Develop the following ideas. Make use of the expressions in brackets.
1. A decrease in suicide rates in Western countries is seemingly unrelated to the existence of any national plan.
( to face smth, to have a structured strategy, to possess a prevention programme, a “cohort effect”, to connote a generation, to be postulated, a description of factors, relevant environmental factors, the fundamental influence, cultural differences, to be universally applicable)
2. An unexceptionable reduction in youth suicide rates is presently taking place.
(worrying increases, motives for trends, to puzzle researchers, to create a task force, a transcultural perspective, to promote a study, a randomized intervention, to attempt suicide, socio-cultural indicators).
3. New initiatives in suicide prevention have been launched.
(suicide research, to require investment, multi-disciplinary teams, integrated approach, large-scale and long-term projects, to capture priority, lack of scientific evidence, to characterize an area)
Critical Thinking Tasks.
1. Search the Internet for the following key words and word combinations from both the Case Study and Role Play sections: suicidology, suicidality, suicide phenomenon, suicidal behavior, suicide prevention, suicide rate, means of suicide, youth suicide, suicide attempters, suicide mortality, attempted/completed suicide. Use the obtained information in your case analysis.
2. Sum up trends in suicide rates. What steps are being undertaken worldwide to challenge further suicide prevention?
3. Comment upon the major risk factors for suicide. Are they stable or changeable?
Are these factors universal across countries and cultures?
3. Dwell on factors, apart from medical aspects, involved in complex suicide phenomenon.
4. Elaborate on the socio-economic events which can influence suicide rate.
5. Think of the factors which are likely to protect an individual from suicide.
6. Prepare the report on the case.
Role Play
Situation
Suicide is among the top 20 leading causes of death globally for all ages. Every year, almost one million people die from suicide; a "global" mortality rate of 16 per 100,000, or one death every 40 seconds. In the last 45 years suicide rates have increased by 60% worldwide. Suicide is among the three leading causes of death among those aged 15-44 years in some countries, and the second leading cause of death in the 10-24 years age group; these figures do not include suicide attempts which are up to 20 times more frequent than completed suicide.
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Worldwide, the prevention of suicide has not been adequately addressed due to basically a lack of awareness of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities.
Task. : Act out a round-table discussion on the global suicide prevention strategies.
David Shaffer, head of the department, the International Association for Suicide Prevention, NY, USA: You run a discussion. Several specialists were invited to give their opinions. You start the discussion by saying that in humanistic domains such as ethics, philosophy and anthropology the debate on the legitimacy of preventing suicide seems to have proceeded in parallel with the history of human development. Even in the medical world, where suicide has been acknowledged as a primary public health problem within the past century, and where the World Health Organization declared the fight against suicide as a priority for the first time in the year 2000, there is disagreement about the effectiveness of preventive efforts. There are many reasons for such scepticism, all of them more or less centred on the extreme complexity of the suicide phenomenon which is really complex with psychological, social, biological, cultural and environmental factors involved.
Make use of the following helpful phrases:
Ø My function is to act as presiding officer and introduce those who…
Ø Let’s be clear first of all over the general problem.
Ø Before we move on to particulars…
Ø How/What do you feel about …?
Ø Could you be more specific, please, and tell us…
Ø What is your alternative proposal?
Ø The floor is yours, Dr…
Ø Are there any other points to discuss?
Ø I’ll leave it there unless there are further questions.
Ella Arensman, postdoctoral research psychologist, Medical Defence Union of Scotland: You believe that despite the huge amount of literature and research on the topic, prevention of suicidal behaviours remains an imperfect art based on scant scientific evidence. The most commonly cited reasons for this are: inadequate sample sizes for randomised, controlled studies; programmes of insufficient duration; numerous biases inherent in suicide research, notably the use of people who have attempted suicide as research participants. You add that little is known (because they are poorly investigated) about factors that are likely to protect against suicide, such as coping skills, problem-solving capabilities, social support and connectedness.
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Make use of the following helpful phrases:
Ø In spite of much development and understanding in…
Ø …remains essentially a land of hopes and promises, but not certainties.
Ø My personal feeling is…
Ø It must be admitted that …
Ø One of widespread misunderstandings is…
Ø Furthermore, …
Dr Diego De Leo, Australian Institute for Suicide Research and Prevention: You are sure that lessons can be learned from approaches to the prevention of life-threatening conditions such as, for example, ischaemic heart disease. You give an example that a significant reduction in mortality from ischaemic heart disease has been achieved only by addressing a wide range of factors: knowledge of family predisposition, exercise, dieting, smoking cessation, cholesterol level control, sophisticated diagnostic techniques that allow early intervention, treatment in highly specialised intensive care units and personalised rehabilitation programmes, have all contributed to substantial improvements in survival rates and mortality reduction. Suicide is a much more complex phenomenon than myocardial infarction, so it seems illogical for you that strategies to fight suicide have to be simpler or less integrated than the struggle against coronary artery disease.
Make use of the following helpful phrases:
Ø Let me just say at the beginning…
Ø It makes sense (for somebody to do something)…
Ø May I remind you that …
Ø It goes without saying that …
Ø It seems illogical for me that …
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B. Ravi Shankar, Department of Psychiatry, Christian Medical College, India: You argue that the previous speaker’s comparison of suicide prevention with that of ischaemic heart disease seems inappropriate. You point out that the risk factors for ischaemic heart disease are well known, stable and quantifiable. You imply that risk factors used for predictive purpose should be stable, whereas in suicide, clearly, most are not. Therefore, when risk factors are not stable it will be difficult to apply the same analogy to suicide prevention.
Make use of the following helpful phrases:
Ø I’m afraid, I cannot agree with…
Ø I’d like to point out that…
Ø For the most part…
Ø Therefore…
Opher Feldman, CNN analyst: You are in favour of Dr De Leo’s opinion. You think his analogy has simply highlighted the need for a multifaceted approach to anti-suicide strategies. You make the point that a single preventive measure would not be effective in reducing suicide mortality, as evidenced through the prevention of other types of death such as ischaemic heart disease. You suppose that in the case of suicide, the worldwide optimal treatment of depression would bring only a minimal reduction in suicide rates. You are certain that given the complexity of its pathways, the prevention of suicide, like the prevention of many types of death, requires a combination of approaches, such as public and medical education, promoting community connectedness, controlling access to means, early identification and intervention, etc.
Make use of the following helpful phrases:
Ø May I have a say?
Ø I’m in favour of…
Ø It goes without saying that…
Ø An argument goes that …
Ø Given the complexity of…
Robert Goldney, consultant liaison sociologist: You raise the opinion that multi-disciplinary approaches to the prevention and investigation of suicide are often flagged up but virtually never practised. Research teams have difficulties in achieving a balanced composition between biologically and psychologically oriented investigators (both equally important in the study of suicide). This is further complicated by the need to evaluate also other important factors, such as socio-economic, cultural and religious aspects. Socio-economic events (wars, major economic fluctuations) produce tremendous fluctuations in suicide mortality, particularly in men. Obviously, the controllability of social events remains hypothetical and their relevance to suicide prevention largely speculative. However, the impact of socio-cultural phenomena should be considered when evaluating suicide prevention programmes. Besides, it is necessary to understand local perspectives and regional factors that influence suicide rates.
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Make use of the following helpful phrases:
Ø It’s beyond doubt that…
Ø As I see it…
Ø This is further complicated by…
Ø Understandably, …
Ø That would be the best idea under circumstances to…
Ø A comprehensive policy should not neglect…
Keith Hawton, professor of psychiatry, UK: You agree that cultural factors have a major role in suicidal behaviour and there are huge differences in the dimension and characteristics of this problem around the world. You give an example that the average ratios between the lowest and the highest suicide rates internationally are as large as 1:102.4 for men and 1:35.8 for women. You share the opinion that cross-cultural comparisons should be encouraged. They may improve our understanding of causative and protective factors, and consequently help to reorient prevention strategies.
Make use of the following helpful phrases:
Ø I‘m all for the opinion that…
Ø We can hardly ignore it.
Ø This suggests that …
Ø It’s obvious that …
Annette Beautrais, head of the department, the International Association for Suicide Prevention, Christchurch, New Zealand: You assume that risk factors for suicide are unstable and may change over time. This recalls an important point which refers to the local (cultural/traditional) specificity of suicidal behaviour. You state that in countries such as China risk factors for suicide are not dissimilar from those of Western countries; what varies is their ranking in terms of importance and expressivity. Furthermore, it is well-known that within the same country there may be contiguous areas with largely differing suicide rates and that the same risk factors may operate differently in different social contexts. To identify the exact components of a multifaceted prevention programme, tailored to local characteristics, greater knowledge of risk and protective factors is needed for both the psychiatric and general populations.
Make use of the following helpful phrases:
Ø There is another matter I’d like to bring up.
Ø This recalls an important point which refers to…
Ø At the same time…
Ø Furthermore, …
Ø Considering all these…
Eleanor Hazell, spokesperson for the World Health Organisation: You support the idea that risk factors for completed suicide are universal across countries and cultures. Findings suggest that the most important risk factor for suicide seems to be mental illness, but some other factors are also crutial. Hopelessness, or negative expectations about the future, has long been emphasized as one of the most important factors leading to suicide in depressed individuals. Next come alcoholism and other addictions: it is estimated that approximately 15% of alcoholics eventually commit suicide. The risk of suicide among drug addicts is also known to be very high: the risk of suicide among male heroin addicts is approximately 20 times that of the general population. Another factor is personality disorders. Individuals most at risk are those who show marked lability of mood, aggressiveness, impulsivity and those who have become alienated from their peers, especially if this picture is complicated by alcohol or drug abuse. Physical disorders, especially those of a chronic nature, are common among suicides: at least half of the suicides had relatively serious physical disorders and in many cases the illness appeared to have contributed to the suicide. Physical illness was especially common among elderly male suicides. Besides, death of a parent during childhood may increase the risk of suicide in adulthood probably because of increased vulnerability to depression. Recent bereavement, particularly loss of a spouse or parent, is also a risk factor. This risk is increased for at least 4 or 5 years following bereavement, and is particularly high during the first 2 years. Unemployment is another factor: there is substantial evidence that the risk of suicide is increased among unemployed men. You restate that cultural and social background represents major risk factors for suicide.
Make use of the following helpful phrases:
Ø It may be well true that…
Ø There is no convincing evidence that …
Ø However,
Ø Numeral findings suggest that …
Ø To start with, …
Ø Next come …
Ø All in all, …
Kees van Heeringen, coordinator, the Suicide Prevention – Multi-site Intervention Study on Suicide (SUPRE-MISS):You stress that mental disorders (particularly, depression and alcohol use disorders) are a major risk factor for suicide in Europe and North America; however, in Asian countries impulsiveness plays an important role. You proceed with the idea that it seems unlikely that suicide can be prevented easily by medical means. Non-medical considerations are much more important, including questions of moral, philosophy and sociopolitical matters. In your opinion, internationally, there are large, poorly explained variations in moral and societal attitudes to suicide, as well as different definitions, putative causes, methods, rates, and policies for treatment, research, and, inevitably, prevention. The result is strategic confusion and incoherence.
Make use of the following helpful phrases:
Ø Excuse my interrupting you, but…
Ø I can well believe it.
Ø I’d like to stress that…
Ø It seems unlikely that …
Ø In my opinion, …
Ø This results in …
Dr Jim Rogers, one of the world’s leading experts on suicide prevention: You sum up the opinions by saying that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g. education, labour, police, justice, religion, law, politics, the media. You finalise the discussion by providing the information that there is compelling evidence indicating that adequate prevention and treatment of depression and alcohol and substance abuse can reduce suicide rates, as well as follow-up contact with those who have attempted suicide. Besides, strategies involving restriction of access to common methods of suicide, such as firearms or toxic substances, have proved to be effective in reducing suicide rates. However, there is a need to adopt multi-sectoral approaches involving many levels of intervention and activities. Such commonly cited measures may involve: targeting general hospital services for people who have attempted suicide; identification and management of persons suffering from mental disorders, improved access to health and social services, encouraging responsible reporting of suicide in the media; education in schools and of the public on mental health; addressing problems such as family and marital breakdown, unemployment, and poverty.
Make use of the following helpful phrases:
Ø Let me sum up everything that has been said.
Ø I’d like to finalise our today’s discussion by …
Ø There is compelling evidence indicating that…
Ø Let’s take a closer look at …
Ø Moreover, …
Ø And, finally, …
Making a Decision
In coming to a decision about this case consider the following points regarding the elaboration, development and advancement of the global suicide prevention strategies:
§ The complexity of the suicide phenomenon with a wide range of factors involved.
§ Socio-economic environments which can have impact on suicide rate.
§ The major risk factors and factors which may protect a person from suicide.
What other factors should be discussed?
GRAMMAR BACK UP
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