1 Centre for Rural and Remote Mental Health, The University of Newcastle, Orange, New South Wales, Australia.
2 Sydney Nursing School, The University of Sydney, New South Wales, Australia.
Int J Health Serv. 2018 Jan;48(1):189-203. doi: 10.1177/0020731417716086. Epub 2017 Jun 26.
The medical model continues to dominate research and shape policy and service responses to suicide. In this work we challenge the assumption that the medical model always provides the most effective and appropriate care for persons who are suicidal. In particular, we point to service user perspectives of health services which show that interventions are often experienced as discriminatory, culturally inappropriate, and incongruent with the needs and values of persons who are suicidal. We then examine "humanistic" approaches to care that have been proposed as a corrective to an overly medical model. We argue that the focus on improving interpersonal relations set out in humanistic approaches does not mitigate the prevailing risk management culture in contemporary suicide prevention and may impede the provision of more effective care. Finally, we draw attention to the tradition of non-medical approaches to supporting persons who are suicidal. Using Maytree (a U.K. crisis support service) as a case study, we outline some of the key features of alternative service models that we consider central to the design of more culturally appropriate and effective interventions. We conclude by making three key recommendations for improving services to persons who are suicidal.
医学模式继续主导着自杀的研究，并影响政策和服务的制定。在这项工作中，我们质疑这样一种假设，即医学模式总是为有自杀倾向的人提供最有效和最合适的护理。特别是，我们从服务使用者的角度来看待卫生服务，这些服务表明干预措施往往被视为歧视性的、文化上不适当的，并且与有自杀倾向的人的需求和价值观不一致。然后，我们研究了“人本主义”的护理方法，这些方法被认为是对过度医学模式的一种纠正。我们认为，人本主义方法中强调改善人际关系，并不能减轻当代预防自杀工作中普遍存在的风险管理文化，反而可能会阻碍更有效的护理的提供。最后，我们提请注意非医学方法支持有自杀倾向的人的传统。我们使用 Maytree（英国的一个危机支持服务）作为案例研究，概述了我们认为是更具文化适应性和更有效的干预措施设计的关键替代服务模式的一些特征。最后，我们提出了改善对有自杀倾向者服务的三项关键建议。
