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Behavioral Health’s “Elephant in the Room”

By Tony Salvatore, MA

Among the many unwieldy problems in behavioral health, one looms especially large. This pachyderm-sized concern is “chronic suicidality.” This is repetitive parasuicidal behavior involving suicide threats and acts without any intent to die. It may arise at any time and convert low-risk situations into what appears to be a potential life-threatening psychiatric emergency.

Chronic suicidality seems to co-occur with a desperate “need” for shelter, inpatient care, or residential rehabilitation. Dramatic and emphatic suicide threats are voiced with an effect that comes from much practice. Immediately, urgent attention is forthcoming, doors open, and then the suicidal crisis usually subsides.

Curiously and incongruously such “suicidal” individuals who project themselves to be at imminent risk of self-destruction may still feel the need for a smoke break or a sandwich. Equally surprising is that despite the depth of their despair they have often managed to pack for what they hope will be a long stay in a hospital or rehab. Continue reading