A new article published in the Australian and New Zealand Journal of Psychiatry argues that the newly popular ‘Zero Suicide’ movement within healthcare and mental healthcare settings “requires a radical reimagining of inpatient care” to be effective.
“In addition to being a target, Zero Suicide is a framework for system-wide, organizational commitment to safer care center on systemic approaches to quality improvement in the areas of leadership, training, engagement, and treatment,” the authors write.
The debate concerning best practices in suicide prevention contains many viewpoints and varying philosophical perspectives. Some take a more critical approach, while others remain more mainstream. However, despite the many approaches one can take to understand suicidality, it is widely acknowledged that involuntary hospitalization often increases the likelihood of someone attempting suicide again.
The article, written by Australian practitioners and professionals Hannah Myles, Shih Yang Tan, and Matthew Large, was inspired by and relied heavily on research conducted by their Australian colleagues Gin S. Malhi, Erica Bell, Zola Mannie, and Pritha Das. Their research titled, “Attempting suicide changes the brain?” published in the latter half of 2020, posits that when someone attempts suicide, it fundamentally changes their brain, that is, how they understand themselves, their lives, and their relationships, making another suicide attempt far more likely in the future.
With Mahli’s biopsychosocial research in mind, Myles, Tan, and Large point out that it is no coincidence that individuals who are temporarily segregated from their community in acute psychiatric facilities often leave inpatient treatment at a higher risk for suicide. Indeed, by design, these acute psychiatric centers do not foster an environment conducive to healing both physically and mentally. Instead, they are more likely further alienate individuals who have previously attempted suicide from themselves and their community.
The increased risk of suicide post inpatient treatment necessitates a radical rethinking of our shared assumptions surrounding suicidality and a reimagining of care facilities, particularly the non-consensual shared spaces found in treatment centers.
According to the authors, most acute mental healthcare facilities are “almost medieval”—citing that many individuals admitted to a facility will either witness or become a victim of violence or aggression within the first twenty-four hours of arrival.
However, these acute care facilities are not inherently the problem, claim the authors. Rather, it is the aggregation and collectivization of individuals in a space that they, by necessity, are not allowed privacy in. With a reimagining of acute care can come a new understanding of suicide prevention that allows for new integrations of different and more critical understandings of suicidality.
The authors conclude:
“These spaces should be hopeful, open, and welcoming to family and friends. They should foster optimism, recovery, and ultimately even neural plasticity while minimizing stigma and trauma. There is no need for non-consensual contact between patients, including the contagion of interpersonal violence or, for that matter, infectious contact such as COVID-19. There is no need for psychiatric care to be noisy and foreboding. While such an arrangement would require imagination and money, it would allow genuinely individualized treatment, would lessen stigma, would provide better connection, and if done properly, would foster social connectedness.”
Myles, H., Tan, S. Y., & Large, M. (2021). Zero Suicide requires a radical reimagining of inpatient care. Australian and New Zealand Journal of Psychiatry (ANZJP) (Link)