Suicidal Behavior - Richard McKeon - ebook

Suicidal Behavior ebook

Richard McKeon

97,99 zł


Almost one million people die worldwide by suicide each year, making it one of the leading causes of death throughout the lifespan. Suicide attempts outnumber deaths by suicide by a ratio of at least 25:1, those who attempt suicide are at high risk of later death by suicide, and suicide risk is one of the most frequent reasons for admissions to inpatient psychiatric units. Treatment of those at risk for suicide is thus a pressing priority. Research over the past two decades has led to the development of excellent empirically supported treatment methods. This book aims to increase clinicians' access to empirically supported interventions for Suicidal Behavior, with the hope that these methods will become the standard in clinical practice.

Ebooka przeczytasz w aplikacjach Legimi lub dowolnej aplikacji obsługującej format:


Liczba stron: 242

Suicidal Behavior

About the Authors

Richard McKeon PhD, MPH received his doctorate in Clinical Psychology from the University of Arizona, and a Master’s of Public Health in Health Administration from Columbia University. He has spent most of his career working in community mental health, including 11 years as director of a psychiatric emergency service and four years as Associate Administrator/Clinical Director of a hospital based community mental health center in Newton, New Jersey. He established the first evidenced based treatment program for chronically suicidal borderline patients in the state of New Jersey utilizing Marsha Linehan’s Dialectical Behavior Therapy. In 2001, he was awarded an American Psychological Association Congressional Fellowship and worked for United States Senator Paul Wellstone, covering health and mental health policy issues. He spent five years on the Board of the American Association of Suicidology as Clinical Division Director and has also served on the Board of the Division of Clinical Psychology of the American Pychological Association. He is currently a public health advisor on suicide prevention for the Substance Abuse and Mental Health Services Administration where he coordinates suicide prevention activities. He also serves as Co-Chair of the Federal Working Group on Suicide Prevention.

Advances in Psychotherapy – Evidence-Based Practice

Danny Wedding; PhD, MPH, Prof., St. Louis, MO

(Series Editor)

Larry Beutler; PhD, Prof., Palo Alto, CA

Kenneth E. Freedland; PhD, Prof., St. Louis, MO

Linda C. Sobell; PhD, ABPP, Prof., Ft. Lauderdale, FL

David A. Wolfe; PhD, Prof., Toronto

(Associate Editors)

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a “reader-friendly” manner. Each book in the series is both a compact “how-to-do” reference on a particular disorder for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education.

The most important feature of the books is that they are practical and “reader-friendly:” All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls”, marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Suicidal Behavior

Richard T. McKeon

Former Clinical Division Director, American Association of Suicidology

Library of Congress Cataloging in Publication

is available via the Library of Congress Marc Database under the

LC Control Number 2008939655

Library and Archives Canada Cataloguing in Publication

McKeon, Richard T

Suicidal behavior / Richard McKeon.

(Advances in psychotherapy--evidence-based practice)

Includes bibliographical references.

ISBN 978-0-88937-327-3

1. Suicidal behavior--Prevention. 2. Suicidal behavior--Treatment.

I. Title. II. Series.

RC569.M41 2008



© 2009 by Hogrefe & Huber Publishers



Hogrefe & Huber Publishers, 875 Massachusetts Avenue, 7th Floor,Cambridge, MA 02139Phone (866) 823-4726, Fax (617) 354-6875; E-mail [email protected]


Hogrefe & Huber Publishers, Rohnsweg 25, 37085 Göttingen, GermanyPhone +49 551 49609-0, Fax +49 551 49609-88, E-mail [email protected]



Hogrefe & Huber Publishers, Customer Services Department,30 Amberwood Parkway, Ashland, OH 44805Phone (800) 228-3749, Fax (419) 281-6883, E-mail [email protected]


Hogrefe & Huber Publishers, Rohnsweg 25, 37085 Göttingen, GermanyPhone +49 551 49609-0, Fax +49 551 49609-88, E-mail [email protected]



Hogrefe & Huber Publishers, 1543 Bayview Avenue, Toronto, Ontario M4G 3B5


Hogrefe & Huber Publishers, Länggass-Strasse 76, CH-3000 Bern 9

Hogrefe & Huber Publishers

Incorporated and registered in the State of Washington, USA, and in Göttingen, Lower Saxony, Germany

No part of this book may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written permission from the publisher.

Format: EPUB

ISBN 978-1-61334-327-2


I would like to acknowledge all those who have made this book possible, including the publisher, Hogrefe and Huber, and especially Robert Dimbleby for his patience and support. I would also like to thank series editor Danny Wedding for supporting the inclusion of a book on suicidal behavior in the series Advances in Psychotherapy: Evidence Based Practice. His guidance during the development of this manuscript was invaluable.

It is of particular importance for me to express my gratitude to all those who have shared their stories, their pain, and their hopes with me over the years, including all those I have worked with in community mental health. All that I know I learned from them. To all the colleagues I have worked with to prevent suicide, whether we have worked together in emergency rooms, or on conference calls, in therapy groups or in symposiums, thank you for sustaining me in our shared vision of reducing the tragic loss of lives to suicide. I must also acknowledge all those I have met who have survived the loss of a loved one to suicide, but who have utilized their grief to insist we must do better, and in so doing have transformed a nation.

Finally, this book would not have been possible without the support of my family. I would like to thank my wife, Liz, for her advice, love, editing and encouragement, my sister, Kathy, for her assistance, my mother, Ruth, for her continued interest and support, and my daughters Britt and Shauna, who are my sources of hope for the future.


All opinions expressed in this book are those of the author alone and do not represent the views of the Substance Abuse and Mental Health Services Administration.


This book is dedicated to the memory of United States Senator Paul David Wellstone. Paul was a passionate champion for suicide prevention, and a transforming influence on all those who knew him.

Table of Contents




1         Description

1.1      Terminology

1.2      Definition

1.3      Differential Diagnosis

1.4      Epidemiology

1.5      Course and Prognosis

1.6      Comorbidities

1.7      Assessment Procedures

2         Theories and Models of Suicidal Behavior

2.1      Neuropsychiatric Theories

2.2      Psychological Theories

3        Risk Assessment and Treatment Planning

3.1      Assessing Suicide Risk and Protective Factors

3.2      Estimating Suicide Risk Level

3.3      Resolving Contradictory Risk Factors

3.4      Understanding the Time Dimension of Suicide Risk

3.5      Documenting Suicidal Risk

4        Treatment

4.1      Methods of Treatment

4.1.1   Multiphase Models

4.1.2   Orientation and Engagement

4.2      Crisis Intervention and the Management of Acute Risk

4.2.1   Assuring Telephone Accessibility After Hours

4.2.2   Suicide Prevention Hotlines

4.2.3   Emergency Appointment Capability

4.2.4   Use of the Emergency Department

4.2.5   Psychiatric Emergency Services

4.2.6   Involuntary Hospitalization and the Use of the Police

4.2.7   Use of Mobile Outreach Services

4.3      Safety Planning

4.3.1   Involving Family and Friends

4.3.2   Means Restriction

4.3.3   Safety Planning Versus No-Suicide Contracts

4.4      Treatment Techniques

4.4.1   Skills Training

4.4.2   Self Monitoring/Homework Assignments

4.4.3   Cognitive Interventions

4.4.4   Exposure Treatment

4.4.5   Reducing Perceived Burdensomeness

4.4.6   Failed Belongingness

4.4.7   Bibliotherapy

4.4.8   Outreach and Follow-up

4.4.9   Postvention

4.5      Mechanisms of Action

4.6      Efficacy and Prognosis

4.7      Variations and Combinations of Methods

4.7.1   Medication and Psychotherapy

4.7.2   Working With Families

4.7.3   Treatment of Adolescents

4.7.4   Individual and Group Treatment

4.8      Problems in Carrying Out the Treatments

4.8.1   Problems in Communication and Information Gathering

4.8.2   Problems in Continuity of Care

4.8.3   Problems in Initial Risk Assessment

4.8.4   Problems in Collaboration

4.9      Multicultural Issues

5        Case Vignette

6        Case Example

7        Further Reading

8        References

9        Appendices: Tools and Resources



Worldwide, about a million people per year die by suicide, more than are lost to homicide or war

Suicide is a tragic end to an individual’s life, a devastating loss to families and friends, a diminishment of our communities, and a public health crisis for our nation. For clinicians, losing a patient to suicide is probably our worst fear. In 2005, over 32,000 Americans died by suicide (Centers for Disease Control, 2008a). Worldwide, an estimated one million people die by suicide each year, more than are lost to homicide or to war (World Health Organization, 2000). Self-inflicted injury is estimated to account for 1.4% of the total burden of disease worldwide (World Federation for Mental Health, 2006). Yet, despite the magnitude of these losses, or perhaps because of the depth of our distress and uncertainty when confronted with acts of deliberate self-destruction, we have tended as a society to look away and not grapple with the issue of suicidal behavior, despite the tragic toll it exacts.

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!