The discursive construction of 'suicide' and the effects for clinical practice

In mainstream mental health services, the current approach to suicide prevention is often based on ‘risk’ management, the identification and treatment of mental health problems. Critics have argued that using this pathological/risk framework is inherently problematic; limiting the ways in which service-users and professionals are able to work together to understand suicide, contributing to service-user dissatisfaction and professional burnout. The current study aimed to critically examine the accounts of professionals, to explore how the concept of ‘suicide’ was constructed in language, together with the effects of those constructions for both thinking and practice. Semi-structured interviews were conducted with six clinical psychologists and four psychiatrists working in adult mental health services. Transcripts were studied using a method of Critical Discourse Analysis. Three dominant discourses; “not in your ‘right’ mind”, “blame” and “human-rights” and two subjugated discourses; “contextualising” and “fostering hope” were identified. Professional accounts drew on multiple, competing discourses. Suicide was dominantly constructed as the final act of an unbalanced mind, with the causes and solutions located within the individual and requiring ‘expert’ treatment; however resistances to the dominant discourse were also at work. Subjugated discourses opened up language to embed new meanings, legitimized different perspectives and explored other ways of ‘knowing’ about suicide. The study’s limitations are discussed, together with implications for clinical practice and future research.