Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Intervention. Show all posts
Showing posts with label Intervention. Show all posts

Monday, February 26, 2024

Hope for Suicide Prevention

Ellen Barry
The New York Times
Originally published 21 Feb 24

Here is an excerpt:

Research has demonstrated that suicide is most often an impulsive act, with a period of acute risk that passes in hours, or even minutes. Contrary to what many assume, people who survive suicide attempts often go on to do well: Nine out of 10 of them do not die by suicide.

Policymakers, it seems, are paying attention. I have been reporting on mental health for The New York Times for two years, and in today’s newsletter I will look at promising, evidence-based efforts to prevent suicide.

A single element

For generations, psychiatrists believed that, in the words of the British researcher Norman Kreitman, “anyone bent on self-destruction must eventually succeed.”

Then something strange and wonderful happened: Midway through the 1960s, the annual number of suicides in Britain began dropping — by 35 percent in the following years — even as tolls crept up in other parts of Europe.

No one could say why. Had medicine improved, so that more people survived poisoning? Were antidepressant medications bringing down levels of despair? Had life in Britain just gotten better?

The real explanation, Kreitman discovered, was none of these. The drop in suicides had come about almost by accident: As the United Kingdom phased out coal gas from its supply to household stoves, levels of carbon monoxide decreased. Suicide by gas accounted for almost half of the suicides in 1960.

It turns out that blocking access to a single lethal means — if it is the right one — can make a huge difference.

The strategy that arose from this realization is known as “means restriction” or “means safety,” and vast natural experiments have borne it out. When Sri Lanka restricted the import of toxic pesticides, which people had ingested in moments of crisis, its suicide rate dropped by half over the next decade.


Here is my summary

The article discusses new suicide prevention measures in the U.S., where suicide rates have risen 35% in recent decades. This contrasts with global trends of declining suicide rates.
  • It highlights how installing barriers on bridges, buildings, and other high structures can deter impulsive suicide attempts. Many communities are now considering such barriers.
  • Research shows most who survive a suicide attempt go on to live their lives and not die by suicide later. This suggests preventing access to lethal means in moments of crisis can save lives.
  • Restricting access to highly lethal means like guns and toxic pesticides has significantly reduced suicide rates when implemented in other countries.
  • In the U.S., red flag laws that temporarily remove guns from high-risk individuals have been associated with drops in firearm suicides.
  • Educating gun owners on safe storage habits is another promising approach, as is providing incentives for measures like locking devices or gun safes.
  • Even brief counseling for gun owners has proven effective in getting people to voluntarily store guns securely and prevent access during periods of risk.
In summary, the text highlights several evidence-based strategies for reducing access to lethal means during periods of acute suicide risk, thereby giving people a chance to recover and survive their suicidal crises.

Saturday, July 29, 2023

Racism in the Hands of an Angry God: How Image of God Impacts Cultural Racism in Relation to Police Treatment of African Americans

Lauve‐Moon, T. A., & Park, J. Z. (2023).
Journal for the Scientific Study of Religion.

Abstract

Previous research suggests an angry God image is a narrative schema predicting support for more punitive forms of criminal justice. However, this research has not explored the possibility that racialization may impact one's God image. We perform logistic regression on Wave V of the Baylor Religion Survey to examine the correlation between an angry God image and the belief that police shoot Blacks more often because Blacks are more violent than Whites (a context-specific form of cultural racism). Engaging critical insights from intersectionality theory, we also interact angry God image with both racialized identity and racialized religious tradition. Results suggest that the angry God schema is associated with this form of cultural racism for White people generally as well as White Evangelicals, yet for Black Protestants, belief in an angry God is associated with resistance against this type of cultural racism.

Discussion

Despite empirical evidence demonstrating the persistence of implicit bias in policing and institutional racism within law enforcement, the public continues to be divided on how to interpret police treatment of Black persons. This study uncovers an association between religious narrative schema, such as image of God, and one's attitude toward this social issue as well as how complex religion at the intersection of race and religious affiliation may impact the direction of this association between an angry God image and police treatment of Black persons. Our findings confirm that an angry God image is modestly associated with the narrative that police shoot Blacks more than Whites because Blacks are more violent than Whites. Even when controlling for other religious, political, and demographic factors, the association holds. While angry God is not the only factor or the most influential, our results suggests that it does work as a distinct factor in this understanding of police treatment of Black persons. Previous research supports this finding since the narrative that police shoot Blacks more because Blacks are more violent than Whites is based on punitive ideology. But whose version of the story is this telling?

Due to large White samples in most survey research, we contend that previous research has undertheorized the role that race plays in the association between angry God and punitive attitudes, and as a result, this research has likely inadvertently privileged a White narrative of angry God. Using the insights of critical quantitative methodology and intersectionality, the inclusion of interactions of angry God image with racialized identity as well as racialized religious traditions creates space for the telling of counternarratives regarding angry God image and the view that police shoot Blacks more than Whites because Blacks are more violent than Whites. The first interaction introduced assesses if racialized identity moderates the angry God effect. Although the interaction term for racialized identity and angry God is not significant, the predicted probabilities and average marginal effects elucidate a trend worth noting. While angry God image has no effect for Black respondents, it has a notable positive trend for White respondents, and this difference is pronounced on the higher half of the angry God scale. This supports our claim that past research has treated angry God image as a colorblind concept, yet this positive association between angry God and punitive criminal justice is raced, specifically raced White.

Here is a summary:

The article explores the relationship between image of God (IoG) and cultural racism in relation to police treatment of African Americans. The authors argue that IoG can be a source of cultural racism, which is a form of racism that is embedded in the culture of a society. They suggest that people who hold an angry IoG are more likely to believe that African Americans are dangerous and violent, and that this belief can lead to discriminatory treatment by police.

Here are some of the key points from the article:
  • Image of God (IoG) can be a source of cultural racism.
  • People who hold an angry IoG are more likely to believe that African Americans are dangerous and violent.
  • This belief can lead to discriminatory treatment by police.
  • Interventions that address IoG could be an effective way to reduce racism and discrimination.

Friday, January 20, 2023

Teaching Empathy to Mental Health Practitioners and Trainees

Ngo, H., Sokolovic, et al. (2022).
Journal of Consulting and Clinical Psychology,
90(11), 851–860.
https://doi.org/10.1037/ccp0000773

Objective:
Empathy is a foundational therapeutic skill and a key contributor to client outcome, yet the best combination of instructional components for its training is unclear. We sought to address this by investigating the most effective instructional components (didactic, rehearsal, reflection, observation, feedback, mindfulness) and their combinations for teaching empathy to practitioners.

Method: 
Studies included were randomized controlled trials targeted to mental health practitioners and trainees, included a quantitative measure of empathic skill, and were available in English. A total of 36 studies (37 samples) were included (N = 1,616). Two reviewers independently extracted data. Data were pooled by using random-effects pairwise meta-analysis and network meta-analysis (NMA).

Results:
Overall, empathy interventions demonstrated a medium-to-large effect (d = .78, 95% CI [.58, .99]). Pairwise meta-analysis showed that one of the six instructional components was effective: didactic (d = .91 vs. d = .39, p = .02). None of the program characteristics significantly impacted intervention effectiveness (group vs. individual format, facilitator type, number of sessions). No publication bias, risk of bias, or outliers were detected. NMA, which allows for an examination of instructional component combinations, revealed didactic, observation, and rehearsal were included among the most effective components to operate in combination.

Conclusions:
We have identified instructional component, singly (didactic) and in combination (didactic, rehearsal, observation), that provides an efficient way to train empathy in mental health practitioners.

What is the public health significance of this article?

Empathy in mental health practitioners is a core skill associated with positive client outcomes, with evidence that it can be trained. This article provides an aggregation of evidence showing that didactic teaching, as well as trainees observing and practicing the skill, are the elements of training that are most important.

From the Discussion

Despite clear evidence on why empathy should be taught to mental health practitioners and how well empathy interventions work in other professionals, there has been no systematic integration on how best empathy should be taught to those working in mental health. Thus, the present study sought to address this important gap by applying pairwise and network meta-analytic analyses. In effect, we were able to elucidate the efficacious “ingredients” for teaching empathy to mental health practitioners as well as the relative superiority of particular combinations of instructional components. Overall, the effect sizes of empathy interventions were in the moderate to large range (d = .78; 95% CI [.55, .99]), which is comparable to previous meta-analyses of randomized controlled trials (RCTs) of empathy interventions within medical students (d = .68, Fragkos & Crampton, 2020), health care practitioners (d = .80, Kiosses et al., 2016; d = .52, Winter et al., 2020), and mixed trainees (adjusted g = .51; Teding van Berkhout & Malouff, 2016). This effect size means that over 78% of those who underwent empathy training will score above the mean of the control group, a result that clearly supports empathy as a trainable skill. 

Wednesday, January 26, 2022

Threat Rejection Fuels Political Dehumanization

Kubin, E., Kachanoff, F., & Gray, K. 
(2021, December 4).

Abstract

Americans disagree about many things, including what threats are most pressing. We suggest people morally condemn and dehumanize opponents when they are perceived as rejecting the existence or severity of important perceived threats. We explore perceived “threat rejection” across five studies (N=2,404) both in the real-world COVID-19 pandemic and in novel contexts. Americans morally condemned and dehumanized policy opponents when they seemed to reject realistic group threats (e.g., threat to the physical health or resources of the group). Believing opponents rejected symbolic group threats (e.g., to collective identity) was not reliably linked to condemnation and dehumanization. Importantly, the political dehumanization caused by perceived threat rejection can be soothed with a “threat acknowledgement” intervention.

General Discussion 

Does perceived threat rejection sow political divisions? Results suggest perceiving the “other side” as rejecting realistic (more than symbolic) threat increases moral condemnation and dehumanization, lending support to the asymmetry hypothesis. DuringCOVID-19, those who relatively favored social distancing saw opponents as rejecting realistic threats and morally judged and dehumanized them. In contrast, support for social distancing did not reliably relate to perceiving the other side as rejecting symbolic threat—and symbolic threat was not robustly associated with moral judgment or dehumanization.

Within a novel threat context, people who were more willing to sacrifice their group’s culture to prevent realistic threats to health or resources viewed opponents as rejecting realistic threats and in turn morally condemned and dehumanized them. Similarly, people who were more willing to endure realistic threat to protect their culture, viewed opponents as rejecting symbolic threats, in turn morally condemning and dehumanizing them, yet these effects were significantly weaker than for realistic threat rejection. Our findings are consistent with research suggesting people condemn behaviors which are perceived as causing concrete (realistic) harm rather than abstract (symbolic) harm (Schein & Gray 2018).

Using a threat-acknowledgement-intervention, we decreased the tendency of people who tended to prioritize protecting the group from realistic threat (i.e., those who tended to support social distancing)to morally judge and dehumanize opponents who prioritized protecting the group from symbolic threat (i.e., those who tended to resist social distancing). Our intervention did not require opponents to compromise their stance –this intervention worked by simply having opponents acknowledge both realistic and symbolic threats when providing a rationale for their position. 

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Note: Helpful research when working with politically intense patients who frequently bring in partisan information to discuss in psychotherapy.

Tuesday, October 15, 2019

Want To Reduce Suicides? Follow The Data — To Medical Offices, Motels And Even Animal Shelters

Maureen O’Hagan
Kaiser Health News
Originally published September 23, 2019

Here is an excerpt:

Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That’s where Debra Darmata, Washington County’s suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there.

Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention.

“I’ve worked in suicide prevention for 11 years,” Darmata said, “and I’ve never seen anything like it.”

The sheriff’s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too.

The info is here.

Monday, July 30, 2018

Mental health practitioners’ reported barriers to prescription of exercise for mental health consumers

KirstenWay, Lee Kannis-Dymand, Michele Lastella, Geoff P. Lovell
Mental Health and Physical Activity
Volume 14, March 2018, Pages 52-60

Abstract

Exercise is an effective evidenced-based intervention for a range of mental health conditions, however sparse research has investigated the exercise prescription behaviours of mental health practitioners as a collective, and the barriers faced in prescribing exercise for mental health. A self-report survey was completed online by 325 mental health practitioners to identify how often they prescribe exercise for various conditions and explore their perceived barriers to exercise prescription for mental health through thematic analysis. Over 70% of the sample reported prescribing exercise regularly for depression, stress, and anxiety; however infrequent rates of prescription were reported for conditions of schizophrenia, bipolar and related disorders, and substance-related disorders. Using thematic analysis 374 statements on mental health practitioners' perceived barriers to exercise prescription were grouped into 22 initial themes and then six higher-order themes. Reported barriers to exercise prescription mostly revolved around clients' practical barriers and perspectives (41.7%) and the practitioners' knowledge and perspectives (33.2%). Of these two main themes regarding perceived barriers to exercise prescription in mental health, a lack of training (14.7%) and the client's disinclination (12.6%) were initial themes which reoccurred considerably more often than others. General practitioners, mental health nurses, and mental health managers also frequently cited barriers related to a lack of organisational support and resources. Barriers to the prescription of exercise such as lack of training and client's disinclination need to be addressed in order to overcome challenges which restrict the prescription of exercise as a therapeutic intervention.

The research is here.

Tuesday, May 17, 2016

America’s Suicide Epidemic Is a National Security Crisis

Fredrik Deboer
Foreign Policy
Originally published April

Here is an excerpt:

Too many in our culture, meanwhile, still place the blame for suicide on its victims. It’s common, after high-profile suicides like that of actor and comedian Robin Williams, for some to argue that suicide is “the coward’s way out,” that taking one’s own life is somehow a cowardly act. Such attitudes are a flagrant failure of empathy, as well as a misunderstanding about the relationship between suicide and mental illness and addiction, both of which are strongly associated with suicide risk. Like many social problems, suicide does not have single and obvious causes but rather a concert of contributing factors working together. To blame suicide on a lack of personal character demonstrates ignorance about the nature of the problem. But such thinking contributes to the country’s persistent and deep inability to grapple with suicide in an open and healthy way.

The article is here.

Friday, April 8, 2016

Why Therapist Should Talk Politics

By Richard Brouillettee
The New York Times
Originally published March 15, 2016

Here is an except:

Typically, therapists avoid discussing social and political issues in sessions. If the patient raises them, the therapist will direct the conversation toward a discussion of symptoms, coping skills, the relevant issues in a patient’s childhood and family life. But I am growing more and more convinced that this is inadequate. Psychotherapy, as a field, is not prepared to respond to the major social issues affecting our patients’ lives.

When people can’t live up to the increasingly taxing demands of the economy, they often blame themselves and then struggle to live with the guilt. You see this same tendency, of course, in a variety of contexts, from children of divorce who feel responsible for their parents’ separation to the “survivor guilt” of those who live through disasters. In situations that may seem impossible or unacceptable, guilt becomes a shield for the anger you otherwise would feel: The child may be angry with her parents for divorcing, the survivor may be angry with those who perished.

The article is here.