomes over time, as moderated by the training conditions. Results Clinician participants’ negative emotional responses decreased after two training sessions with virtual human interactions in both conditions. Participants in the scaffolded condition exhibited enhanced empathic communication after one training session, while two sessions were required for participants in the non-scaffolded condition. Surprisingly, after two training sessions, clinical efficacy was improved in the non-scaffolded group, while no similar improvements were observed in the scaffolded group. Conclusion Lower clinical efficacy after virtual human interaction training in clinicians with higher verbal empathic communication suggests that nonverbal expressions of empathy are critical when interacting with suicidal patients. Future work should explore virtual human interaction training in both nonverbal and verbal empathic communication.

In this article, a truly personal experience of a therapist-patient relationship is being described. This is the experience with a patient Ms. A, who attempted a suicidal act. The nature of demands, difficulties, and emotions the therapist was exposed to while managing this patient is depicted. The therapist-patient relationship was believed to influence critical care of the patient, and a positive therapeutic relationship was associated with continuity of care and favorable treatment response. Human emotions are based on ideas, and control of emotional turmoil may be achieved by changing one's ideas. This presentation will describe the need for us to focus on the specific integrative skills required in handling relationship issues in suicidal patients. The intervention efforts focused on decreasing the suffering experienced, while simultaneously building a patient's capacity to cope with difficulties from an emotional perspective.

The psychiatric emergency room, a fast-paced combat zone with pressure to match, thrusts its medical providers into the outland of human experience where they must respond rapidly and decisively in spite of uncertainty and, very often, danger. In this lively first-person narrative, Paul R. Linde takes readers behind the scenes at an urban psychiatric emergency room, with all its chaos and pathos, where we witness mental health professionals doing their best to alleviate suffering and repair shattered lives. As he and his colleagues encounter patients who are hallucinating, drunk, catatonic, aggressive, suicidal, high on drugs, paranoid, and physically sick, Linde examines the many ethical, legal, moral, and medical issues that confront today's psychiatric providers. He describes a profession under siege from the outside—health insurance companies, the pharmaceutical industry, government regulators, and even \"patients' rights\" advocates—and from the inside—biomedical and academic psychiatrists who have forgotten to care for the patient and have instead become checklist-marking pill-peddlers. While lifting the veil on a crucial area of psychiatry that is as real as it gets, Danger to Self also injects a healthy dose of compassion into the practice of medicine and psychiatry.