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Eight steps should help strengthen parasuicide services. (Treatment Studies Reviewed).

Mental health services could improve in several ways their treatment of patients who commit or are likely to commit low- or high-lethality acts that may lead to suicide--despite a lack of research on the subject, said Katherine Anne Comtois, Ph.D., of the University of Washington, Seattle.

By reviewing literature from 1970 to 2001 and looking at established health service strategies, Dr. Comtois suggested eight steps aimed at improving services:

1. Establish case registries. The identification and inclusion of parasuicide, which Dr. Comtois defines as "any nonfatal, self-injurious behavior with a dear intent to cause bodily harm or death," and other risk factors for suicide on case registries will help to define the rates of suicide and parasuicide in all patients receiving mental health care. This group will likely have a higher rate than the national prevalence (Psychiatric Services 53[9]: 1138-44, 2002).

2. Evaluate quality of care. Guidelines involving suicide risk assessment, treatment for disorders comorbid with parasuicide, and the maintenance of general behavioral health standards could be applied as tools for evaluating mental health programs in light of the absence of data on the effectiveness of current interventions.

3. Evaluate training. Little research has been conducted in evaluating the effectiveness of training programs for empirically supported treatments, Dr. Comtois said. So far, only clinician training in dialectical behavior therapy theory has proven to be cost-effective in parasuicide treatment.

4. Adjust treatment models. "A synthesis is needed, such that the treatment works in the setting in which it is needed but remains consistent enough with the research model that it keeps its effect," she said.

5. Evaluate outcomes. Well-designed case registries will help to evaluate outcomes of treatment for suicidal behaviors.

6. Evaluate local programs. Any model programs across the country that are especially effective in preventing parasuicide need to be compared with normal treatment.

7. Provide support to the infrastructure. It would help to provide referring clinicians with Feedback on patients' attendance at the referred treatment. Such reminders may help determine when more time and effort is needed for a patient.

8. Implement quality improvement. By addressing weaknesses in a health service, quality improvement projects could use the options mentioned above to incrementally improve services.
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Author:Evans, Jeff
Publication:Clinical Psychiatry News
Date:Nov 1, 2002
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