East Asian Arch Psychiatry 2010;20:94


“Suicidal Behaviour” — Advances in Psychotherapy (Evidence-based Practice)

Von R. McKeon
Hogrefe & Huber Publishers
USD24.80; pp96; ISBN: 978-0-88937-327-3

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This book is one of the evidence-based treatments for common mental illnesses series produced by the Hogrefe and Huber Publishers. It is a compact and handy book that takes you no more than an hour to peruse to get the essential details. As with other books in this series, it is reader- friendly: enriched with tables, boxed clinical ‘pearls’, marginal notes and summary boxes.

This very engaging book takes a psychotherapeutic stance right from the beginning. The author quotes Kay Redfield Jamison “The gap between what we know, and what we do, is lethal”. The author further argues that “...it is also tragically true that there is a huge gap between what we know and what we need to know to prevent suicide more effectively. This gap is also lethal…despite the fact that involuntary hospitalization laws across the U.S. utilize the concept of imminent risk, the research on acute risk factors for suicide measures risk in months, not in hours or days. We also know distressingly little about how to successfully engage people at risk in treatment.” These succinct and factual arguments get to the heart of many clinical dilemmas in our day-in-day-out management of suicidal patients.

This book speaks to mental health professionals in training as well as the experts. In well-presented style, the author takes you through the cornerstones of suicidology systematically. It describes the terminology, definition, epidemiology, assessment procedures as well as neuropsychiatric and psychological models of suicidal behaviour in the first two chapters, which are followed by a chapter devoted to risk assessment and treatment planning. It ends with a very long chapter that candidly reveals the fine details of real-life clinical management issues arising from psychotherapeutic relationship with suicidal patients. These issues include orientation and engagement, crisis intervention, accessibility after hours, suicide prevention hotlines, emergency appointment capability, use of emergency departments, psychiatric emergency services, involuntary hospitalization and use of the police, use of mobile outreach services, safety planning, involving family and friends, means restrictions, treatment techniques (cognitive therapy, behavioural approach, bibliotherapy, individual vs. group), skills training, self- monitoring / homework assignments, postvention of suicide attempts and treatment of adolescents. Experts engaged in training may find this guidebook useful for developing training manuals relevant to their own clinical settings. Although this book does not have extensive references, the poignant insight it offers into the limitations of suicide research findings is constructive for building future research paradigms in suicidology.

Suicide is not a specific disease but the tragic outcome of a confluence of mental health–related problems. It is no easy task to grapple with the many perspectives in suicidology in a ‘how-to-do-it’ style book. This book achieves a fine balance between the historical / theoretical / empirical aspects and their clinical utilities. The author articulates with ease insightful information and reflections that join the many different up-to-date aspects of suicidology. Even a quick read through will give you important and convincing take-home messages that shine through the texts. For instance, the author emphasises that a clinician’s duty is not the prediction of suicide but the performance of suicide risk assessment based on the available scientific evidence. Risk assessment comes from clinical assessment rooted in a therapeutic relationship, not from clinical assumption. Clumsy clinical assessment may disconnect you from your client, whereas a useful assessment is a chance to connect. In clinical reality, we need to exercise clinical judgement to resolve contradictory risk factors. There is no psychometric formula for risk prediction. Complementary use of psychometric instruments and clinical assessment is recommended. Suicidality is a fluid state and time dimensions must be considered when doing suicide risk assessment. One must not assume that treating the underlying risk factors will necessarily alter the fatal outcome without offering specific interventions for the suicidal state.

Such powerful messages may easily be lost in weighty suicidology textbooks. The succinctly organised short text and witty case illustrations in this book deliver these important principles effectively.

One must acknowledge that a substantial proportion of the epidemiological data and clinical contexts referred to in this book are based in America. This does not preclude the generalisation and application of this book to other socio- cultural settings as the author keeps revisiting common management principles when illustrating them in an American context. The scope and depth of this book are also conveyed effectively through the wisely constructed clinical vignettes that lighten up the texts. The final chapters contain thoughtfully chosen case vignettes and case examples that apply an integrative approach from the multi-phasic models illustrated in earlier chapters of this book.

Sandra Chan, MRCPsych, FHKAM (Psychiatry), FHKCPsych
Department of Psychiatry
The Chinese University of Hong Kong
Hong Kong SAR, China

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