Psychiatry & Suicide Prevention:
A 30-year Failed Experiment

Maria Bradshaw
17
100

In 2008, Professor Roger Mulder, head of psychiatry at Otago University published research in which he concluded “Antidepressant treatment is associated with a rapid and significant reduction in suicidal behaviours. The rate of emergent suicidal behaviour was low and the risk/benefit ratio for antidepressants appears to favour their use.”[1]

10 years before he had stated that “the development of improved [psychiatric] treatment and management strategies for young people with psychiatric morbidity may be a very effective approach to reducing youthful suicidal behaviors.[2]

Last week, he presented at two conferences to mark world suicide prevention day and, after having conducted a thorough review of the current evidence stated that psychiatry’s medical model of suicide prevention was “a 20- or 30-year experiment which hasn’t worked.”

It takes courage and integrity to make changes to your beliefs and approach when a review of current evidence points to the need to take a different tack and to make your changed views public. Medical professionals who do this are often accused of attacking their own profession, criticizing or undermining their colleagues and being fickle. In reality they are staying true to the values of reflective practice, patient-centred care and evidence-based medicine. The reality of challenging the medical approach to suicide prevention from within the profession of psychiatry is that those who stick their heads above the parapet, following the pioneering steps of heroic people like Professor David Healy, often face many negative consequences. In a small country like New Zealand, Professor Mulder exposes himself to ostracism from his colleagues.

In his conference presentations, he stated that a medical/psychiatric paradigm has dominated approaches to suicide since WWII, targeting high risk groups with psychological/pharmacological interventions and that this paradigm has largely failed to influence suicide rates. In Professor Mulder’s view “New approaches are required – possibly public health, sociological, community or combinations in addition to, or instead of, medical approaches.”

Given the Director of Mental Health reports the rate of suicide by those who have used mental health services within the previous year is 18 times higher than that of those who have not used services in the year prior to their death, CASPER would argue that rather than failing to influence suicide rates, the evidence is that mental health treatment has in likelihood increased them. In fact, 137.6 suicides per 100,000 for those who have used mental health services in the last 12 months compared to 7.6 per 100,000 for those who have not had recent mental health involvement.

Professor Mulder presented the evidence that traditional psychiatric models of suicide prediction and prevention are not working, psychiatrists are acting in their own rather than their patients’ best interests, that the risks of antidepressants outweigh any benefits and that very few psychiatric interventions have been shown to reduce the incidence of suicide.”

In relation to suicide risk assessment, Professor Mulder told the conference participants that psychiatrists are very poor at predicting suicide risk. He described current suicide risk assessment as “an organisational attempt to tame clinician anxiety rather than improve patient care” and admitted that “patients may be detained to reduce staff anxiety rather than for their treatment needs.” with patients seen as a source of threat to a clinicians professional standing. Professor Mulder confessed he had engaged in this behavior himself.

His recommendations to psychiatrists were to

–  Be humble.

–  Acknowledge the uncertainty of our knowledge base.

–  Re-educate the community that we are poor at predicting rare events like suicide.

–  Educate health workers about the risks of risk assessment.

–  Accept that mental illness models are neither necessary nor sufficient to explain suicide

In addition to being someone willing to honestly assess the lack of efficacy of the psychiatric approach to suicide prevention and courageous enough to tell it like it is, Professor Mulder is the Chair of CASPER’s Scientific Advisory Committee. For those not familiar with CASPER, it is the charity I started following my son’s antidepressant induced suicide and an organization that rejects the medical model of suicide in favour of a sociological model. The advisory committee chaired by Professor Mulder provides independent advice to CASPER supporting us with expert advice on research associated with suicide prevention and on our own research programme.

Professor Mulder’s committee will take the same approach with CASPER as it has with mental health professionals providing an honest evaluation of the evidence that underpins our programmes and helping us conduct rigorous evaluations of our interventions. It is critically important to us that our approaches and actions are rigorously challenged and underpinned by the very best evidence, that we prevent deaths; not just count education sessions.

We thank Professor Mulder for his courage and integrity and for taking on the role of leading a team of professionals in providing expert advice to CASPER. We look forward to having our beliefs and approaches challenged and to being kept honest and effective so that we provide the best possible interventions, information and advice.


[1]Mulder RT, Joyce PR, Frampton CMA, Luty SE. Antidepressant treatment is associated with a reduction in suicidal ideation and suicide attempts Acta Psychiatr Scand 2008: 118: 116–122

[2]ANNETTE L. BEAUTRAIS, PETER R. JOYCE, ROGER T. MULDER, Psychiatric Contacts Among Youths Aged 13 Through 24 Years Who Have Made Serious Suicide Attempts, Journal of the American Academy of Child & Adolescent Psychiatry, Volume 37, Issue 5, May 1998, Pages 504-510

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17 COMMENTS

  1. It’s quite something when someone so pro-medication looks at the facts and figures and realises they were wrong. Props to Roger Mulder for not only re-evaluating his stance but for actually speaking out about it.

    Well done to you too Maria for getting Mulder on board at Casper.

    You truly are a force to be reckoned with.

    I salute you.

  2. Wonderful. Now we need another KOL to use his/her scientific training and take a look at the mass shootings caused by people on psychotropic drugs. From the news this morning, it seems we just had another of those in the US. It is very tragic that greed is causing so many avoidable deaths.

  3. Marian,

    Thank you for this post, and all you’re doing to improve the system.

    I’m all for education and training, but sometimes I wonder how much of this can be “taught.” I wonder how many people just need to have a person with a caring heart who will listen.

    At the risk of making this subject too simplistic, I think listening – without judgement; with empathy and concern; with the best of our humanity may be the missing link in suicide prevention.

    “The first duty of love is to listen.” – Paul Tillich

    Duane

      • Oh, thank you.

        I’ve lost my father by suicide. I miss him. He was in hospital psychiatry four times. He took psychopharmacons. It didn’t help. Or did it even worse his soulpain?

        Taking someone to hospital psychiatry can promote his urge to die. Doing nothing is also dangerous.

        I think the only way is to stay with the loved one around the clock. But because of the conditions of employment and work this is hardly possible for many people. We need sick certificates for people who want to care about a relative or a good friend.

    • Hi Duane, I was looking over this(I read it over a week ago) and noticed this.
      What many studies show is that advanced training, higher education is of no value. You’re not familiar with this. Robyn Dawes makes argument for evidence-based treatment and goes over the data in House of Cards–as I recall it was published in late 1990s. These studies overestimate the relative advantage of psychologists and psychiatrists because the subjects are not those against whom professionals are most biased–“psychotics.” The classic study compared depressed college students who went to professionals with years of experience to control who went to English professors posing as professionals. Both groups improved –but to the same extent. Thus the entire training/higher education process is a waste of time. As stated these studies were done quite awhile ago and thus did not involve use of drugs–inconceivable today. So at its best therapy is merely purchase of friendship.
      Seth Farber, Ph.D.
      http://www.sethHfarber.com

  4. Maria,
    We both belong to that club that no one would ever imagine they find themselves in- mothers whose teens, or adult ” children ” have taken their precious lives. My son (who was just 25) at his death like what I’ve read about your son, loved life, lived it to its fullest, had an abundance of friends, four of his closest friends insist my son was their “best” friend. How is that possible? Because my son gave that much of himself when he took that responsibility as a ” best” friend close to heart. Sadly, a ” sea of stressors” almost overnight led to the first of two breakdowns ( nervous breakdown is still the best way I can describe it since my husband and I were with him both times) but the mental “death” industry rushed to dx, judge, brainwash, massively drug despite his tox screen was + for a psychoactive ingredient, cannabis, that can and is altering some young brains for anxiety, depression and sadly, in my son’s case- psychosis. Only after recently obtaining my son’s medical file which has been the toughest review of my life, I believe beyond a shadow of a doubt my son’s barbaric treatment inside a locked unit contributed to his eventual suicide. My son was forcibly held down multiple times each day given countless neuroleptics, benzodiazepines, and antidepressants ( antidepressants -never had he taken in his life) which IMO was like throwing kerosine onto a young brain that was already under assault from the lipophilic compound of THC which is one of the few drugs that cross the blood-brain barrier.
    Deapite entering the drug rehab/psych hospital with NO self-harm, NO suicidal or NO homicidal thinking ( per his Adm Eval) which coincides wirh every person closest to him who knew my son always said he could never harm himself because of the horror he saw his wife’s family endure ( his eventual wife’s father had taken his life the yr before they started dating) but the mix of such toxic psychotropics, being warehoused, drugged so severely he developed EPS sxs in a matter of days while locked up against his will, violating any representation for being held against his will for 11 days, all the while we, his parents, were blatantly lied to night after night. Then this mental ” death” system “dumped” him once his PPO ins refused further authorization. Did our son get the drug educ rehab we were guaranteed as long as he passed the Adm test? Never, and the $7500/ wk we paid believing the hospital lies was for nothing, just provided more revenue for this greedy, money hungry hospital chain. This is the unscrupulous, tainted MH industry in America.

    Bless you for starting the CASPER foundation in your beloved son’s memory. I hope eventually I will find some way to honor my son in the hope what happened to him, and the horror our family lives with knowing the very system we trusted to help our son (IMO actually was the biggest factor which ultimately took his life), can be stopped. Indeed, why isn’t there more action to reject the failed medical treatment for MH issues?

  5. The experiment continues, under Sir Peter Gluckman [Geneticist], Chief Science Advisor to The Prime Minister.

    “Prime Minister’s Youth Mental Health Project (2012): These programmes represented a milestone in social science and policy interaction. It was acknowledged from the outset, both by the contributing researchers and policy advisors, that it was not known which of the 22 programmes in the initiative would in fact be effective. This was simply because of the general lack of understanding of many of the factors associated with modern adolescent morbidity. Such acknowledgement by the political process is in itself refreshing, but importantly the launch coincided with the allocation of funding specifically for on-going programme evaluation.”

  6. I’m finding a logical flaw in the sixth paragraph. You’re suggesting that the higher suicide among users of mental health services is caused by the usage of mental health services, but suicidality is often the reason treatment is sought in the first place. By that logic, thousands of Stage IV cancer patients are killed by chemotherapy every year, and diabetic neuropathy is caused by insulin. It’s great that mental health professionals are admitting the limits of their knowledge and considering alternate approaches to mental health, but that does not mean that their current approaches are completely invalidated.

  7. Fair enough. I was perhaps extrapolating from my (very) personal experience that such is the case, so can provide no hard numbers. It does stand to reason, however that, given a random sampling of people who feel their emotional issues are severe enough to seek mental health treatment and a random sample of people who are not seeking mental health treatment, that you are likely to find a higher incidence of ALL signs of mental illness, including suicidal ideation and intention, in the sample that is seeking mental health services. I would also point out that in my (very) personal experience, it is entirely possible to be suicidal without the people closest to the suicidal person knowing, and it is possible to be too depressed to do anything about it. I would hypothesize that such may be the case with at least some people who commit suicide shortly after beginning a medication regimine, but of course research would be required to test said hypothesis.

  8. Anna,
    I agree that David Healy has made a major contribution–I think
    Pharmageddon is his best book and one of the breakthrough books on the topic…I know from his work on SSRIs that he underwent a transformation. He has also to his credit associated himself with the reform movement. HOWEVER one cannot just push under the rug the fact that he profits from giving electroshock in his clinic in Wales. He makes no bones about that–he co-authored a book with Max Fink defending electroshock, which I have not read. I am friendly with 2 of the well known shock survivors: Leonard Frank and Linda Andre. Linda is author of Doctors of Deception.
    Seth Farber, PhD.