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Artificial Intelligence for Suicide Prediction

Suicide is a global problem that causes 800,000 deaths per year worldwide. In the United States, suicide rates rose by 25 percent in the past two decades, and suicide now kills 45,000 Americans each year, which is more than auto accidents or homicides.

Traditional methods of predicting suicide, such as questionnaires administered by doctors, are notoriously inaccurate. Hoping to save lives by predicting suicide more accurately, hospitals, governments, and internet companies are developing artificial intelligence (AI) based prediction tools. This essay analyzes the risks these systems pose to safety, privacy, and autonomy, which have been under-explored.

Two parallel tracks of AI-based suicide prediction have emerged.

The first, which I call “medical suicide prediction,” uses AI to analyze patient records. Medical suicide prediction is not yet widely used, aside from one program at the Department of Veterans Affairs (VA). Because medical suicide prediction occurs within the healthcare context, it is subject to federal laws, such as HIPAA, which protects the privacy and security of patient information, and the Federal Common Rule, which protects human research subjects.

My focus here is on the second track of AI-based suicide prediction, which I call “social suicide prediction.” Though essentially unregulated, social suicide prediction uses behavioral data mined from consumers’ digital interactions. The companies involved, which include large internet platforms such as Facebook and Twitter, are not generally subject to HIPAA’s privacy regulations, principles of medical ethics, or rules governing research on human subjects.

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Patient Safety in Mental Health Care

By John Tingle

Mental health care is a high government NHS priority. There is a real drive to rob this care area of its Cinderella image. Mental health care should not now be seen as the poor relation of acute physical care in terms of resource allocation as it has been seen in the past. However, a recent report by the Health and Social Care Regulator of England, the Care Quality Commission (CQC) seems to push this care area back into the Cinderella limelight again with the finding that sexual incidents appear commonplace on mental health wards in the NHS. The CQC is a very important health and social care regulator in England and it produces excellent reports on health care quality and patient safety. The organisation makes sure health, social care services provide people with safe, effective, compassionate, high-quality care, and they encourage care services to improve.

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Patient Safety, Health Quality and Learning Disability

By John Tingle

Tragic stories of mental health care failings leading to injury and in some cases death have featured strongly in the English media in recent years. The reports reveal common threads such as poor resources, inadequate staffing levels, limited service availability, poor inter-agency cooperation, poor patient engagement, poor understanding of the Mental Capacity Act 2005 and so on. This care area seems to largely remain a Cinderella health care service provision, existing in the shadows, with the focus being predominantly on physical acute care. There are however now welcome and firm Government commitments to drive improvement into mental health care supported by a raft of promising initiatives.

When patient stories of learning disability and autism care failings are read from several reference sources a picture emerges. Care for people with learning disability and autism can be seen to share many of the patient safety and health quality problems that beset patients who are classified as being mentally ill: Read More

The Health Service Ombudsman: NHS Failing Patients with Mental Health Problems

By John Tingle

Failings in National Health Service (NHS) care for patients with mental health problems is a worryingly persistent story in the English media. Many reports show harrowing and dramatic failings in NHS care provision for the mentally ill some of which result in avoidable deaths.The Health Service Ombudsman  (HSO) represents the final stage in the NHS complaints procedure and is an independent  office reporting  directly  to Parliament.The HSO carry’s out investigations into complaints  and makes the final decisions on those that have not been resolved by the NHS in England.In a recently published report the HSO reveals reveals unjust, shocking and tragic failings  in NHS care provision for patients with mental health problems.Some mental health care complaints figures are given in the report.In 2016-2017 there were 14,106 complaints made to NHS mental health trusts (hospitals) with ,65% being upheld or partly upheld by the local organisation.Case work data between 2014-15 and 2017-18 was analysed and five key themes showing persistent failings that the HSO see in complaints being made emerged from this exercise:

  • Diagnosis and failure to treat.
  • Risk assessment and safety
  • Dignity and human rights.
  • Communication.
  •  Inappropriate discharge and provision of aftercare.

The HSO also points out in the report that the other common factor in the cases examined is too frequent substandard complaint handling by the NHS organisation. This adds insult to injury, compounding the impact of failings. Read More

Taking action to prevent male suicide

By John Tingle

The issue of male suicide and prevention seems to have been an obscured or perhaps even a forgotten issue in reports discussing the care of vulnerable people. The UK media have recently focussed on this issue with the Project Eighty-Four campaign. This campaign  aims to raise awareness of male suicide with sculptures being placed on the top of a London tower block to mark this. The sculptures are on the top of ITV’s (Independent Television ) Buildings on London’s Southbank Promenade from 26th March 2018.The sculptures are designed to get people talking about the issue. Friends and families of the deceased men helped create them: “Each one, a poignant reminder of a real life lost and a call to society to come together and ultimately take a stand against male suicide.

BBC News has also covered the event. Project Eighty Four states that the statistics on male suicide are shocking. Every two hours a man in the UK takes his own life. Project Eighty Four is an initiative of the charity CALM (Campaign Against Living Miserably).CALM is dedicated to preventing male suicide and they say that male suicide and mental health is a big issue that cannot be ignored for any longer.

Interestingly they report in latest annual report and accounts a modest but noticeable increase in the number of female callers for help and advice. CALM’s focus is on men because of the high rate of male suicides.Helpline workers helped to directly prevent 409 suicides in 2016-17, up 19% on the previous year. Read More

Improving Mental Health Care in the NHS

By John Tingle

The Guardian newspaper recently published it’s investigation into Coroners Prevention of Future Deaths Notices (PFDN’s) issued between 2012-2017 involving people receiving NHS care for mental health conditions. The findings from its investigation are shocking; many cases deaths could have been prevented had better care been given. Some errors identified are classic patient safety errors and these included:

  • Poor communication between agencies and/or staff, non-observation of protocols or policies (or lack of protocols or policies.
  • Lack of appropriate care or continuity of care.
  • Poor record keeping, poor communications with the patient or his or her family.
  • Insufficient risk assessment  and delays.

The investigation revealed 45 cases reported by the coroner where patients were discharged too soon or without adequate support. Seventy-two instances of poor or inappropriate care, 41 cases where treatment was delayed.

Children and young people’s mental health
The Care Quality Commission (CQC) is the the independent regulator of health and social care in England and they have recently reviewed children and young people’s mental health services and have found significant systems failures which could well put children and young people at risk of harm. Mental health problems are the report states, quite common in children and young people with estimates suggesting around 1 in 10 being affected.

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Failings in care for patients being treated under the Mental Health Act 1983

By John Tingle

The Care Quality Commission (CQC)  is the independent regulator of health and social care in England and they have recently produced their annual report to Parliament on how health services are applying the Mental Health Act 1983 (MHA) .This report, shines a very strong light on failing health care practices in mental health care relating to the  MHA. Shocking failures are revealed and the errors are compounded by the fact that the poor practices have been identified in previous reports and are long standing in nature.

The CQC state that national data from the last 25 years shows an increasing use of the MHA to treat people in hospitals. From 2005/06 to 2015/16, the reported number of uses of the MHA to detain people in hospital increased by 40%. There was a 9% increase from 2014/15 to 2015/16 rising to 63,622 uses of the MHA. The CQC can find no single cause for the increases in detention rates over the last 10 years.

The CQC once again draw attention to the persistent theme present in its previous reports of black and minority ethnic over representation figures in the use of the MHA.

The CQC found that there are still services that continue to fail in their legal duties to give patients information about their rights, verbally and in writing as soon as possible after their detention or community treatment order commences. They found no evidence that staff had discussed rights with the patient on admission in 11 % (378) of patient records that they checked. In a further inspection of 9%, (286) of records, no evidence could be found to say that patients received the information in an accessible format.

Consent to treatment

The CQC state that they have concerns about whether the patient consents, refuses consent or is incapable of consent. They expect to see capacity assessments to support views and possibly evidence that staff have considered ways in which they could help the patient gain or regain capacity. They have frequently raised concerns over whether clinicians have recorded evidence of their conversations with patients who are detained over their proposed treatment and their views. Read More

“Ex-Gay” Speaker, Attempted Suicide, and HCSMs

On February 16, Jackie Hill-Perry, an outspoken speaker against homosexuality, delivered a controversial, unapologetically homophobic speech at Harvard’s Emerson Hall. Harvard College Faith and Action, the religious student group that invited Hill-Perry, reserved all the center-front seats for attendees “engaged in protest,” who were “welcomed” to their space of worship. This seemingly beneficent seating arrangement, however, allowed many protestors wearing rainbow flags to experience 30 minutes of worship songs with references to sin and redemption, before having a close-encounter with Hill-Perry. The emphatic speaker then recounted her own journey from initially accepting her same-sex attraction to her eventual embrace of heteronormativity due to her rediscovered Christian faith. A few protestors stormed out of the lecture hall during the height of her speech, when she called same-sex attracted Christians to practice “self-denial,” the same way a Christian would deny lying, stealing, and other grave “sins.”

As undergraduate and graduate students at Harvard, we are fortunate to have access to resources that may help us deal with and recover from the detrimental effects from a hate-filled speech like this. Though far from perfect, we do have at least a limited access to mental health services and other support groups on campus. Intellectually, we have academic resources that could dispute the religious reasoning behind homophobia. In his opening question for Hill-Perry, Professor Jonathan Walton of the Memorial Church quickly challenged the flawed theology Hill-Perry relied on, revealing the parallels between biblically justified racism to biblically justified homophobia. Some students from the audience also pointed out several logical missteps in her reasoning, which led Hill-Perry exclaim how “smart” people at Harvard are. Perhaps, she wasn’t used to speaking to a highly academic audience during her tours. Nonetheless, many non-protesting members of the audience, presumably members of the Harvard Christian group, did nod and clap during her speech. If her remarks could resonate with these Harvard students, how much more persuasive would it be in Christian conferences and churches? Who could stand up for LGBT people, especially the youth, in evangelical communities?

It has long been demonstrated that LGBT youths have a much higher suicide and attempted suicide rate comparing to their heterosexual counterparts in the United States and abroad. They are also significantly more likely to suffer from mental health issues ranging from depression to self-harm. Moreover, those living in evangelical families or communities where homophobia is still prevalent are especially vulnerable. Listening to a speech like the one delivered by Hill-Perry may worsen their daily struggles and increase their risk of suicide. Given these health risks of LGBT youths, we might expect that evangelical leaders who “love the sinner but hate the sin” would at least care about the health and safety of these minors, or simply respect their dignity as human beings. However, the reality could be far gloomier, falling short of these minimum expectations. The rest of the essay will turn the discussion toward how LGBT youths might be treated under the practices of Christian health-sharing ministries (HCSMs).

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