Konrad Michel

Universität Bern | UniBe

Studies indicate that the quality of the doctor–patient relationship moderates the effect of pharmacotherapy. To enhance the quality of the therapeutic relationship in the pharmacotherapy of depression, we developed a brief manual with interactive materials for residents in psychiatry and their patients. In a pilot study at a psychiatric university...

Konrad Michel, a leading psychiatrist and acclaimed expert, draws on decades of experience to offer necessary new ways of understanding and preventing-suicide. After one of his first patients died by suicide, Michel devoted himself to researching self-harm. Writing vividly and personally, he recounts more than forty years of working with and learni...

Suicide is the leading cause of death among Swiss adolescents. Often, a suicide attempt is the outcome of a "suicidal process" at the end of which death is perceived as the only means of escaping from intolerable psychic pain. A suicide attempt entails a high risk of repetition. AdoASSIP, a brief adjunctive therapy adapted for adolescents, which is...

Objective The Attempted Suicide Short Intervention Program (ASSIP) was adapted for hospital delivery and to address substance use problems as well as evaluated for feasibility, acceptability, and therapist fidelity in a series of preparatory steps (n = 28) and in a pilot randomized controlled trial, RCT (n = 34). Method In the RCT, patients with s...

Theoretical models of suicide are based on risk factors associated with suicide, such as psychiatric pathology, genetics, epigenetics, functional brain disorders, and impaired decision making. In current clinical practice, the predominant risk model is the medical model, which posits that treating suicide risk is primarily a matter of treating psyc...

Background Disorders of mental health are major risk factors for suicidal behavior and require adequate treatment. However, the effect of psychotropic medication on suicidal behavior is unclear. Methods The 120 participants in a randomized clinical trial of a brief therapy for suicide attempters (Attempted Suicide Short Intervention Program, ASSIP...

When faced with a patient who may have suicide ideas or plans, clinicians usually perform a suicide risk assessment. However, short-term suicide prediction is a virtually impossible task. Suicidal individuals often deny suicidal plans, even when the issue is addressed directly by the clinician. An important aspect of the communication problem betwe...

Suicide is a complex process understood as anchored somewhere on the continuum between a conscious decision, on the one hand, and an illness, on the other [1]. We see action, and thus any suicide actions, as an integrative process of manifest behaviour, internal processes and social meaning thus overcoming the Cartesian dualism [2] of some psycholo...

This article aims to investigate helpful relationship characteristics in suicide attempt health care. Semistructured interviews with seven participants (five women and two men; meanage = 26) were conducted after a suicide attempt. All participants took part in the Attempted Suicide Short Intervention Program (ASSIP). Findings revealed the necessity...

Importance This is the first cost-effectiveness analysis of a brief therapy, the Attempted Suicide Short Intervention Program (ASSIP), for individuals who attempt suicide. Objective To explore the cost-effectiveness of the ASSIP intervention in the context of the Swiss health care system. Design, Setting, and Participants In this economic evaluat...

Suicide is a complex process understood as anchored somewhere on the continuum between a conscious decision, on the one hand, and an illness, on the other [1]. We see action, and thus any suicide actions, as an integrative process of manifest behaviour, internal processes and social meaning thus overcoming the Cartesian dualism [2] of some psycholo...

Background: The internal suicide debate hypothesis assumes that in a suicidal crisis, individuals are involved in an internal struggle over whether to live or die. Reasons for living (RFL) and Reasons for dying (RFD) are important individual reasons for staying alive (e.g. family) or wanting to die (e.g. hopelessness) and reflect this internal mot...

Objective The development of individual coping strategies for suicidal crises is essential. But the association between risk reduction after a brief intervention and the effect on coping strategies are largely unknown. This study aims to investigate the influence of the brief therapy ASSIP (Attempted Suicide Short Intervention Program) on the devel...

This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP—Attempted Suicide Short Intervention Program). Key elements are an early therapeutic alliance, narrati...

The participants’ study participation experiences in an intensive research methodology that examined recent aborted suicide attempts were explored. Individuals aged 18 or above and whose suicide attempts were voluntarily aborted after the suicide crisis negotiation with the police negotiators were interviewed and followed up at 1 and 3 months after...

It has been suggested that suicidal persons engage in distorted thinking. We propose that suicide can be understood as a distorted goal-directed action. The purpose of this qualitative study was to identify the specific distortions in the goal-directed processes of suicide as indicated in suicide narratives of 40 persons after a suicide attempt. Th...

Objective: To investigate the role of therapeutic alliance on suicide ideation as outcome measure in a brief therapy for patients who attempted suicide. Method: Sixty patients received the three-session therapy supplemented by follow-up contact through regular letters. Therapeutic alliance was measured with the Helping Alliance Questionnaire (HA...

This article describes the application of a dual-regulation model to a case example of a female suicide attempter. The model complements the traditional goal-and-feedback view with self-organizing processes, which may help to better understand the suicidal process. From this view, impulsive suicidal behavior can be interpreted as a dysfunctional pa...

Background: Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal beh...

Original trial protocol for ethics committee, May 22, 2009. (PDF)

Homework task: “Suicide Is Not a Rational Act.” From: Michel K, Gysin-Maillart A. ASSIP—Attempted Suicide Short Intervention Program: a manual for clinicians. Goettingen: Hogrefe Publishing; 2015. pp. 93–96. http://doi.org/10.1027/00476-000. Reproduced with permission from Hogrefe Publishing (http://www.hogrefe.com) (PDF)

CONSORT checklist of items for reporting trials of nonpharmacologic treatments. (PDF)

Objectives: To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. Method: As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tes...

Limited research exists on internal risk processes in suicide at- tempters and factors that distinguish them from nonsuicidal depressive individ- uals. In this qualitative study, we investigated Plans, motives, and underlying self-regulatory processes of the two groups and conducted a comparative analysis. We analyzed narrative interviews of 17 sui...

To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups. Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitorin...

Objective: Suicide attempts are important predictors of completed suicide. Adolescents admitted to the emergency room of a large university hospital in Bern after a suicide attempt during the years 2004-2010 were prospectively assessed for methods of suicide attempt. Method: Adolescents (N = 257; 66.5% female; age 14-21 years), presenting after...

This report describes the investigation of care recommendations in the medical system across European countries to immigrants who attempted suicide. Data from seven European countries with 8865 local and 2921 immigrant person-cases were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour and ensuing MONSUE (Monitoring Suicidal Behavio...

Ausgehend von der Untersuchung einer auf den ersten Blick irritierenden Intervention einer Therapeutin im Erstgespräch mit einer Patientin nach Suizidversuch gehen die Autoren der Frage nach, was diese Intervention humorvoll macht und was eine solche, potenziell riskante Intervention für die Entwicklung der Begegnung bedeuten kann. Anhand der gespr...

Objectives: To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. Method: As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tests...

Studies report high rates of suicide attempts for female immigrants. This study assesses variations in the distribution of suicide attempts across gender in immigrant and non-immigrant groups in Europe. Method: Data on 64 native and immigrant groups, including 17 662 local and 3755 immigrant person-cases collected, between 1989 and 2003, in 24 mill...

This is a pilot study whose objective was to collect data on attempted suicide in 5 districts of Shanghai and to test the feasibility of introducing an ongoing monitoring of attempted suicide. Data on a total of 363 cases were collected. The mean age of the patients was 33 years, 67% being female. Ingesting drugs or other chemical substances was th...

IntroductionThe Communication of Suicidal IntentAssessing Suicide Risk: Patient-Oriented versus Physician-Oriented ApproachTherapeutic Alliance: Some BasicsTherapeutic Alliance with the Suicidal PatientUnderstanding Suicide as Goal-Directed BehaviourWhere the Truth Lies: Narrative InterviewingThe Provision of a Secure Base: Long-term AnchoringConcl...

This study compares the frequencies of attempted suicide among immigrants and their hosts, between different immigrant groups, and between immigrants and their countries of origin. The material, 27,048 persons, including 4,160 immigrants, was obtained from the WHO/EURO Multicentre Study on Suicidal Behaviour, the largest available European database...

Suicide is a poorly understood phenomenon. A clinical model of suicide conceptualizes suicidal behavior as a solution to an unbearable state of mind, experienced as mental pain. In order to investigate the neural correlates of suicidal behavior, we used fMRI during presentation of autobiographical scripts extracted from personal narratives reactiva...

In the course of their lives individuals may encounter the phenomenon of suicide in various ways, for example, directly through suicidal behavior in the family or among peers; or indirectly through hearsay, the media, literature, etc. The study investigates such memory traces (engrams) in patients with and without a suicide attempt. Ten patients fr...

The usual clinical practice When clinicians are called to see a patient who has attempted suicide, they usually try to assess the risk of further suicidal behaviour by interviewing the patient in their search for clinical risk factors, particularly for signs of a psychiatric disorder, such as depression, substance abuse, severe personality disorder...

The goal of the study was to determine social and diagnostic characteristics of persons who end their lives by jumping from heights and to compare the characteristics of those who jump from bridges with those jumping from other sites. Data on suicide in Switzerland between 1990 and 2003 were collected from the Swiss Federal Statistical Office and f...

IntroductionThe Communication of IntentSuicide Risk FactorsModels to Understand Suicidal BehaviourKnowledge and AttitudesAvailability and ContinuityThe Use of Medication in Primary CareHigh-Risk Patients May Need AdmissionConclusions References

Rates of suicide by jumping show large regional differences. Barriers on bridges may prevent suicides but also may lead to a substitution of jumping site or method. The aim of our study was to compare suicide data from regions with and without suicide bridges and to estimate the effects on method and site substitution if bridges were to be secured....

Objective: The aim of the study was to examine the relationship between suicide attempts and major public holidays in Europe. Method The analysis was based on data on 24388 suicide attempts by persons aged 15 years or older in the period 1989–1996. Data from 13 centres (representing 11 countries) participating in the WHO/EURO Multicentre Study on P...

The associations between life events in the 12 months preceding an episode of self-poisoning resulting in hospital attendance (the index episode), and the suicide intent of this episode were compared in individuals for whom the index episode was their first, episode and in individuals in whom it was a recurrence of DSH. Results indicated a signific...

In an earlier paper [1] we reported on the patients’ own views about why they had attempted suicide. We made a distinction between reasons and causes which people give for their suicide attempt. Reasons (= motives) were most often expressed as “putting an end to an unbearable situation/state of mind”, which we interpreted as the expression of the m...

In the present study we examined to what extent persons who attempt suicide describe their attempt in terms of social, joint processes. Psychotherapists interviewed 40 patients hospitalized in a general hospital for a few days after an attempted suicide. The content of the interviews was analyzed for the level of systemic processes the patients ref...

Previous analyses of the narratives of 40 persons hospitalized in a general hospital after suicide attempt found that they described their suicide attempts as goal-directed processes, sometimes planned in advance, sometimes executed spontaneously. They also described short-term actions, mid-term projects, and long-term careers reflecting goal-direc...

Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. Method. As part of the WHO/EURO...

The city of Bern has a high percentage of suicides by jumping (28.6%). Related to other local hotspots, the highest number of deaths (mean 2.5 per year) is found at the Muenster Terrace in the old city. In 1998, after a series of suicides, a safety net was built to prevent people from leaping from the terrace and to avoid further traumatization of...

The paper presents a discussion between two therapists—one female, the other male, one a clinical psychologist and the other a psychiatrist, one working in an institution and the other in a private practiceeach surviving the suicide of a client. It discusses what helped

Introduction: Conceptualizing suicide and suicide prevention processes in terms of goal-directed systems as actions, projects and careers we address subjective, manifest and social processes (Michel and Valach, 2001; Valach et al., 2002). To work within these perspectives we employ systematic observation in studying manifest actions (Valach et al.,...

It is suggested that health promoting as well as health detrimental behaviours are organized in goal-directed systems of actions, projects and career. To a certain extent this is widely accepted as it is generally shared that a change towards a healthy lifestyle requires an intentional and goal-directed action. It is maintained that between these t...

This study investigated the usefulness of an action theoretical model of suicide in interviewing suicide attempters. Eighteen interviews were video-recorded and transcribed. The patients' narratives were reconstructed and life-career issues relevant for the patient's suicidality formulated. Skin conductance response was used to determine narrative...

In many European countries suicidal behaviour constitutes a major public and mental health problem and a considerable drain on resources in both primary and secondary health care settings. To implement effective suicide prevention programmes reliable data about the magnitude of the problem and time series of these data are needed. The WHO/Europe st...

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A literature search was conducted to collect randomized controlled studies evaluating the outcome of psychological and psychosocial interventions after attempted suicide and deliberate self-harm. Twenty-five studies meeting the inclusion criteria were identified. The studies are grouped according to the psychological approach chosen for the interve...

The aim of this study was to compare patterns of contact made by patients with GPs and other healthcare professionals in two European cities prior to attempting suicide. The objective was to determine whether differences between a public and a private healthcare system could be a possible factor influencing the help-seeking behaviour of suicide att...

The aim of this study was to assess any predictive factors for repeated attempted suicide and completed suicide in a 1-year follow-up on a sample of elderly European suicide attempters (60 years and over). From 1990 to 1993, 63 subjects completed the first interview and were recontacted after 1 year. At follow-up, eight subjects (12.7%) had taken t...

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant dif...

Psychiatric and psychological assessment after parasuicide is characterized by a number of difficulties. The interview is a strategically complex task for the patients trying to accommodate the wishes of the psychiatrist/psychologist and their own goals. The psychiatrist/psychologist on the other hand needs to gain information about the event and t...

The findings of an international workshop on improving clinical interactions between mental health workers and suicidal patients are reported. Expert clinician-researchers identified common contemporary problems in interviews of suicide attempters. Various videotaped interviews of suicide attempters were critically discussed in relation to expert e...

Examined whether differences between public and private health care systems influence the help-seeking behavior of suicide attempters. 101 suicide attempters (mean ages 33.4 and 36 yrs) residing in Pecs, Hungary, and 66 suicide attempters (mean ages 38.5 and 38.8 yrs) residing in Bern, Switzerland, completed interviews concerning patterns of contac...

Objective The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989–93).Methods Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating cent...

Data on recommended care for young people aged 15–19 years after attempted suicide from nine European research centres during the period 1989–1992 were analysed in terms of gender, history of previous suicide attempt and methods used. Altogether 438 suicide attempts made by 353 boys and 1,102 suicide attempts made by 941 girls were included. Analys...

National suicide statistics show remarkable differences in the frequencies of various methods used for completed suicide. The WHO/EURO Multicentre Study on Parasuicide makes possible for the first time an international comparison of the frequencies of methods used in attempted suicide, because the data are based on geographical catchment areas of m...

As part of the WHO/EURO Multicentre Study on Parasuicide, the level of suicide intent among female and male parasuicide patients from various European regions was compared. From nine regions, a total of 1,212 parasuicide patients, 752 females and 460 males, were included in the study. Although some statistical significant differences in level of su...

This study was conducted to support the publication of guidelines for media reporting on suicide. First, quantitative and qualitative aspects of suicide reporting in Swiss print media were surveyed over a time span of 8 months. The results were presented at a national press conference, and written guidelines for suicide reporting were sent out to a...

In order to measure social support among suicide attempters, an instrument was especially designed to be included in the follow-up interview study being part of the WHO/Euro Multicentre Study on Parasuicide which is carried out in cooperation with EC Concerted Action on Attempted Suicide. In this paper, which is to be the first in a series, the the...