“Hotspots” and “copycats”: a plea for more thoughtful language about suicide

LetterThis is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.The meta-analysis by Jane Pirkis and colleagues presents a useful contribution to knowledge about the effectiveness of interventions to prevent suicides in public places. I take issue not with the content of their work, but with its language. They use the term “hotspot(s)” no fewer than 30 times in their paper. For some years, this term has served to denote specific public sites that are frequently associated with acts of suicide, usually by jumping. Beloved of the media, its continued, uncritical use in scientific literature is concerning

Communication and interpretation of emotional distress within the friendships of young Irish men prior to suicide: A qualitative study

This is the peer reviewed version of the article, which has been published in final form at DOI: 10.1111/hsc.12124. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.The potential for young men in crisis to be supported by their lay networks is an important issue for suicide prevention, due to the under-utilisation of healthcare services by this population. Central to the provision of lay support is the capability of social networks to recognise and respond effectively to young men's psychological distress and suicide risk. The aim of this qualitative study was to explore young men's narratives of peer suicide, in order to identify how they interpreted and responded to behavioural changes and indications of distress from their friend before suicide. In-depth qualitative interviews were conducted during 2009/10 with 15 Irish males (aged 19-30 years) who had experienced the death by suicide of a male friend in the preceding 5 years. The data were analysed using a thematic approach. Through the analysis of the participants' stories and experiences, we identified several features of young male friendships and social interactions that could be addressed to strengthen the support available to young men in crisis. These included the reluctance of young men to discuss emotional or personal issues within male friendships; the tendency to reveal worries and emotion only within the context of alcohol consumption; the tendency of friends to respond in a dismissive or disapproving way to communication of suicidal thoughts; the difficulty of knowing how to interpret a friend's inconsistent or ambiguous behaviour prior to suicide; and beliefs about the sort of person who takes their own life. Community-based suicide prevention initiatives must enhance the potential of young male social networks to support young men in crisis, through specific provisions for developing openness in communication and responsiveness, and improved education about suicide risk

Communication and interpretation of emotional distress within the friendships of young Irish men prior to suicide: a qualitative study

The potential for young men in crisis to be supported by their lay networks is an important issue for suicide prevention, due to the under-utilisation of healthcare services by this population. Central to the provision of lay support is the capability of social networks to recognise and respond effectively to young men’s psychological distress and suicide risk. The aim of this qualitative study was to explore young men’s narratives of peer suicide, in order to identify how they interpreted and responded to behavioural changes and indications of distress from their friend before suicide. In-depth qualitative interviews were conducted with 15 Irish males (aged 19-30 years) who had experienced the death by suicide of a male friend in the preceding five years. The data were analysed using a thematic approach. Through the analysis of the participants’ stories and experiences, we identified several features of young male friendships and social interactions that could be addressed in order to strengthen the support available to young men in crisis. These included: the reluctance of young men to discuss emotional or personal issues within male friendships; the tendency to reveal worries and emotion only within the context of alcohol consumption; the tendency of friends to respond in a dismissive or disapproving way to communication of suicidal thoughts; the difficulty of knowing how to interpret a friend’s inconsistent or ambiguous behaviour prior to suicide; and beliefs about the sort of person who takes their own life. Community-based suicide prevention initiatives must enhance the potential of young male social networks to support young men in crisis, through specific provisions for developing openness in communication and responsiveness, and improved education about suicide risk

Needs and fears of young people presenting at Accident & Emergency department following an act of self-harm: Secondary analysis of qualitative data

This is the author accepted manuscript. The final version is available from the Royal College of Psychiatrists via the DOI in this record.Background: Presentation at an Accident and Emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood. Aims: To examine young people’s perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter. Method: Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm. Results: Participants reported avoiding A&E whenever possible, based on their own and others’ previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received ‘treatment as usual’, i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle. Conclusions: The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.National Institute for Health ResearchThanks must again be given to all the primary study participants, who gave so much time and energy and allowed us access to their private worlds. We also acknowledge the other members of the primary study team. C.O. and S.S. were supported for part of the time spent on this paper by the National Institute for Health Research (NIHR) CLAHRC for the South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

Preventing suicides in public places: A practice resource

This practice resource is for those with responsibility for suicide prevention in local authorities and their partner agencies. It has been developed to help them contribute to the delivery of the national suicide prevention strategy for England, in particular area 3 of the strategy, ‘Reduce access to the means of suicide’. It replaces the ‘Guidance on action to be taken at suicide hotspots’ published in 2006 by the National Institute for Mental Health in England (NIMHE). It has a broader focus, includes learning from those who have tried to take their own lives in public places, draws on recent research and expert opinion, and provides examples of innovative practice from England and around the world. This document sits alongside PHE’s ‘Guidance for developing a local suicide prevention action plan’: www.gov.uk/government/publications/suicide-prevention-developing-a-local-action-planPublic Health Englan

Recognising and responding to suicidal crisis within family and social networks: qualitative study

Objective To shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene

How people come to recognise a problem and seek medical help for a person showing early signs of dementia: a systematic review and meta-ethnography

Evidence suggests that there is usually a long delay between noticing first signs of dementia and seeking medical help. We conducted a systematic review of what people experience and how they make decisions during this time, and used a meta-ethnographic approach to synthesise the findings. Screening and quality assessment resulted in nine studies eligible for inclusion. People with dementia mainly report experiencing memory lapses, while carers focus on more subtle changes in personality. People respond to these changes in one of three ways: 1) they discount them as normal; 2) they reserve judgement as to their cause and significance, or 3) they misattribute them. Pivotal events can finally trigger help seeking. Active reflection and seeking of further evidence may lead to earlier recognition of the possibility of dementia and the need to seek help; it also reduces the risk of a pivotal event. Public education should aim to improve recognition of more subtle signs and to encourage repeated evaluation and reflection

Measuring outcomes in trials of interventions for people who self-harm:Qualitative study of service users’ views

This is the final version. Available on open access from Cambridge University Press via the DOI in this recordBackground Patients often have very different ideas from clinicians about what they want treatments to achieve. Their views on what outcomes are important are not always reflected in trials. Aims To elicit the views of people who self-harm on the most commonly used outcome measures and to identify the outcomes that matter to them. Method We conducted in-depth interviews with 18 people with histories of self-harm, recruited from hospital and community settings. We conducted thematic analysis using a framework approach and used visual mapping to arrive at our final analysis and interpretation. Results Participants' accounts contained a number of challenges to the validity and meaningfulness of current trial outcome measures. Five broad issues emerged: (a) relationship between frequency and severity of self-harm; (b) behavioural substitution; (b) self-management skills; (d) the role of self-harm as survival tool and affect regulator, and (e) strategic self-presentation. We show how these affect the visibility and measurability of commonly used outcomes. The outcomes that mattered to participants focused on positive achievements in three domains: (a) general functioning and activities of everyday living; (b) social participation, and (c) engagement with services. Participants conceptualised these as both measures and means of sustained improvement. Conclusions Our findings suggest that current self-harm trial science rests on flawed assumptions about the relationship between mental states and behaviours and about our ability to measure both. Greater understanding of the outcomes that matter to people who self-harm is needed to inform both intervention development and trial design.National Institute for Health Research (NIHR

Interventions to reduce suicides at suicide hotspots: a systematic review

BACKGROUND: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. METHODS: We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?' RESULTS: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. CONCLUSIONS: More well-designed intervention studies are needed to strengthen this evidence base.Australian Government Department of Health and AgeingUK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the Southwest Peninsul

Engaging Without Exposing: Use of a Fictional Character to Facilitate Mental Health Talk in Focus Groups With Men Who Have Been Subject to the Criminal Justice System.

In an effort to encourage men with experience of being subject to the criminal justice system to contribute to focus group discussions on the sensitive topic of mental health, while also doing our utmost to protect them from discomfort or risk of exploitation, we used a novel technique involving the creation of a fictional character, supplemented by an audio-recorded vignette. We studied the role played by this technique in achieving our stated aims of "engaging without exposing." In this article, we report on the use of this technique in three focus groups, showing how in very different ways it shaped the interaction between participants and generated crucial insights into the lives and service needs of each group. We conclude that the technique may lend itself to being used in focus groups with other marginalized or seldom-heard populations