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VISN 19 Mental Illness Research & Education Clinical Center (MIRECC)

VISN 19 Mental Illness Research & Education Clinical Center (MIRECC). Self-Directed Violence Classification System Training Katie Bellon , Ph.D. Lisa A. Brenner, Ph.D. Lisa Betthauser , MBA

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VISN 19 Mental Illness Research & Education Clinical Center (MIRECC)

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  1. VISN 19 Mental Illness Research & Education Clinical Center (MIRECC) Self-Directed Violence Classification System Training Katie Bellon, Ph.D. Lisa A. Brenner, Ph.D. Lisa Betthauser, MBA Ryan E. Breshears, Ph.D. Elizabeth Holman, Psy.D. Herbert. T. Nagamoto, MD Morton M. Silverman, MD Developed in collaboration with the Centers for Disease Control and Prevention Version - May 24, 2010

  2. Self-Directed ViolenceClassification System Training Objective: to learn and exhibit proficiency in the acquisition and use of a new suicide nomenclature • Training Overview • Review of the language of suicidology • Rationale for a self-directed violence classification system • Implementation of a new classification system

  3. Case Example 1 A healthy 21-year-old female is brought by her boyfriend to the Emergency Department after telling him she ingested 4-6 regular strength acetaminophen [Tylenol] capsules (1300-1950 mg total dose). She reports no ill effects. During triage, she states that before she took the capsules, she was upset and wished she was dead. She feels better now and requests to go home.

  4. Suicidal ideation Death wish Suicidal threat Cry for help Self-mutilation Parasuicidal gesture Suicidal gesture Risk-taking behavior Self-harm Self-injury Suicide attempt Aborted suicide attempt Accidental death Unintentional suicide Successful attempt Completed suicide Life-threatening behavior Suicide-related behavior Suicide The Language of Self-Directed ViolenceIdentification of the Problem

  5. The Language of Suicidology Implications of the Problem • Clinical • Research • Public Health (Rudd, 2000)

  6. The Language of Self-Directed ViolenceA Solution to the Problem Nomenclature (def.): • a set of commonly understood • widely acceptable • comprehensive • terms that define the basic clinical phenomena (of suicide and suicide-related behaviors) • based on a logical set of necessary component elements that can be easily applied (Silverman, 2006)

  7. Nomenclature Essential Features • enhance clarity of communication • have applicability across clinical settings • be theory neutral • be culturally neutral • use mutually exclusive terms that encompass the spectrum of thoughts and actions (Silverman, 2006) Peter Brueghel the Elder, 1563

  8. Classification System Essential Features • “exhaustive” • Builds upon a nomenclature • Further differentiates between like phenomena (Silverman, 2006)

  9. When both Thoughts and Behaviors are present Behaviors Trump Thoughts for purposes of classification

  10. When both are present, Self-Directed Violent Behaviors trump Preparatory for purposes of classification

  11. Key ConceptSuicidal Intent The individual … COMPONENT 1 wishes to die COMPONENT 2 means to kill him/herself COMPONENT 3 understands the probable consequences (i.e. death)

  12. Key ConceptPreparatory Behavior 4:00 p.m. 5:00 p.m. 6:00 p.m. 8:00 p.m. an SDV Behavior occurs preparatory behaviors

  13. Key ConceptPreparatory Behavior 4:00 p.m. 6:00 p.m. 8:00 p.m. Purchases ammunition for a handgun Contacts attorney Confronted by son

  14. References Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. [Online]. (2008). Available: http://www.cdc.gov/ncipc/wisqars/nonfatal/definitions.htm#nonfatal injuryreports. De Leo, D. Burgis, S., Bertolote, J.M., Kerkhof, A.J.F.M., & Bille-Brahe, U. (2006). Definitions of suicidal behavior: Lessons learned from the WHO/EURO Multicentre Study. Crisis,27(1), 4-15. Rudd, M.D. (2000). Integrating science into the practice of clinical suicidology: A review of the psychotherapy literature and a research agenda for the future. In R.W. Maris, S.S. Canetto, J.L. McIntosh, & M.M. Silverman (Eds.). Review of suicidology 2000 (pp. 49-83). New York: Guilford. Silverman, M.M. (2006). The language of suicidology. Suicide and Life-Threatening Behavior, 36, 519-532. Silverman, M.M., Berman, A.L., Sanddal, N.D., O’Carroll, P.M., & Joiner, T.E. (2007). Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part I: Background, rationale, and methodology. Suicide and Life-Threatening Behaviors, 37, 264-277.

  15. Thank You Lisa .Brenner@va.gov

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