Staff Perspective: Clarifying the Use of the Modifier “Interrupted” in Suicide Nomenclature
The Self-Directed Violence Classification System (SDVCS) provides a common language to describe suicidal and suicidal-related behavior. Developed in a collaborative effort between VISN 19’s Mental Illness Research, Education, and Clinical Centers and the Centers for Disease Control, the SDVCS nomenclature was adopted for use by the Veterans Health Administration in April 2010. The Center for Deployment Psychology (CDP) teaches the SDVCS as part of the course Assessing Suicidal Behavior in the U.S. Military: Strategies for Assessment, Crisis Intervention, and Treatment. This course is made available by the CDP to both military and civilian mental health professionals in an effort to educate them about the most current and empirically-supported ways to manage suicidal and suicidal-related behaviors.
In teaching the course about suicide prevention and treatment, I have noticed that one area seems to be highly likely to generate confusion (and disagreement) among the participants. (If you are not familiar with the SDVCS, now would be a good time to look at the information at the following link so the comments in this blog will make sense.
http://www.dcoe.mil/content/Navigation/Documents/SPC2012/2012SPC-Matarazzo-etal-SDVCS_Training.pdf
Notice that there is a modifier “interrupted by self or other” that can apply to non-suicidal self-directed violence, undetermined self-directed violence, and suicidal self-directed violence. The idea here is that in each of these categories, the behavior in question is interrupted (i.e., cut short, prevented, stopped). This interruption may originate from the person engaging in the self-directed violence or some other person or circumstance. The key here is that the self-directed violence does not occur if it’s interrupted.
Here are some examples that may clarify:
Question: “If a person takes 50 Tylenol tablets, then calls 911, isn’t that considered ‘interrupted by self’?”
Answer: No. Because the pills were ingested, a suicide attempt actually occurred. Had the pills been lined up on the counter, or even put in one’s mouth and spit out, the behavior would have been interrupted.
Question: “If a person is discovered unconscious in his/her car in the garage with the car running by a friend, is that considered “interrupted by other?”
Answer: No, in this case a suicide attempt actually occurred.
It may be helpful to differentiate “interrupted” from “rescue.” In the above examples, the suicide attempt was carried out, not interrupted. However, there was a post-attempt rescue in both cases, one by the individual him/herself and one by another person.
Regina Shillinglaw, Ph.D., is a Deployment Behavioral Health Psychologist with the CDP. She is located at Wright Patterson Medical Center in Ohio, where she is a faculty member and the assistant training director of the APA-approved pre-doctoral psychology internship training program.
Reference:
Brenner, L. A., Breshears, R. E., Betthauser, L. M., Bellon, K. K., Holman, E., Harwood, J. E. F., et al. (2011). Implementation of a suicide nomenclature within two VA healthcare settings. Journal of Clinical Psychology in Medical Settings, 18(2), 116-128.
The Self-Directed Violence Classification System (SDVCS) provides a common language to describe suicidal and suicidal-related behavior. Developed in a collaborative effort between VISN 19’s Mental Illness Research, Education, and Clinical Centers and the Centers for Disease Control, the SDVCS nomenclature was adopted for use by the Veterans Health Administration in April 2010. The Center for Deployment Psychology (CDP) teaches the SDVCS as part of the course Assessing Suicidal Behavior in the U.S. Military: Strategies for Assessment, Crisis Intervention, and Treatment. This course is made available by the CDP to both military and civilian mental health professionals in an effort to educate them about the most current and empirically-supported ways to manage suicidal and suicidal-related behaviors.
In teaching the course about suicide prevention and treatment, I have noticed that one area seems to be highly likely to generate confusion (and disagreement) among the participants. (If you are not familiar with the SDVCS, now would be a good time to look at the information at the following link so the comments in this blog will make sense.
http://www.dcoe.mil/content/Navigation/Documents/SPC2012/2012SPC-Matarazzo-etal-SDVCS_Training.pdf
Notice that there is a modifier “interrupted by self or other” that can apply to non-suicidal self-directed violence, undetermined self-directed violence, and suicidal self-directed violence. The idea here is that in each of these categories, the behavior in question is interrupted (i.e., cut short, prevented, stopped). This interruption may originate from the person engaging in the self-directed violence or some other person or circumstance. The key here is that the self-directed violence does not occur if it’s interrupted.
Here are some examples that may clarify:
Question: “If a person takes 50 Tylenol tablets, then calls 911, isn’t that considered ‘interrupted by self’?”
Answer: No. Because the pills were ingested, a suicide attempt actually occurred. Had the pills been lined up on the counter, or even put in one’s mouth and spit out, the behavior would have been interrupted.
Question: “If a person is discovered unconscious in his/her car in the garage with the car running by a friend, is that considered “interrupted by other?”
Answer: No, in this case a suicide attempt actually occurred.
It may be helpful to differentiate “interrupted” from “rescue.” In the above examples, the suicide attempt was carried out, not interrupted. However, there was a post-attempt rescue in both cases, one by the individual him/herself and one by another person.
Regina Shillinglaw, Ph.D., is a Deployment Behavioral Health Psychologist with the CDP. She is located at Wright Patterson Medical Center in Ohio, where she is a faculty member and the assistant training director of the APA-approved pre-doctoral psychology internship training program.
Reference:
Brenner, L. A., Breshears, R. E., Betthauser, L. M., Bellon, K. K., Holman, E., Harwood, J. E. F., et al. (2011). Implementation of a suicide nomenclature within two VA healthcare settings. Journal of Clinical Psychology in Medical Settings, 18(2), 116-128.