Suicide & Candy Corn: The Utility and Challenges of Risk Assessments

Sera Davidow
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3270

Suicide risk assessments don’t work. I mean, they work in some ways. They’re good at engendering fear, causing and/or resurfacing trauma, and throwing the assessor and person being assessed into an unspoken game of “What do I say to get to where I want to go?” But as far as actually predicting suicide? They just aren’t effective. No, I don’t say that because I hold “radical fringe perspectives,” or any other way in which someone may frame my words in an attempt to discredit them. Nope, that suicide risk assessments don’t work well to identify who is truly going to act on suicidal thoughts or words is a pretty widely known fact, at least among researchers. Don’t believe me? Well check out what this guy (Joseph Franklin) has to say:

“Our analyses showed that science could only predict future suicidal thoughts and behaviors Joseph Franklin on Suicide Riskabout as well as random guessing. In other words, a suicide expert who conducted an in-depth assessment of risk factors would predict a patient’s future suicidal thoughts and behaviors with the same degree of accuracy as someone with no knowledge of the patient who predicted based on a coin flip. This was extremely humbling—after decades of research, science had produced no meaningful advances in suicide prediction.”

I mean, if the white, conventionally attractive Harvard man says it’s so, then it’s no longer “radical,” right? Of course, Franklin immediately followed that statement up with this nonsense, soooo….

“The findings do not necessarily mean that widely used risk guidelines are invalid or useless, or that therapists should abandon them. As most of these guidelines were produced by expert consensus, there is reason to believe that they may be useful and effective. We recommend that these guidelines remain in use but emphasize that there is an urgent need to evaluate these guidelines within longitudinal studies.”

Ah, privilege and power. How closely they are linked. In any case, risk assessments fail us in many regards. Not only are they no better than a coin flip overall, but they’ve seen no improvement in accuracy outcomes in over 40 years. Then there’s the small matter that suicide risk assessments are often used to measure whether or not someone should be held in a psychiatric facility, but holding people in psychiatric facilities (particularly where coercion or force are involved) raises the risk of suicide, all potentially without ever even finding out why someone wanted to die. Great.

If not for the reminder of how power and privilege rules all (courtesy Harvard guy), it’d be a real mystery as to how suicide risk assessment continues to be considered a best practice. Tools that are no better than coin flips aren’t really tools at all. And yet, when presenting on this information in public forums it is not at all unusual that someone (usually a provider of some sort) raises their hand and says, “But what about the other 50% that suicide risk assessment saves?”

There are many things wrong with that question, not the least of which is the idea that stopping someone from killing themselves in the moment constitutes their having been “saved.” In fact, it reminds me of the opening quote I used in “Suicidal Tendencies, Part III: So, When Do I Get to Call the Cops?”:

“What if the key to saving someone is to admit you are powerless to save anyone at all?”

Savior complexes aside, there’s another issue, and I’ve had a really hard time parsing out how to respond to it. Until now. Research and people’s stories do suggest that some people –at least retrospectively–have felt helped by suicide risk assessments at least in regard to how they’ve served as precursors to other forms of support. The problem is that the two sides aren’t equal. In other words, it’s not as simple as that some people are helped, and some people are not helped by suicide risk assessment. Rather, it’s that some people are helped, and others are harmed. A lot of people, in fact. Enter candy corn.

candy cornIn order to best illustrate this point, let’s pretend we have a pile of candy corn. As it turns out, research suggests that around 50% of the population likes candy corn. (Reminder: Suicide risk assessment has been found to be about 50% accurateat best at predicting actual suicide risk. Just ask Harvard guy.) Now, if I give a room full of people candy corn, assuming they more or less follow the statistical prediction, about half of them will like that candy corn, and the other half will be disappointed. However, 0% of them will be harmed (unless the candy corn was poisoned, I suppose). At worst, they’ll throw it away, or stuff it in a pocket to bring home to their kids before moving on entirely. (When I first started testing out this way of explaining the matter, I used chocolate bars… but too many people like those!)

On the other hand, unlike with candy corn, if we take 100 people in distress and give them suicide risk assessments, a significant portion of people who aren’t helped will be actively harmed. How? Here are but a handful of examples:

  • They may feel forced to lie for fear of what comes next.
  • They may lose trust in the person assessing them (who, in some cases, may have been the only person they have to talk to about any of this at all).
  • They may end up losing their liberty as a result of the risk assessment.
  • Their suicide risk may go up as a result of the consequences of the risk assessment.
  • They may be less likely to try and reach out for help ever again.

Given that research also tells us that 95% of those marked “high risk” based on suicide risk assessments will not die of suicide, that sure leaves us with a lot of “false positives” to potentially be harmed. But, let’s add a few other points to the mix. First, it’s worth noting that it’s unclear what the 50% rate of efficacy even means when it comes to suicide risk assessment. We speak of it often as a way to discredit risk assessments as standard practice, but rarely do we dig deeper into what “effective’ actually means. For example, does the research count among its successes the ongoing incarceration of a woman I recall my nurse friend talking about who attempted to kill herself by jumping in front of a train, and who has now spent about a decade wandering the halls of a state psychiatric facility… still wanting to die? Yes, what is counted as a positive outcome or success in research is a longstanding issue most often defined by those in power (i.e. rarely those most directly affected), and not often rooted in “help” that truly helps. For the most part, I think the “success’ in this case refers almost entirely to the simple ability to predict, whether or not someone goes on to live or die, and that’s not much of a success at all.

Finally, perhaps the most important point is that we do have other choices. Ones that are more like that candy corn, that may not work for everyone but don’t cause harm. Instead of tromping down the path of “do you have a plan,” or some of the traumatizing nonsense found in the much-lauded Columbia Suicide Severity Rating Scale, we can instead focus on validation, genuine curiosity, sharing of ourselves, and finding new ways to form connections that might help tether someone to this world. That won’t prevent all suicide, but death by one’s own hand has existed since the beginning of time. However, in a world where we’re always going to lose some people, we would do best to actually evaluate where the biggest losses are likely to fall, and precisely what happens to those who stick around. Otherwise, we actually become complicit in people’s deaths over the long term for the sake of making sure they stay alive right now.

Suicide risk assessments don’t work, and they can be harmful. They aren’t anything like candy corn, even if they merit the statistical comparison. Thus, we need to stop talking about that 50% figure as if it represents anything so neutral as preference in sweets. As we watch suicide rates climb, we need to remember that real lives are on the line. Continuing to center risk assessments simply because Harvard guy and a host of other people in power are caught with each other in a loop of mutual appreciation and denial of the facts that even they profess is never how best practices should be defined. When left with a choice between suicide risk assessment and candy corn, I’ll choose the corn every time.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

66 COMMENTS

  1. Candy Corn & Harvard Guy

    “Ah, privilege and power. How closely they are linked. In any case, risk assessments fail us in many regards. Not only are they no better than a coin flip overall, but they’ve seen no improvement in accuracy outcomes in over 40 years.”

    Yes!

    Thank you for summing up the undercurrents in the comments section!! That is, summing up the conversations, “longitudinally!” See? We can speak Harvard guy ‘round here too!

    The research that tries to tabulate possible harm to oneself or another goes into aggregate data (in many cases unknowingly) for software development. It’s called predictive programming.

    Pre-crime software.

    This software is highly coveted, makes big bucks & returns for its “investors” & is sold to police departments, intelligence communities, & their respective Department of Justice cronies….

    $$$$$$

    You said, “Tools that are no better than coin flips aren’t really tools at all.”

    What this software bundling DOES NOT tabulate (because it makes no $$$$$$$$$$)

    Is that someone who is more likely to harm oneself or another, is also LESS LIKELY TO DO SO!!!!!!

    You said, “However, in a world where we’re always going to lose some people, we would do best to actually evaluate where the biggest losses are likely to fall, and precisely what happens to those who stick around.”

    The hardest battles. The most obstacles.

    The house of superlative HARDESTS & MOSTESTS are also less likely to do harm in this world!!!! The software cannot tabulate & never WILL be able to tabulate: free-will choice, human dignity, compassion, community, nor self-mastery.

    EVEN SICKER! If you have been flagged for “pre-crime,” enormous pressure is put on you to harm yourself or another to complete the closed confirmation bias loop.

    If you hurt yourself or another, then the software is ACCURATE, THE RETURN ON THE INVESTMENT IS SEALED! Because we cannot disappoint our investors. . .

    And one last word about “SCIENCE.”

    Harvard guy said:
    “science had produced no meaningful advances in suicide prediction.”

    Has anyone heard some of these choicers?

    “Science says.” “Science teaches us.” “Science doesn’t care what you believe.”

    SCIENCE IS NOT A CONSCIOUS ENTITY, HARVARD GUY!!!!!!!!!!!!!!!

    Merry Solstice & Solar Eclipse, Sera!

    Thank you for summing up all of my frustrations, concerns, & rage that the bundled software COULD NOT and NEVER WILL be able to do.

  2. I wonder if the Harvard geniuses looked at the Hoffer/Osmond Diagnostic (the HOD test). Probably not, as Hoffer and Osmond were the evil geniuses of psychiatry back in their salad days, using niacin and vitamin C as the basis for treating the dysperceptive.
    I have a copy of this test, which has a subsection where the authors state the tester should inquire about suicidal thoughts in the individual being tested. A couple of years ago, I went through the dozens of protocols I had (100 plus?) and found all of five “suicide HOD’s”. Every one of the five had attempted suicide (I knew most of the testees’ histories).
    But then those guys were the accursed Black Princes of psychiatry, abhorred by respectable shrinks, who wished they’d go away because “everyone knew” that vitamins had no role in the treatment of “schizophrenia syndrome”. That they’d both used hallucinogenic drugs before they became “respectable” confirmed the psychiatric beliefs of the day.

  3. I’ve had the experience of accompanying many people to such assessments. Those who haven’t gone through this ordeal probably have fantasies about a wise and understanding therapist carefully listening to every word about why you are in such distress and responding with empathy about common human emotions. Maybe they see a motherly or fatherly image handing you a tissue or giving you a comforting pat on the back and validating you’re feelings of despair and hopelessness in a stressful and complicated world. The unknowing public also might imagine that the therapist would help you immediately connect to a support network of caring family and friends and a safe comfortable space to chill out.

    But, it’s usually nothing like that. I’ve found it to be more like undergoing a lie detector test which also are not accurate. But, they’re searching for magic suicidal words showing a “plan”, “means”, “how soon” and “have you attempted before“?

    This stranger with credentials and keys who often remains emotionally neutral can keep asking you question after personal intrusive question with little empathy until you hit the jackpot to “get helped” by answering them correctly or not (which as you say accurately predicts nothing). And for many this ordeal happens after being handcuffed and transported by the police to an unpleasant office where the police wait somewhere nearby to complete your confinement in a locked facility “when necessary“.

    If you happen to not answer the questions in ways to get yourself locked up, you are left alone to receive no therapy or compassion or resources at all and may have no way to get home. Your consolation prize might be a referral with a long waiting list which you may or may not want or be eligible for to meet your needs.

    No wonder we have more people dying from suicide than homicide each year.

    • I so agree. I think a “Miranda”-type warning should be given to anyone undergoing such an “assessment.” “You have the right not to say anything or answer my questions. Anything you say can be used against you to lock you in a psychiatric ward against your will. You have the right to have an attorney present during this ‘assessment.'”

      • “You have the right to have an attorney present during this ‘assessment.’””

        Is this true in the US?

        I consider my situation where I specifically asked to be allowed to speak to a lawyer and was denied that right. Of course had I been provided with that right, then they would have had to tell them that I had been ‘spiked’ with benzos to assist in torturing me, because they knew I would under no circumstances speak to a filthy ‘verballing’ public officer, hence the need to torture.

        I had been detained by police because of the knife and cannabis that had been planted on me after I collapsed (s. 68 [e] Criminal Code) but police did nothing more than jump me in my bed and before even speaking to me made referral under s. 195 of the Mental Health Act (Police Powers) to the waiting Community Nurse. How did they form the suspicion on reasonable grounds that a man asleep in his bed was suffering from a mental illness (other than hearsay which is not considered “reasonable”)?

        My legal status was thus I was under arrest, and was referred to mental health services for ‘assessment’, though the reality was I was being subjected to a conspiracy to stupefy and commit an indictable offence namely kidnapping. Just because police were present and being used as a tool to torture doesn’t mean it was lawful.

        However, if they were actually doing this lawfully, would I have the right to legal representation in the US? Not here, I was denied the right to speak to legal rep, and to speak to the person who they were claiming was my Doctor (to sort the matter out) The Community Nurse was fully aware that I was not by definition of the Mental Health Act a “patient” and that what he was doing was criminal. This matters nought to people who are using the Emergency dept as their own personal slaughterhouse though.

        And of course what we find in that the people at the Mental Health Law Centre are prepared to accept fraudulent documents from the hospital to conceal the use of known torture methods, and are not actually acting in their clients best interests. Their funding would be at risk if they didn’t assist in the concealment of the use of torture. And they would be fully aware of the need for the citizen to be a “patient” by definition before engaging in acts of what would be torture if the person did not have said status. Money well spent by the government to fund a Law Centre that is used as a tool to conceal torture. Not that they care, their on the side that wins every time, and they can then accept fraudulent documents regarding the unintended negative outcome and spread the word “nothing to see here” to anyone else who might look.

        Human rights advocates? I wrote to them and openly declared they were part of the human rights abuses they were enabling. Along with the politicians who remain silent on these known abuses. This method of enabling torture needs to be understood by victims of these people. They are not representing YOUR interests at all. And they have no respect for a rule of law, preferring to pervert the course of justice via fraud and the bearing of false witness.

        Just noticed Johns comment below. In my case the process involves the Community Nurse having police ask the question and then answering for you to make the ‘referral’ to him appear lawful. There are protections in our laws from this being done (under the crimes against a persons liberty) but they don’t have any respect for the law so ……. just abuse it and any problems fuking destroy the person complaining. Simple when you have a slaughterhouse available. Though some don’t have the stomach for what they are doing, but guess why we have a perfect human rights record and zero breaches of the Convention against the use of Torture? Even the Human Rights Commission and our Attorney General can’t say where a person makes a complaint about the use of torture. Because dead men tell no tales.

        So can mental health workers call police and ask them to snatch anyone off the street in the US? I get it that what is now being done under our new Mental Health Act are labelled ‘welfare checks’, but where is the protection from a doctor who calls police and says deliver this person who I have never met before to a hospital because I wish to treat them for an illness I will make up when I examine them?

        Or are these welfare checks simply a kidnapping service provided by police for doctors? They want someone dropped at a hospital to be unintentionally negatively outcomed and call police who suddenly without reasonable grounds have concerns for your welfare.* Reading the torture methods used by our police in the Kennedy Royal Commission and the Black Deaths in Custody i’d have concerns for the welfare of anyone who came into contact with our police.

        * without personal examination it is unlawful for a doctor to diagnose and then treat without consent. Problem being that they would need to gain access to you to do that. Calling police and expressing concerns about someones welfare if you are their doctor is one thing (though still hearsay), but when you don’t even know the person?? And of course if police have received hearsay evidence and then go and check, how many people are NOT taken into custody and ‘referred’ to the doctor who wants the person kidnapped? Still with police with no respect for the law it, and who simply do what they’re told it matters nought.

          • In Australia it isn’t. But then again it also isn’t the case that if you retain the services of a lawyer that they will represent YOUR interests. And what better way to torture people than to be able to deny them access to a lawyer who represents YOUR interests.

            In my State they will assist in identifying where the crimes occurred and then aid in the distribution of fraudulent and slanderous documents, and get you to pay for it. FACT. So I don’t know that it is of any benefit in having access to legal representation. The priest will maintain confidentiality in the confessional, but not so much the eavesdropper. Same system is at work in our legal fraternity here (see Nicola Gobbo for example)

            It does seem a very important question though to not be sure of the answer. Do you have a legal right to representation before being subjected to kidnapping and torture (disguised as medicine)? And can that representation be subjected to coercion to have them provide consent to what are called ‘treatments’ (though minus the change of status consist of acts of torture).

            I can’t even be told by my government what drugs I can be spiked with, or who has the power to do that to me. I know I can, because the Community Nurse who has no prescribing rights allowed it to be done to enable the planting of items for police but ……. who else?

            Sure brings into sharp relief what Dr Gotzsche and others are saying about the drugs causing the illness. This is obviously known about by the Community Nurse who allows ‘spikings’ and then writes down the effect as being an illness that needs treating with the drugs they spiked with.

            I would ask a lawyer about the issue of the right to representation but I can’t find one in my State that even understands the protection of a burden of proof in law. Either that or they are assisting in the gaslighting of a person who was tortured and kidnapped by the State as is now being slandered while they turn their backs and assist. I think the latter is more likely.

            Maybe someone with a knowledge of the law in the US might know if this right exists?

            And my right to access my medical records (in an ‘unedited’ form)? Sure I understand why there may be situations where I can’t have access, but even with legal protections a hospital can send fraudulent documents to lawyers when they contain proof of serious criminal offences? There is an Operational Directive ensuring the right of legal reps to access unredacted documents to ensure the protection of human rights, on signing a confidentiality agreement. The exception being where the hospital has kidnapped and tortured a citizen, then they seek instruction on how to conceal those crimes from the legal reps, and police will assist in retrieving any documents that may demonstrate the fraud. Can’t have citizens running around with documents showing they were tortured by police and mental health. What next, people knowing how they are doing ‘hot shots’ in the ED to dispose of witnesses?

            Its a tough job being in power let me say that in their defense. Tampering with evidence with impunity makes it a little easier but …. I guess the worry would be that in 40 years someone might say “this was wrong” like they did with these priests who were spreading the love of Jesus, though that euphemism seems to have been dropped for the more common term of child rapist.

      • What constitutes an assessment? By the courts as in a mental inquest warrant? Or going to see a psychologist or a psychiatrist for the first time? If there are only two people in the room, then how do the scales of justice operate? What sort of documentation accurately records the evolving perspectives between one human and another?

        • I would say any time the “professional” is considering the possibility of “hospitalization,” it becomes an assessment. If someone asks questions that lead them to decide you need to be “hospitalized,” and they haven’t warned you they were “assessing,” none of that data is useable for petitioning the court. It’s thrown out, just like an illegal search. And no one gets to “prep” the official “assessor” with any lead-ins, like “He’s my patient and I’m really worried about him,” or anything like that. Just facts, with any self-disclosures eliminated that have not been “Mirandized.” That’s my thinking.

          • “And no one gets to “prep” the official “assessor” with any lead-ins, like ……” I’ve ‘spiked’ him with benzos and planted a knife and some cannabis for police to find and provide you with a referral, and conceal the crimes your about to commit (torture and kidnapping). If you keep the ‘spiking’ between you and me you can do your ‘assessment’ while he is suffering an acute stress reaction and is spiked with benzos without his knowledge Mr Community Nurse. You now have a bright future in the use of known torture methods, and can use police to assist you in that process.

            One might think that the law would protect citizens, and on the surface they do appear to do that. However, given that acts of fraud and perjury are seen as being “noble corruption” by the state when committed by public officers in the performance of their duties, they can literally do whatever they wish and it will be concealed by the State authorities.

            Miranda rights are as easy to get around for mental health professionals as they are for police. They stamped my documents saying I had been informed of my rights which consisted of me telling the nurse to shove it where the sun don’t shine. I already knew that where filthy ‘verballing’ public officers are concerned, you have no rights. And any legitimate complaint will result ion you being ‘fuking destroyed’.

            In a State where police make comments to one another about 8 year old boys like “If the little black bastard gives you any trouble, shoot him” you think you will be treated fairly?

          • The concept I am trying to allude to though is difficult to communicate in typing as opposed to the space in which we could talk. And admittedly when one experiences the depression then the mania, to realize the shift or what gives rise to said experience requires one to self assess. If one doesn’t have the clarity to see beyond and come back to the present, then there will be some obstacles to resolve. If one is left with a “professional”, and there only two people in the room, who is more politically astute to the space for healing? There are only two pans or might there be three? Or maybe more, in the brevity of a session whereby one leaves with a prescription. I would not be hospitalized the first time, and the records show there was some consideration of that. Which I thought in recovering within the family home, the idea would be discussed. Being introduced to Lithium was a passive choice, in part pressure was being made to take the medicine. And soon, instead of the vibrancy of colors and thoughts pinging inside the brain, the thoughts would emerge with a different awareness that was concerned about weight gain, tremor and brittle hair. So, where are the scales of justice within the self? is the balance tension across the beam, the optic chiasma that connects the right and left hemisphere? Just where are the dendrons having their Congress to speak up or voting to remain silent? And how many actually understand the legal nature of their commitment process? My experience through a State Hospital would result in the pamphlet about rights though the document was not quite understood in terms of the Bill of Rights. And the trip into the Baptist Hospital seemed to be set up to operate on a hospital ward that was never designed for recovery. Or really conducive to a space where one can find the answers that would be unique to the self. The public defender assessed in a few minutes before the hearing, the ombudsman seemingly assessed, as all are reading the mind of the floor that Orval Faubus would create …. The Keys, so to speak that the patient would ask Dr. Welsing about are in part contextual to a law yet written that values the lives that matter though so often dismissed without an engaged hearing, not necessarily in a court of law. Hence, to become aware of the law working at some level to evolve for its own sake rulings in response to reconciling problems fails the customer. With or without a Miranda, the confusion seems to be a political experience of power dynamics that fails to take note of the customer.

          • Power dynamics really are the ultimate problem, which Mirandizing the potential victims does not resolve in any way. It might just let a few more people escape from knowing what they’re up against. But I’m sure it would only stop a very small proportion of the current batch of forcibly “hospitalized” people (inmates). At the least, giving such a warning would be an acknowledgement to the larger society that we are not talking about “treatment” when we lock someone up.

          • True Steve.

            My whole point behind suggesting the hospital be rename the Ariel Castro Memorial Hospital. To acknowledge what it actually is they behave like there, rather than mislead people into thinking there are doctors and nurses working in the place, and that healing is the goal lol

            I know most if not all of the patients I spoke to during my sentence think of rights as a joke. They live in a place where they are more likely to be visited by the tooth fairy than someone who would defend their rights. As I have shown (and can prove) lawyers are part of the reason that human and civil rights are being abused. They’re in on the game, not unlike the Catholic ‘confessional’ and the use of eavesdroppers. (Would you spy on your brother? Would you eat your dead brothers flesh? Nay, yeah would abhor it. Al Hujurat 12 ).

            Once the lawyers had identified that I had been tortured and kidnapped, they ensured they were not provided with the proof of those offences, and thus they didn’t need to provide any assistance to their ‘client’, they merely became ‘gaslighters’ by handing on false and misleading information to any and all interested parties. The hospital then free to have police retrieve the documents I had and then negative outcome me. I’m sure that if you watch the documentary about the young 12 year old boy who hung himself after being abused by one of the priests in Newcastle, and whose mother then received a visit from three of the staff at the church asking if there had been any note left, the path to concealment becomes fairly obvious. [three part doco on ABC. I can dig that section out if required]. Oh how that sent shivers down my spine after hearing the psychologist asking “who else has got the documents?” for police who obviously were concerned about who knew about their use of known torture methods. People are so disgusting when they are doing cover ups of such vile acts.

            The beige cardigan wearing psychologist would assist police in the concealment of torture lol. Still, he did provide me with two valuable pieces of information that will not be traced back to him. One being that he was subjected to threats to his family to assist police and breach his code of ethics to use therapy to gather information for them …… the other much more valuable. Boans sings along to Dirty Deeds Done Dirt Cheap by AC/DC. So I guess I owe him in that sense. Always good to know where the traps are laid, and by whom.

  4. Good article. My guess is suicide assessments are to help organisations not be criticized if a, “Client,” kills themselves.

    I was once arrested for sitting on the top of Houses of Parliament, ie the Palace of Westminster (Greenpeace protest – natch). When the police processed us before locking us in the cells, it was 2am by then, they asked all sorts of pertinent (name, address, any known illnesses or disabilities) and impertinent questions such as are you thinking of killing yourself. I laughed, as I was interested in what in the UK is called Section 136, where the police detain you for reasons of mental health and thought this is probably what they ask a distressed person when they take them off the street before taking them to the hospital or putting them in the cells. The policeman checking me in asked why I laughed, so I replied I wondered how they did that assessment. He replied, “Well how else am I supposed to know?” I could have given him an answer but really they just wanted to tick the tick sheet and lock me up. As long as that was done it didn’t matter if me or anyone else tried to kill themselves as they were covered – job done. Time for a tea break and wait till the end of the shift.

  5. At training group

    – the left side takes the candy corn.

    – The right side does not take candy corn.
    * point is everyzbody ok.

    Sera, Very different with suicide assessments. In terms of training group. You cut through lies with the suicide assessments. I appreciate that.

    I swoon reading this article.

  6. Thank you for this. There are few places where a person can actually talk about something as serious as suicide and not have to worry about being locked up against their will.

    One of those places is a Reddit group called SuicideWatch. It’s worldwide and there are always quite a few people online, so the chances are good that you’ll get some sort of response from someone who is going through or has gone through the same sort of experience. There are quite a few people who’ve never talked about their pain and desperation before and a lot of people who have tried things like the Suicide hotline and either had a bad experience or were scared that they’d have the police called on them.

    I wish that people wouldn’t treat the hotline as the end-all-be-all response to someone thinking about suicide. It seems to follow the same line of thought that only the “professionals” can handle someone who’s at their wit’s end and are opening up. I’d be more than a little hurt if I decided to divulge that sensitive information to someone and their only response would be “Oh, here’s the suicide hotline” like that would make everything peachy keen.

    I think we just need a way of reframing the topic.

  7. If I were a therapist or something like that I can see wanting to have some way of finding out where a new client was at mentally and emotionally, to help me plan out what to do with the person, or to help me decide to say, “sorry, I just can’t help you.”
    But what an appalling thing to discover that this desire to “know before you go” would deteriorate into a “suicide risk assessment!”
    This just goes to show how clueless the “experts” in the field still are, after all the opportunities we’ve given them to “smarten up!” I might chalk it all up to pure stubborn self-importance. Too bad.

  8. I keep thinking of that movie The Minority Report.

    Psychiatry is our society’s pre crime division. But unlike the movie, no one holds them accountable for their mistakes. And those they accuse get punished anyhow.

    All by pretending the treatments are restorative rather than punitive in nature. And they’re doctors. Not penal enforcers of unwritten rules they can change on a whim. 0 accountability and 100% immunity.

    Why not just make suicide illegal and say all unsuccessful attempts will be punished by imprisonment, pharmaceutical torture, possible brain mutilation, and public defamation? The only difference between this scenario and the way things actually are is the Pre-Crime Psych(ic) enforcers are allowed to pose as medical healers. Psychiatry’s got nothing to do with healing people.

    • Rachel777:
      “I keep thinking of that movie The Minority Report.
      Psychiatry is our society’s pre crime division.”

      YES! That’s exactly what the pre-crime software is modeled after. Except AI is a lot more efficient than a group of psychics suspended in a goo in an underground lab. (It’s been awhile since I’ve seen the movie) The software *was* modeled on human experimentation though (and still is).

      You said something about taking some time out to read a book. Not to me. Just generally. I’m reading something entirely unrelated to this right now, a novel. (You are a Jane Austen fan? Cool.)

      But the ideas for some of my posts came from this book (and insights on the experiments done on *me*):

      “Weapons of Math Destruction. How Big Data Increases Inequality and Threatens Democracy.” by Cathy O’Neil.

      Cathy O’Neil is a data scientist & mathematician. She became critical of the applications of Big Data after working for a hedge fund & start-ups which could predict peoples’ purchases.

      She gives a lot of examples of the prison population. I extended it to psychiatry, since she is unaware of that debate. *Most* people outside of MIA are unaware of this debate, which is what I am trying to change.

      It requires the patience of a saint. “Heathcliff!!!”

      No, I’m reading something more contemporary, but Wuthering Heights could be up for a re-read. Time to go all dark & Bronte.

      And “Weapons of Math Destruction” would be the read to produce an article on this topic.

  9. The pain behind suicide takes a long time to help, so the immediate things they do have to be ineffective at resolving their problems. They can threaten them or distract them, but it doesn’t take it away, it may even just make them more determined and better at it. There is no answer except to stop building people lives with pain in them. Or be able to remove it more skillfully. The greatest threat to society is parents who trust their instincts. They should put a lot of thought, study, prayer, and careful consideration together with their instincts for what they do for the next generation. We have to make better lives.

    • yes and people will be imperfect as we all are.
      This is part of life.
      Psychiatry further hurts. It demonstrates that “pain” from childhood does not always manifest itself as needing a shrink, but possibly as one being a shrink or “MH” workers who abuse. Function and social success does not lie in an ability to wield power over the vulnerable and that is where we went wrong, simply thinking that if you can hold a job, bathe, sleep and have two friends and a card, and car, we are a “nice” part of society.

  10. The one time I was really ( sort of, but not really REALLY) “suicidal”, I was probably more “homicidal”. After about 3 days in the local psych ward, i decided to mess with their heads. During “morning meeting”, I said
    to the staff I was actually not “mental”, but rather I was a college student writing a research paper, and that’s why I lied my way into the place. They sent me home that day, which was stupid on their part, but lucky for me! Otherwise, I have been victimized several times by persons LYING and falsely claiming I was “suicidal”, when I was NOT. Being abused by those in power for being supposedly “suicidal” has hurt me worse than if I had just killed myself. The pain of being abused by the system is worse than any of my own personal pain.
    BTW, i find Sera’ s repeated use of the phrase “Harvard guy” to be disrespectful, demeaning, juvenile, dismissive, and inappropriate coming from Mia staff writers. She is using her OWN PRIVILEGE here, in the same exact way that “Harvard guy” uses his. No, 2 wrongs don’t make a right, but sometimes they do make it even. Which means we have gone in a complete circle, and have made NO PROGRESS.

    • Bradford, your comment resonates for me as I too was falsely portrayed as being “suicidal” when I was NOT. And when I provided more information in order to emphasize the fact I was NOT the psychiatrist simply twisted my words to suit her agenda.

      Re “Harvard Guy”, I really took that as Sera showing disdain for the selfish motives that he (HG) displayed through his hypocritical stand on the matter of assessments.

  11. Sera,
    I wonder if Bradford meant to capitalize ‘here’ also…meaning your privilege on this website, though the website’s reach is little comparatively.

    As for the tone or ‘style’ as you say, yes, this article was a struggle for me to get thru, and I typically enjoy your articles. One of the girls in my wife’s system is a social justice warrior, and she has helped me move to a more -balanced (i.e. center/right) position on most issues, but this kind of read more like something I’d see on Slate. If I used similar, derogatory language coming for my formerly, far-Right perspective, it would never even make it thru the moderators, and it shouldn’t.
    The style detracts from your article.
    Sam

  12. Thank you Sera, you get two thumbs up from me for this piece.
    I learned first-hand the whole assessment thing is totally clueless, biased and harmful. As for “Harvard Guy” I viewed that comment as your usual witty cynicism towards those in positions of power who claim to “help” but whose actions – and hypocrisy – are in fact an existential threat to those in need of help.

    Yes there certainly should be more to life than simply existing or surviving an “assessment” only to spend years aimlessly walking the halls of a psychiatric hospital.

    • “I learned first-hand the whole assessment thing is totally clueless, biased and harmful.”

      I think it is important to understand the way this loophole to enable human rights abuses has slipped under the radar of our communities.

      When the UN stated that Australias laws were a violation of human rights and that the treatments may constitute torture (proving motive if Doc kept their mouth shut the means of ensuring the statement could not be ARE acts of torture) our respective State governments rewrote their Mental Health Acts to invalidate that statement.

      The standard party line was “there are added protections”, but they never openly stated what those protections were. They were protections from law suit for giving ECTs to teenage girls, the forced sterilization of children without parental consent, CTOs, and to ensure that the torture and kidnappings they have been arranging (like mine) were not capable of being prosecuted. They were now to be concealed under the guise of ‘welfare checks’ to remove your right to “reasonable grounds” for detention, and replace that with a good faith defense for kidnappings and torture. Doctor was to be given legal protections from prosecution for acts that were once considered criminal.

      Of course we all want “added protections” right? So our politicians giving themselves pay rises for allowing their doctor friends to kidnap and torture with impunity was a success, given that the public were happy with their new added protections, not realising who it was that was being ‘protected’. It’s clever, and my government are as a result of the laws they are passing becoming nervous about being labelled “nazis”. In fact when they started with the propaganda about the Euthanasia Bill,m they told the newspapers (and media) to not use the term Euthanasia because of the similarity to the laws passed by the National Socialists in Germany. They preferred the term “assisted dying” as a euphamism.

      My problem is that given when I was tortured and kidnapped, and the hospital found out that was what occurred, they then “edited” the documents they provided to my legal representatives to conceal the truth. Authorised by the Clinical Director. So the ‘protections’ offered under the Euthanasia Act work how? A doctor slips one under the nose of the Coroner, and if the families lawyers question the matter the State authorises the distribution of “edited” documents? I mean I get it that this “edited” means fraudulent, which is precisely what I consider removing the documents that prove a person was ‘spiked’ with benzos and wasn’t a “patient”, to a set that shows a “mental patient” of 10 years was taken from their home and delivered by police to a locked ward for ‘treatment’ by their doctor MIGHT be considered “editing”, but I really do prefer the correct term of fraud. Two lawyers provided with the two sets of documents would come to very different conclusions, that’s fraud if it is done with the intention of deceiving them. And well, I was told they would fuking destroy me.

      But rather than have to go through and kill complainants, it was much easier to change the law to enable these acts of kidnapping for doctors and police to deal with their corruption using the slander of mental health, and provide them with protections from people like me turning up in police stations with the proof. What a knee jerk reaction that caused, as a result of police knowing about the cover up (i was ‘flagged’ as “patient” to allow uttering and commit offences against me. Can’t have torture victims being listened to could they?), they call mental health and request a transport to a hospital for some dribble therapy to silence one of their victims.

      I don’t know that citizens are aware of how dangerous it is to speak to anyone associated with mental health. I cringe when I see the ‘Venus fly traps’ being advertised on television these days as a result of COVID.

      Slightly sad looking actor looks to screen while on phone to services, next scene is happy playing with grandchildren and smiling while on beach.

      Disabled pensioner with back problems dragged form home by 6 police, beaten with night sticks and pepper sprayed in eyes while being asked “You like that?”, and filmed by one officer on his phone like the inmates of Abu Ghraib.

      I just can’t see the links.

      Too late anyway, they got the laws through, and the public is blissfully unaware their rights have been seriously eroded. They feel ‘protected’ as a result of our politicians not speaking openly and honestly about the consequences of the changes. They speak in euphemisms of ‘treatment’ and ‘care’ and ….. go take a look in one of these places. Best they don’t I guess, and like the National Socialists they will restrict access to the initiated, those who have the stomach for it.

        • No I can’t say I have contacted the Justice Action org here Rosalee, but thanks for the information. I may contact them but a few things to consider. I have contacted an awful lot of people who have told me some very strange things.

          Shine Lawyers – “your doctor authorised the ‘spiking’ with benzos” to which I asked “which doctor would that be because its plain on those documents you have I didn’t have a doctor?”. “We can’t tell you who your doctor is”.

          Australia today issued a warning to travelers regarding the possibility of arbitrary detentions on China.

          https://www.washingtonpost.com/world/asia_pacific/australia-warns-of-arbitrary-detention-risk-in-china/2020/07/07/79b51a0e-c033-11ea-8908-68a2b9eae9e0_story.html

          I have a letter here from the Chief Psychiatrist enabling the arbitrary detention of any citizen in this State. He writes that the Community Nurse (who has completed the 2 days course at a community college) can have police detain anyone he wishes if he “suspects” that the person requires incarceration and forced drugging. This ‘model’ was confirmed in writing by a Cabinet Minister (Leader of the Upper House) as “not being a misrepresentation”. Now my point is this, that the law states that the Community Nurse must “suspect on reasonable grounds” that a person needs to be locked up an drugged, and that there is a whole section of the law (s.26) which sets out the “criteria” which must be met for a person to be detained and loose their right to liberty. Otherwise what we have are arbitrary detentions (‘suss laws’ with the ability to drug without consent). Now why is the Australian government on the one hand complaining about the possibility of arbitrary detentions in China, and yet a Cabinet Minister is authorizing them State wide where I live? The new Mental Health Act of course allows people to be concerned about your “welfare” and makes the arbitrary detentions that enables, appear to be something other than what they are. I’d be seriously concerned about anyone who was wanted by the State for a ‘welfare check’ because their welfare is in serious jeopardy.

          The lawyers at the Mental Health Law Centre do not agree with my interpretation of the way the Chief Psychiatrist has rewritten the law and enabled arbitrary detentions and claim that one needs to understand “the spirit of the Act”, which is to enable citizens to be drugged without their knowledge until police can snatch them from their beds and deliver them to a hospital where a doctor can treat them against their will.

          Police do not have a copy of the Criminal Code in a large Metropolitan Police Station, and therefore the documented proof that I was ‘spiked’ with an intoxicating drug without my knowledge is not a crime.

          http://www.austlii.edu.au/cgi-bin/viewdoc/au/legis/wa/consol_act/ccaca1913252/notes.html#appendixb

          see for example s. 305A Intoxication by Deception, or

          s. 336 Procuring the apprehension or detention of a person not suffering from a mental illness, or

          etc

          It’s a real shame police can’t find their copy, because if the actually looked they would find that two people got together and conspired to stupefy and commit an indictable offence, namely kidnapping. But they have made the choice not to look, while the ‘good medical people’ fuking destroyed me, retrieved the documents and then had me killed in an Emergency Dept. Of course they are going to claim they were ‘on to it’ all along, and were there when they interrupted the process. Rubbish, they were actively engaged in assisting the criminals way after that happened.

          Police tell me that turning up in a police station with documented proof of the above is reason to refer the victim for “hallucinating” despite having what a lawyer said was “proof” (her words not mine). When the people at mental health services said it wasn’t an illness to have proof you had been ‘spiked’, they threatened them until they said it never happened and then simply ignored the fact that they had been stooged into torturing and kidnapping a citizen, and were neglecting their duty to conceal their involvement ion further serious offences.

          The Human Right Commission doesn’t take complaints regarding allegations of Torture. They will however help me if I can’t get a baker to make me a cake for my marriage to my husband. I assume the full force of the law would apply in that situation, but torture, not our department.
          I’ve written to Amnesty Int. , Aust. Lawyers for Human Rights, and a host of others including our Attorney General asking who is it that I put these allegations to, as I have the documented proof, and no one can tell me.

          I’ve asked here, and not a peep about who it is.

          Why would it be that Aust is pointing fingers at other Nations regarding their use of torture, and yet we don’t have an authority to deal with allegations of it here? Certainly not because it isn’t being done, it just that under normal conditions the victims are silenced using the ‘medical system’ (aka mental health). Our current Minister for Health has a clever way of dealing with complaints, he says your a nut job and need help from mental health services if you don’t agree with him. And given we have arbitrary detentions, cause too many problems and a team will be dispatched to check on your welfare.

          Aust Health Practitioners Regulation Agency, the licencing authority who give rights to who can and can’t prescribe dangerous drugs. Tell me that the Community Nurse, who they would know has NO prescribing rights, has been given the right to ‘spike’ citizens without their knowledge? In fact their response to my detailed complaint exposes a level of incompetence that should be of concern to the whole community.

          Now I get it, you guys are aware of how much I struggle to explain myself clearly, but these are people who I have sat across the table from, and who I know have clearly understood what I have said.

          My government is involved in large scale human rights abuses, and they do their best to conceal them firstly through fraud and slander, and if necessary they are killing a few in the Emergency Dept. Sure it’s embarrassing for them that I slipped through the net, and well, they have managed to drag matters out for so long now that they can now claim it was so long ago……and well, we have so many people wanting to come here we can afford to ‘waste’ a few good ones with the odd killing in the ED. Plenty more where they came from.

          I don’t know, I’ll have a look and maybe speak to these people Rosalee. I mean it when I say thank you for your kind thought, it’s just that ….. like I have explained to my brothers, I have been left for dead by my community, and I should be spending my time digging my own grave. “I got my head right Boss” as Cool Hand Luke said.

          I really just want my stuff and the right to leave this vile place. I get it that many here don’t get to see the ugly hearts of these people, and I hope they never do. Like the arbitrary detentions being enabled by our Chief Psychiatrist though his dereliction of duty, and playing lets pretend I don’t know what a burden of proof is to the nutjob, they may live their lives never being snatched from their homes and tortured like I was. But I get the feeling that these people are not creating these loopholes in our laws to ensure the protection of the community. Consider, until the ‘outside’ world started to speak up, they would have passed laws allowing the forced strerilisation of children without parental consent. And they have actually passed a ‘wild’ euthanasia law, and consider the government is allowing hospitals to distribute fraudulent documents to conceal kidnapping and torture (I can, and have, proved this to a number of people including a Member of Parliament), so what else are they allowing?

          We will never know in a place where any questions are ignored and you get ‘flagged’ for ‘fuking destruction’ by the State for even asking.

  13. If we go by the standard that punching upwards is always okay, then I think the “Harvard guy” reference is fine. These criticisms of Sera come across as tone policing and bullying, and I’m guessing that the people who have a problem with saying “Harvard guy” are the same people who don’t like being called out as “those white men”. It’s that mentality of the oppressor playing the victim. Anyway, I think Sera’s reply to the original concern was genuine and sensitive, which is more than I can say about the piling on I’m seeing in some of the comments.

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