The Crisis Continuum

By Tony Salvatore, MA

Mental health consumers and providers, and often family members and others, often use the term “crisis” to encompass a wide range of personal, interpersonal, and environmental situations with current or anticipated negative consequences. This “one size fits all” concept of a crisis is overly simplistic, obscures or minimizes the complexity of the situation, and impedes effective intervention and resolution.

Mental illness-related crises vary in scale and in terms of how they affect the individual. They also seem to follow trajectories and may move to higher levels of risk. All may be triggered by life events (or an individual’s anticipation of an adverse life event) that produces emotional discomfort or even the recurrence of psychiatric symptoms. Continue reading

Do 90% of Suicide Victims Really Have Serious Mental Illness? (Part 1)

By Tony Salvatore, MA

Anyone who turns to the print or electronic sources for insight on the topic of suicide and mental illness will encounter this statement in some form: Ninety percent of suicide victims had a psychiatric disorder.(1)  The implication of this contention is almost causal in nature, and it has taken on the trappings of a veritable “truth” of suicide prevention that is rarely questioned.  Mental illness has been shown to be a factor in suicide, but “the relative importance of mental disorders compared to social strains is not fully clear.”(2)

Here we will look into the origins of this assertion and consider some issues with its underlying methodology.  In Part 2, we will look at some actual data on the incidence of mental illness in suicide victims, examine mental illness and suicide from the perspective of current theories of suicide, and show mental illness in its proper role as a suicide risk factor. Continue reading

Do 90% of Suicide Victims Really have Serious Mental Illness? (Part 2)

By Tony Salvatore, MA

In our previous blog, we looked at the use of the psychological autopsy method in suicide research and questioned this approach and its results.  Here we will consider some “hard” data on the incidence of psychiatric diagnoses in suicide victims at the time of death, look at how the role mental illness plays in two current theories of suicide, and argue that mental illness is a serious suicide risk factor but not necessarily the key independent variable in the onset of suicidality in at-risk persons.

Some Countervailing Data

The Centers for Disease Control and Prevention’s National Violent Death Reporting System (NVDRS), has collected data on suicide from death certificates and other sources from sixteen states.[1]  In 2008, of 9276 suicides, approximately 45.4% had a diagnosed mental illness at death.  The NVDRS has found that “mental health problems were the most common circumstances among suicide decedents” in the US.  However, the incidence in a very large population of victims is half that reported by psychological autopsy studies.  Continue reading

Image

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