Asking Patients About Suicide Narrative May Improve Long-Term Outcomes


It is well known that people who have a history of attempted suicide are at a heightened risk for a subsequent attempt. To reduce this long-term risk, Konrad Michel, M.D., a professor emeritus of the University Hospital of Psychiatry in Bern, Switzerland, says psychiatrists need to rethink suicide prevention treatments.

“If we want to become more effective in preventing suicide, we need to think outside of the box,” Michel said Sunday during a lecture at APA’s Annual Meeting.

Placing greater emphasis on a patient’s narrative of the feelings leading up to a suicide attempt may not only strengthen the therapeutic alliance, but create a foundation from which safety planning and long-term outreach can be maintained, he explained.

Michel and colleagues had these factors in mind when they developed the Attempted Suicide Short Intervention Program (ASSIP)—a highly structured, manual-based therapy program consisting of three face-to-face sessions followed by regular, personalized letters sent to the patients over two years. During the lecture, Michel described how to carry out ASSIP, which is meant to be used in combination with pharmacotherapy and/or psychotherapy, and addressed challenges of implementation into clinical practice.

“ASSIP is based on the concept of suicide as a goal-directed action that arises when an individual is in a state of mental pain or anguish with vital goals or needs being seriously threatened,” he told Psychiatric News. “It draws on the capability of individuals to explain the background leading to their suicide attempt by sharing their story to an attentive and empathic listener, leading to the realization that alternative actions could have been possible. This material is utilized in future safety planning. Most importantly, this process builds a powerful therapeutic working alliance, the key element of ASSIP.”

Michel described a recent randomized, controlled trial comparing 120 patients who attempted suicide assigned to ASSIP and treatment as usual with those assigned only to treatment as usual. The trial found patients in the ASSIP group had an 80 percent reduced risk of repeating suicide attempts during the 24-month follow-up period (p < 0.001) and 72 percent fewer days spent in the hospital (p = 0.038). Higher scores of patient-rated therapeutic alliance were associated with a lower rate of repeat suicide attempts.

“ASSIP is a brief and low-cost therapy program that has a considerable potential to reduce suicidal behavior and health care costs,” Michel said. “Additionally, the concept of suicide as an action, which is easy to understand for non-professionals, may also be helpful in general clinical practice as well as in population-based suicide prevention.”

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