WEBVTT Kind: captions; Language: en 1 00:00:39.240 --> 00:00:44.000 Selma, Karl loman, Petrus, dilal Suter Welcome to the public 2 00:00:44.000 --> 00:00:46.880 examination of Selma Karl Loman's dissertation. 3 00:00:46.880 --> 00:00:49.280 Co constructing recovery in Switzerland. 4 00:00:49.280 --> 00:00:53.480 Crises service users perspectives on healthcare and 5 00:00:53.480 --> 00:00:57.720 crisis services after suicidal attempt. 6 00:00:57.720 --> 00:01:17.720 The opponent is Professor Virginia. 73 00:18:55.240 --> 00:18:55.240 professor as the opponents appointed 74 00:18:55.240 --> 00:18:55.240 by the faculty please present the comments that 75 00:18:55.240 --> 00:18:55.240 you see my dissertation has given grounds for is it on dear gustos dear 76 00:18:55.240 --> 00:18:55.240 members of the faculty of psychology dear doctoral candidate dear ladies 77 00:18:55.240 --> 00:18:55.240 and gentlemen first of all I would like to 78 00:18:55.240 --> 00:18:55.240 thank the faculty of psychology for inviting me to examine Selma Gaily-Luoma's thesis and 79 00:18:55.240 --> 00:18:57.040 particularly. 80 00:18:57.040 --> 00:19:02.840 Professors Arnolai Tila and Yuka Holma who have helped me through the process. 81 00:19:02.840 --> 00:19:05.680 I have long standing contact with colleagues at the School 82 00:19:05.680 --> 00:19:08.840 of Psychology of the University of Yuvascula. 83 00:19:08.840 --> 00:19:13.120 I have been following the work you have been doing here on topics of 84 00:19:13.120 --> 00:19:16.600 clinical psychology and psychotherapy and have been impressed with 85 00:19:16.600 --> 00:19:21.040 how systematic and how innovative this work is. 86 00:19:21.040 --> 00:19:26.600 I have visited you Vascular before few years ago and I'm pleased to be here again to 87 00:19:26.600 --> 00:19:31.280 see colleagues and to keep in touch with the developments in research and clinical training 88 00:19:31.280 --> 00:19:36.480 that take place here and which are always an inspiration for me. 89 00:19:36.480 --> 00:19:43.000 I am very happy to act as opponent in the oral examination of Selma GAIL Roma's thesis. 90 00:19:43.000 --> 00:19:47.040 I had the opportunity to engage with it as pre examiner and thus 91 00:19:47.040 --> 00:19:51.600 to appreciate the quality of her research project. 92 00:19:51.600 --> 00:19:58.280 In all, Miss Alma GAIL Iluma's thesis is original, well written and engaging. 93 00:19:58.280 --> 00:20:03.960 The dissertation explores the subjective views and experiences of persons using suicide 94 00:20:03.960 --> 00:20:09.280 prevention service regarding the healthcare services they have received. 95 00:20:09.280 --> 00:20:13.760 As such, it belongs to the growing trend of suicidology research, 96 00:20:13.760 --> 00:20:17.960 which is particularly developed in Finland. 97 00:20:17.960 --> 00:20:22.760 Although there has been extensive research both internationally and in Finland 98 00:20:22.760 --> 00:20:28.200 on the epidemiology and risk factors of suicidal behaviour, as well as on the 99 00:20:28.200 --> 00:20:33.280 effectiveness of suicide treatment and prevention programmes, most of the studies 100 00:20:33.280 --> 00:20:38.880 have been guided by the dominant evidence based medicine paradigm, neglecting 101 00:20:38.880 --> 00:20:42.840 the views and perspectives of service users. 102 00:20:42.840 --> 00:20:48.120 Although internationally the inclusion of service users perspective in healthcare services 103 00:20:48.120 --> 00:20:54.120 planning, evaluation and delivery is gaining ground, it seems that in the field of suicide 104 00:20:54.120 --> 00:20:59.320 prevention and especially in Finland, research is very limited. 105 00:20:59.320 --> 00:21:04.920 In this sense, this doctoral research that focuses on suicide survivors, 106 00:21:04.920 --> 00:21:09.480 suicide attempts, survivors experiences and views of their healthcare 107 00:21:09.480 --> 00:21:12.960 treatment is important and innovative. 108 00:21:12.960 --> 00:21:21.080 It generates new and valuable knowledge for the development of effective and 109 00:21:21.080 --> 00:21:29.400 user friendly suicide prevention services that address service users needs and concerns. 110 00:21:29.400 --> 00:21:33.400 In terms of my own positioning with regard to this research, I am 111 00:21:33.400 --> 00:21:37.480 familiar with Physiology but not an expert in it. 112 00:21:37.480 --> 00:21:42.560 My work focuses on the severe mental disorders seen from clinical psychosocial 113 00:21:42.560 --> 00:21:47.800 perspective and on the development of recovery oriented mental health services 114 00:21:47.800 --> 00:21:51.520 that are responsive to service users needs and goals. 115 00:21:51.520 --> 00:21:57.560 Using mainly qualitative research, reading through the thesis, I found lot of 116 00:21:57.560 --> 00:22:02.840 similarities between the field of suicide prevention that is studied here and trends 117 00:22:02.840 --> 00:22:06.880 in the field of mental health service provision generally. 118 00:22:06.880 --> 00:22:13.680 I will draw upon this background knowledge when I comment on Selma's work later. 119 00:22:13.680 --> 00:22:18.440 The thesis makes use of all the advantages of qualitative research on the effectiveness 120 00:22:18.440 --> 00:22:25.640 of clinical and psychosocial interventions, it prioritises, respects and highlights service 121 00:22:25.640 --> 00:22:32.200 users perspectives and it investigates the interactional processes that are involved in 122 00:22:32.200 --> 00:22:37.840 meaning making and in shaping mental and social reality. 123 00:22:37.840 --> 00:22:44.640 The strength of the thesis, in my view, is showing how how recovery is Co constructed in the 124 00:22:44.640 --> 00:22:51.600 context of suicide crisis services between suicide survivors and professionals. 125 00:22:51.600 --> 00:22:58.000 The thesis demonstrates the relational Co construction of recovery in two senses. 126 00:22:58.000 --> 00:23:03.560 Firstly, how the recovery of suicide survivors is promoted through collaborative 127 00:23:03.560 --> 00:23:10.040 processes in the context of services and interventions, and secondly, how the 128 00:23:10.040 --> 00:23:16.160 meaning of recovery from suicide attempt and the reasons for the suicide attempt 129 00:23:16.160 --> 00:23:20.440 are constructed in the therapeutic interactions. 130 00:23:20.440 --> 00:23:25.920 This of course stresses the role of services and professionals in recovery, and the findings 131 00:23:25.920 --> 00:23:31.400 of this doctoral research may lead to very specific suggestions about the ways in which 132 00:23:31.400 --> 00:23:36.600 professional interventions can become recovery oriented. 133 00:23:36.600 --> 00:23:41.360 The other strength of the study is related to your genuinely reflexive engagement with 134 00:23:41.360 --> 00:23:47.560 your doctoral work and the frankness with which you depict your personal motivations, thoughts, 135 00:23:47.560 --> 00:23:52.560 and aims as mental health professional and as researcher. 136 00:23:52.560 --> 00:23:58.280 In this work, I find some of the best examples of reflexive analysis that avoids the confessional 137 00:23:58.280 --> 00:24:05.840 mode of simply noting one's personal input, but really weaves yourself in its various roles and 138 00:24:05.840 --> 00:24:11.320 dimensions into the design, execution, and writing up of the study. 139 00:24:11.320 --> 00:24:16.800 Moreover, this is done in a very thoughtful and engaging way. 140 00:24:16.800 --> 00:24:21.520 The strengths of the thesis that I described before at the same time 141 00:24:21.520 --> 00:24:25.960 bring to the four tensions and open up issues for debate. 142 00:24:25.960 --> 00:24:30.000 In fact, most of the issues I would like to discuss with candidate 143 00:24:30.000 --> 00:24:34.560 in the oral examination centre around them. 144 00:24:34.560 --> 00:24:37.520 Before we begin our discussion, I would like to suggest that in the 145 00:24:37.520 --> 00:24:41.440 examination we addressed each other in first name terms. 146 00:24:41.440 --> 00:24:46.000 I hope this will help create a setting more conducive to dialogue, and 147 00:24:46.000 --> 00:24:50.280 it's also in line with the egalitarian values that for me, are very characteristic 148 00:24:50.280 --> 00:24:52.960 of the Finnish way of doing things. 149 00:24:52.960 --> 00:25:12.920 So let us begin the discussion. 150 00:25:12.920 --> 00:25:18.840 So starting from the introduction of the theoretical background, I would like 151 00:25:18.840 --> 00:25:24.080 to commend you on the comprehensive, well structured and clearly presented overview 152 00:25:24.080 --> 00:25:29.320 of suicidology research and specifically suicide prevention interventions and 153 00:25:29.320 --> 00:25:33.800 research both internationally and within Finland. 154 00:25:33.800 --> 00:25:39.880 Indeed, the sheer amount of research on suicide as well as the long standing national programmes 155 00:25:39.880 --> 00:25:45.440 and initiatives to develop prevention and intervention efforts make finding topic for original 156 00:25:45.440 --> 00:25:50.320 research on suicide prevention in Finland rather difficult. 157 00:25:50.320 --> 00:25:55.280 On the other hand, the scarcity of qualitative research on the perspectives 158 00:25:55.280 --> 00:25:59.520 of service of suicide survivors is staggering. 159 00:25:59.520 --> 00:26:04.280 This of course creates ample space for your study and makes your argument 160 00:26:04.280 --> 00:26:09.600 for the usefulness of qualitative studies even more important. 161 00:26:09.600 --> 00:26:14.760 I find this lack of qualitative studies surprising given the emphasis on qualitative 162 00:26:14.760 --> 00:26:21.680 care recovery oriented models of practise, developing trusting and respectful care relationships 163 00:26:21.680 --> 00:26:26.880 and prioritising service users perspectives that characterises mental health service 164 00:26:26.880 --> 00:26:32.280 delivery worldwide, including suicide prevention. 165 00:26:32.280 --> 00:26:35.880 On the other hand, it can be explained as you do when you discussing 166 00:26:35.880 --> 00:26:39.720 the findings of this study through the continuing dominance of the medical 167 00:26:39.720 --> 00:26:43.480 model and corresponding positivist research. 168 00:26:43.480 --> 00:26:49.320 So I would like to ask you, is the scarcity of qualitative research on suicide 169 00:26:49.320 --> 00:26:54.160 an international phenomenon or specific to the Finnish context? 170 00:26:54.160 --> 00:26:57.080 And could you elaborate a bit more on what you think 171 00:26:57.080 --> 00:27:01.800 are the most likely explanations for it? 172 00:27:01.800 --> 00:27:04.520 Thank you for that question. 173 00:27:04.520 --> 00:27:07.960 I will try to make concise answer to it. 174 00:27:07.960 --> 00:27:14.000 I think internationally it has been an international phenomenon as well, but I think 175 00:27:14.000 --> 00:27:21.800 internationally there has been in the last maybe 20 years fairly rapid accumulation 176 00:27:21.800 --> 00:27:25.800 of qualitative research on, on suicide prevention. 177 00:27:25.800 --> 00:27:30.040 And maybe in Finland we're lagging little bit behind that. 178 00:27:30.040 --> 00:27:35.600 Of course, there was two years ago doctoral thesis published on, 179 00:27:35.600 --> 00:27:40.640 on the experiences, service experiences or, or service expectations 180 00:27:40.640 --> 00:27:43.080 of suicidal adolescents and their parents. 181 00:27:43.080 --> 00:27:50.880 So, so I'm not the first one to to this ball in Finland either, but I do think that that there 182 00:27:50.880 --> 00:27:59.000 are for example, in the UK, they are a little bit ahead of us in, in this sense. 183 00:27:59.000 --> 00:28:07.160 Also, I think that that there have been a few qualitative research pieces on suicidal 184 00:28:07.160 --> 00:28:14.720 behaviour in Finland back during the suicide prevention programme in in the 90s. 185 00:28:14.720 --> 00:28:21.480 But those were not so much focused on the interactions between suicidal service users and services, 186 00:28:21.480 --> 00:28:25.560 but rather on the suicidal experience, which is of course very valuable. 187 00:28:25.560 --> 00:28:30.520 And perhaps that's something that's also has been going on in suicide research 188 00:28:30.520 --> 00:28:34.080 more widely, that there has been a focus first on trying to understand the 189 00:28:34.080 --> 00:28:37.760 suicidal experience as it happens inside the person. 190 00:28:37.760 --> 00:28:42.080 And then then there's shift in emphasis towards how that is constructed 191 00:28:42.080 --> 00:28:49.040 actually between people or or in relationships. 192 00:28:49.040 --> 00:28:53.880 You wanted reasons also. I now remember. 193 00:28:53.880 --> 00:28:58.200 Let's see if I can give you reasons. 194 00:28:58.200 --> 00:29:04.600 Well, I do think I do think that suicide prevention there, there is also kind of 195 00:29:04.600 --> 00:29:12.920 particular because of the risks associated with suicidal behaviour. 196 00:29:12.920 --> 00:29:21.680 There is there has perhaps been more of need to cling to the certainty that 197 00:29:21.680 --> 00:29:29.880 in some instances the idea of of there being this kind 198 00:29:29.880 --> 00:29:38.240 of way of, of classifying and and then treating kind of objecting these these diagnosable 199 00:29:38.240 --> 00:29:46.440 classes to treatments that have been proven to be effective for those for those conditions. 200 00:29:46.440 --> 00:29:51.200 That it's maybe little bit harder to let go of that idea in when there 201 00:29:51.200 --> 00:29:56.400 is the risk of suicide associated with with the situation. 202 00:29:56.400 --> 00:30:05.640 That I think perhaps that is why the recovery oriented ideas have maybe 203 00:30:05.640 --> 00:30:13.960 gained more ground or gained gained ground faster in other fields of mental health. 204 00:30:13.960 --> 00:30:17.840 So yes, I do think that that we are holding on in suicide prevention. 205 00:30:17.840 --> 00:30:27.360 We are more holding on to the idea that that kind of 206 00:30:27.360 --> 00:30:34.800 maybe fantasy that that we can have have the same kind of medical cures for these 207 00:30:34.800 --> 00:30:43.600 states as we can have for some some other conditions outside of of the field of mental health. 208 00:30:43.600 --> 00:30:46.880 And I think it's not only doctors that hold on to this hope. 209 00:30:46.880 --> 00:30:52.480 I think we are many of us psychologists and, and other professions and 210 00:30:52.480 --> 00:30:56.920 lay people also kind of look at the medical profession with great hopes 211 00:30:56.920 --> 00:31:02.840 for, for assessing risk as precisely as possible. 212 00:31:02.840 --> 00:31:07.840 And then having the cure that has been proven to be effective and and that can be delivered 213 00:31:07.840 --> 00:31:12.640 to the patients that they're suffering patient, regardless of what that patient wants, 214 00:31:12.640 --> 00:31:18.160 because that is of course, often trouble that that the suicidal person themselves are the 215 00:31:18.160 --> 00:31:23.520 least ambivalent about receiving or or reaching for help. 216 00:31:23.520 --> 00:31:25.720 Thank you. 217 00:31:25.720 --> 00:31:33.840 Moving on to the method, you state that the aim of your research was to 218 00:31:33.840 --> 00:31:39.160 produce rich understanding of suicide attempt survivors perspectives on crisis and 219 00:31:39.160 --> 00:31:44.520 healthcare services and to communicate these findings in ways accessible to relevant 220 00:31:44.520 --> 00:31:49.240 audiences, including healthcare professionals and service developers. 221 00:31:49.240 --> 00:31:55.040 For this reason, you adopt A pragmatic approach whereby the epistemological and methodological 222 00:31:55.040 --> 00:31:59.960 choices are driven by questions of generating knowledge that is appropriate to the aims of 223 00:31:59.960 --> 00:32:05.360 the study, rather than purely methodological appropriateness and fate. 224 00:32:05.360 --> 00:32:08.680 So the study design and analysis were primarily influenced 225 00:32:08.680 --> 00:32:11.720 by the constructivist interpretivist paradigm. 226 00:32:11.720 --> 00:32:16.080 That is right, given the emphasis of this paradigm in producing contextually 227 00:32:16.080 --> 00:32:21.200 bound deep understandings of the way that the study participants experience 228 00:32:21.200 --> 00:32:24.880 and make sense of the phenomenon under study. 229 00:32:24.880 --> 00:32:30.720 At the same time, the study admittedly utilises post positive stance in the sense of 230 00:32:30.720 --> 00:32:36.080 attempting to ensure that the knowledge produced is systematically and as objectively 231 00:32:36.080 --> 00:32:41.720 as possible so that it is credible, reliable and generalizable. 232 00:32:41.720 --> 00:32:46.120 And indeed, all three publications are written in the style of post positivist 233 00:32:46.120 --> 00:32:50.080 research with no discussion of your epistemological stance. 234 00:32:50.080 --> 00:32:53.480 The discussion is in the summary of the thesis. 235 00:32:53.480 --> 00:32:57.640 In the third one, there's notable change with the notion of Co construction 236 00:32:57.640 --> 00:33:02.440 being central, but there's still no mention of constructivist epistemological 237 00:33:02.440 --> 00:33:06.400 stance in the publication. 238 00:33:06.400 --> 00:33:10.520 So I think that the choice of the constructivist interpretivist paradigm 239 00:33:10.520 --> 00:33:15.520 is really fitting with the scope and the aim of the study, and I wonder 240 00:33:15.520 --> 00:33:19.280 what the addition of post positivism serves here. 241 00:33:19.280 --> 00:33:23.040 I can see how it would make sense, it would make the study more credible in 242 00:33:23.040 --> 00:33:27.600 the context of the evidence based service context that we live in, but I'm 243 00:33:27.600 --> 00:33:32.600 not sure it is necessary given the way the wealth of interpretive constructivist 244 00:33:32.600 --> 00:33:36.480 work in the clinical field internationally. 245 00:33:36.480 --> 00:33:40.800 There's also the personal perspective to consider here as you reflexively discuss 246 00:33:40.800 --> 00:33:46.240 your original professional socialisation in post positivist paradigms, positivist 247 00:33:46.240 --> 00:33:51.040 and post positivist paradigms before engaging with relational constructivist 248 00:33:51.040 --> 00:33:54.120 understandings in clinical practise. 249 00:33:54.120 --> 00:33:59.160 So I would like your thoughts about this pragmatic approach in what it serves. 250 00:33:59.160 --> 00:34:04.920 From my perspective, the question is why you felt that you needed to complement the 251 00:34:04.920 --> 00:34:09.880 constructivist interpretivist paradigm with post positivist paradigm. 252 00:34:09.880 --> 00:34:16.240 Maybe you can reflexively discuss how you made that choice. 253 00:34:16.240 --> 00:34:18.840 Thank you. 254 00:34:18.840 --> 00:34:23.440 I think it's it's good phrasing that I felt that I need to. 255 00:34:23.440 --> 00:34:27.600 I think this is actually a, a large part of the answer that that 256 00:34:27.600 --> 00:34:31.040 this has of course been also personal journey. 257 00:34:31.040 --> 00:34:34.040 And, and I feel in many ways balancing act. 258 00:34:34.040 --> 00:34:42.000 And, and it is my, it's my experience that working as psychologist in, in the Finnish mental 259 00:34:42.000 --> 00:34:49.000 health service is very much about balancing act between very different kinds of discourses 260 00:34:49.000 --> 00:34:56.080 and, and very different kinds of different ways of looking at, at the service users and, and 261 00:34:56.080 --> 00:35:01.560 what we, what, what are we trying to do and, and, and all of that. 262 00:35:01.560 --> 00:35:07.880 And I think that part of what I've been doing in, in conducting this structural 263 00:35:07.880 --> 00:35:11.960 research and, and writing up the articles has been kind of working through 264 00:35:11.960 --> 00:35:16.640 that for myself to try to understand kind of the different perspectives that 265 00:35:16.640 --> 00:35:21.880 have been in dialogue in my own mind. 266 00:35:21.880 --> 00:35:29.240 But I do hope that it has not only been self-serving endeavour, 267 00:35:29.240 --> 00:35:31.200 but there is also kind of the idea. 268 00:35:31.200 --> 00:35:38.160 It has been my, it has been my hope that this, because I think sometimes 269 00:35:38.160 --> 00:35:43.800 the problem can be that that constructionist research can be conducted and 270 00:35:43.800 --> 00:35:49.080 written up in ways that are hard to access if you are not already familiar 271 00:35:49.080 --> 00:35:52.680 with that, that discourse or that, that world. 272 00:35:52.680 --> 00:35:54.480 That way. 273 00:35:54.480 --> 00:35:59.200 If you are not maybe to put it radically, if you're not already kind of indoctrinated 274 00:35:59.200 --> 00:36:03.080 in that kind of thinking, it's very, it can be very difficult to, to kind of get 275 00:36:03.080 --> 00:36:09.240 into it and, and, and for it to have the kind of credibility that you think that 276 00:36:09.240 --> 00:36:12.040 there's something to take away from this. 277 00:36:12.040 --> 00:36:18.920 So it has been my hope that that in writing up up this research that I could do it justice 278 00:36:18.920 --> 00:36:27.480 in the sense that that that I could actually use use the constructionist methodology to to 279 00:36:27.480 --> 00:36:32.200 bring out insights that are rich and and kind of open that kind of world. 280 00:36:32.200 --> 00:36:37.080 But that I could also kind of package them in in an accessible form. 281 00:36:37.080 --> 00:36:42.760 And I think that that kind of acknowledging the ideas of the post positivistic 282 00:36:42.760 --> 00:36:46.960 paradigm is necessary for that because that's at least my imagination 283 00:36:46.960 --> 00:36:49.080 that this is what readers will be thinking. 284 00:36:49.080 --> 00:36:51.360 They will want answers to these questions. 285 00:36:51.360 --> 00:36:57.400 They will want to know who are these fourteen of the 104 and where are the other 90? 286 00:36:57.400 --> 00:36:59.920 How many is that? 287 00:36:59.920 --> 00:37:03.360 Who were they and why are they not here and what would they have said? 288 00:37:03.360 --> 00:37:05.200 And of course, these are also my questions. 289 00:37:05.200 --> 00:37:09.000 So, so it was important for me to kind of acknowledge 290 00:37:09.000 --> 00:37:11.880 that and address that in some ways too. 291 00:37:11.880 --> 00:37:15.320 Perhaps if I started out now, I would feel less of need to do so. 292 00:37:15.320 --> 00:37:21.600 But yeah, I imagine you started from a more positivist positivist and then 293 00:37:21.600 --> 00:37:26.560 along the way you move to more constructivist understanding that that's, 294 00:37:26.560 --> 00:37:28.880 that was my imagination when I was reading the thesis. 295 00:37:28.880 --> 00:37:32.440 But yeah, thank you. Yes, it's, it's a, it's struggle. 296 00:37:32.440 --> 00:37:36.760 It's always struggle. 297 00:37:36.760 --> 00:37:44.720 Related issue to this is this regards the status of the concept of Co construction. 298 00:37:44.720 --> 00:37:47.840 Co construction seems to be so pervasive in your study that 299 00:37:47.840 --> 00:37:52.920 you included as main term in the title. Rightly so. 300 00:37:52.920 --> 00:37:57.240 You discuss it in the text of the thesis, both with regard to the production of 301 00:37:57.240 --> 00:38:01.920 the research material through the interviews and with regard to the relational 302 00:38:01.920 --> 00:38:06.000 achievement of recovery through therapeutic interactions. 303 00:38:06.000 --> 00:38:10.240 However, it is not mentioned in the 1st 2 publications and Co 304 00:38:10.240 --> 00:38:14.160 construction is only included in the third study. 305 00:38:14.160 --> 00:38:18.760 Also, the concept of Co construction is in accordance with constructivist interpretivist 306 00:38:18.760 --> 00:38:23.000 perspective and this is how you explain it in the thesis. 307 00:38:23.000 --> 00:38:29.240 But then you seem to also use it from a post positivist stance in the third article. 308 00:38:29.240 --> 00:38:35.160 Now I'm fully aware that the concept of Co construction is multifaceted and also of 309 00:38:35.160 --> 00:38:39.000 the struggle that you just described between the different paradigms. 310 00:38:39.000 --> 00:38:43.960 However, since it is central concept in your thesis, I would like you to comment 311 00:38:43.960 --> 00:38:52.360 on how you're conceptualising and using it in the thesis. 312 00:38:52.360 --> 00:38:54.160 This is difficult question. 313 00:38:54.160 --> 00:39:00.240 I will have to think think about all the aspects of it. 314 00:39:00.240 --> 00:39:03.520 And it's also perhaps something that I have been aware. 315 00:39:03.520 --> 00:39:10.040 There are many, many terms that I have used in the research and, and 316 00:39:10.040 --> 00:39:17.680 in in writing it up that have been, that have specific meanings in specific 317 00:39:17.680 --> 00:39:22.000 kind of discourses, specific traditions. 318 00:39:22.000 --> 00:39:30.160 And then it has been, there has been much, well it has been struggle 319 00:39:30.160 --> 00:39:38.200 at times to kind of decide how much and and which which aspects of those 320 00:39:38.200 --> 00:39:44.400 previous discussions or those traditions should should I address if I wish to use term 321 00:39:44.400 --> 00:39:51.840 that that has multiple, multiple kind of roots or or multiple contexts in which it is used. 322 00:39:51.840 --> 00:39:57.680 And I think the the kind of concept of Co construction which can also be understood. 323 00:39:57.680 --> 00:40:03.040 It can be concept and then it can also be kind of just general expression 324 00:40:03.040 --> 00:40:07.480 for phenomenon kind of a general language thing more so. 325 00:40:07.480 --> 00:40:10.840 And I think that's something that I have actually gone that the latter 326 00:40:10.840 --> 00:40:17.000 is what I have been kind of reaching for that I would not. 327 00:40:17.000 --> 00:40:21.160 That it's way to describe what I found in the in the dates. 328 00:40:21.160 --> 00:40:27.160 That's that's kind of the idea that what I found, I went in to look, look at at what's happening 329 00:40:27.160 --> 00:40:34.560 here and what I found was this collaboration Co construction happening. 330 00:40:34.560 --> 00:40:44.200 And, and, and I think that might explain at least in part any, 331 00:40:44.200 --> 00:40:54.680 in any kind of lack of of I'm looking for the English word. 332 00:40:54.680 --> 00:40:56.640 Let's see if I can come up with come up with it. 333 00:40:56.640 --> 00:40:59.800 Inconsistency in, in using the term. 334 00:40:59.800 --> 00:41:01.640 I don't know if this answered your question at all. 335 00:41:01.640 --> 00:41:09.320 Well, yeah, the the term can be used and has different meanings from post positivist 336 00:41:09.320 --> 00:41:12.400 paradigm perspective and from an interpretivist perspective. 337 00:41:12.400 --> 00:41:17.440 So again, yeah, you're trying to weave the two together. 338 00:41:17.440 --> 00:41:23.120 And in your answer it, it seems you're using my my reading because I'm more on the 339 00:41:23.120 --> 00:41:27.960 constructivist constructionist side, constructionist side of things. 340 00:41:27.960 --> 00:41:34.680 I read it much more as Co construction of meaning, while you're you 341 00:41:34.680 --> 00:41:39.560 seem to be describing it more in post positivist terms as the actual, 342 00:41:39.560 --> 00:41:43.680 as describing something that you see there. Yeah. 343 00:41:43.680 --> 00:41:47.240 But yeah, OK, now I think I understand your question better. 344 00:41:47.240 --> 00:41:55.280 Also that's to be honest, I don't think I had actually thought of that, that 345 00:41:55.280 --> 00:42:03.360 I had actually I don't think I had had at least kind of explicitly realised 346 00:42:03.360 --> 00:42:08.200 that that it's true. It is. 347 00:42:08.200 --> 00:42:16.880 It has been an aim, and this is kind of part of the balancing act to very much stay on the, 348 00:42:16.880 --> 00:42:23.560 in that sense, on the surface, on the observable kind of to, to understand, to kind of have 349 00:42:23.560 --> 00:42:27.440 an insightful and and meaningful interpretation of what is going on. 350 00:42:27.440 --> 00:42:33.680 But then also to to be very careful to stay with what has been observed, which can of 351 00:42:33.680 --> 00:42:40.520 course be understood as have having this post positivistic echo at least. 352 00:42:40.520 --> 00:42:47.600 And yes, you are right, I think in that sense sense, except for the discussion 353 00:42:47.600 --> 00:42:52.160 in the summary about the Co construction of of the interviews. 354 00:42:52.160 --> 00:42:57.280 I think the idea has been that that what I'm looking at here is is kind 355 00:42:57.280 --> 00:43:05.720 of the observable reality even as it is observed 356 00:43:05.720 --> 00:43:13.680 through that accounts through the telling of of the service users. 357 00:43:13.680 --> 00:43:17.280 Thank you. Yes, it is tricky. 358 00:43:17.280 --> 00:43:22.200 It is tricky issue. OK, moving on. 359 00:43:22.200 --> 00:43:24.000 Still in the method. 360 00:43:24.000 --> 00:43:28.680 I would like to commend you on the careful consideration of ethical issues. 361 00:43:28.680 --> 00:43:34.440 Indeed, doing research with suicide survivors poses number of ethical concerns. 362 00:43:34.440 --> 00:43:37.880 These were very carefully addressed in this study. 363 00:43:37.880 --> 00:43:42.920 I would only like to ask you concerning your role in the interview. 364 00:43:42.920 --> 00:43:47.040 I understand that your clinical skills and experience, as well as having 365 00:43:47.040 --> 00:43:51.920 worked with individual suicidal individuals, ensure the development of 366 00:43:51.920 --> 00:43:55.800 safe and trusting relationship during the interview. 367 00:43:55.800 --> 00:44:00.600 On the other hand, not practising SIP and not being involved with the particular 368 00:44:00.600 --> 00:44:04.800 services that the participants were receiving, we're ensuring objectivity 369 00:44:04.800 --> 00:44:08.960 and guarding against the danger of double roles. 370 00:44:08.960 --> 00:44:14.040 In the interview, you said that you before the interview, you introduced yourself 371 00:44:14.040 --> 00:44:18.520 to the participants as a clinician as well as researcher. 372 00:44:18.520 --> 00:44:21.960 So I would like you to offer me your thoughts on these 373 00:44:21.960 --> 00:44:25.920 various positionings of yourself. 374 00:44:25.920 --> 00:44:32.400 And how do you think that these positionings influenced what the participants disclosed during 375 00:44:32.400 --> 00:44:38.160 the interviews and therefore how they influence the findings of your study? 376 00:44:38.160 --> 00:44:43.320 You mean the, the positioning that kind of how I introduced myself, the positioning 377 00:44:43.320 --> 00:44:47.520 that was transparent or visible to them in, in their interviews? 378 00:44:47.520 --> 00:44:56.960 Yes, the the various positionings both with which you went into the interview and 379 00:44:56.960 --> 00:45:02.960 the positionings of the participants put you in through the way you introduce yourself. 380 00:45:02.960 --> 00:45:10.720 Yeah, of course it's perhaps important to say at first 381 00:45:10.720 --> 00:45:15.000 that that of course I cannot know that. 382 00:45:15.000 --> 00:45:20.640 I can only imagine the ways that that, that it has influenced the OR 383 00:45:20.640 --> 00:45:25.200 all the ways that, that it has influenced the interviews. 384 00:45:25.200 --> 00:45:33.720 I was careful to go in with, I introduced myself as psychologist and, and told the participants 385 00:45:33.720 --> 00:45:38.040 that I was pursuing doctorate and this was my doctoral research. 386 00:45:38.040 --> 00:45:42.520 But then I tried to emphasise that that the point of doing this research, the reason that I 387 00:45:42.520 --> 00:45:49.400 am doing this research is that I want to better understand the perspective of of the persons 388 00:45:49.400 --> 00:45:54.720 using these services and that I'm very interested to learn from them. 389 00:45:54.720 --> 00:46:03.400 And I was hoping that that would maybe perhaps lessen little bit the, 390 00:46:03.400 --> 00:46:09.160 the tendency or, or the pressure on the, on the participants to give me answers 391 00:46:09.160 --> 00:46:13.480 that I as psychologist or, or would be expecting. 392 00:46:13.480 --> 00:46:17.120 But of course, it does not erase the fact that they know 393 00:46:17.120 --> 00:46:20.880 that, that this is where I'm coming from. 394 00:46:20.880 --> 00:46:25.360 I was happy in one of the actually the first interview which was one of 395 00:46:25.360 --> 00:46:29.720 the longest, we were going on almost two hours I think. 396 00:46:29.720 --> 00:46:36.000 And at that point the interviewee said they, they were criticising some services and, and 397 00:46:36.000 --> 00:46:43.040 then mid sentence they stopped and said, I just came to think that I don't really know where 398 00:46:43.040 --> 00:46:49.680 you work and whether whether what I'm saying concerns your work. 399 00:46:49.680 --> 00:46:54.200 And, and, and I was of course happy to hear that, that for the first 400 00:46:54.200 --> 00:46:56.760 two hours they had not been thinking about that. 401 00:46:56.760 --> 00:46:59.720 But that was also good reminder that this is what people think 402 00:46:59.720 --> 00:47:06.120 about and, and of course they Orient towards that. 403 00:47:06.120 --> 00:47:14.400 I think knowing my own kind of knowing that there is this 404 00:47:14.400 --> 00:47:20.480 tension kind of this this possibility that people will be, that people's responses will 405 00:47:20.480 --> 00:47:28.840 be guided in significant part by what they perceive as my role being or, or my expectations being. 406 00:47:28.840 --> 00:47:31.240 I tried to be during the interviews. 407 00:47:31.240 --> 00:47:39.320 I tried to communicate in all ways that that were possible to me in that situation, 408 00:47:39.320 --> 00:47:45.680 kind of genuine interest and and openness to any experiences that they were sharing. 409 00:47:45.680 --> 00:47:53.680 But in the end, as I hope to have have also kind of explained or or 410 00:47:53.680 --> 00:47:56.440 written up in the summary, there is no way of knowing. 411 00:47:56.440 --> 00:48:00.800 It was something that interviews were something we were producing together and they would 412 00:48:00.800 --> 00:48:06.200 have been different if somebody else had done them, that's for sure. 413 00:48:06.200 --> 00:48:11.440 Yes, indeed. 414 00:48:11.440 --> 00:48:19.760 Moving on little bit with the ethics and quality of research, both in the text 415 00:48:19.760 --> 00:48:27.040 of the thesis and in some of the articles, you locate the sections of the quality of the research 416 00:48:27.040 --> 00:48:32.760 under the heading of ethics, and also in the text you make links between the quality of the 417 00:48:32.760 --> 00:48:38.920 research process and specifically validity and ethical considerations. 418 00:48:38.920 --> 00:48:43.400 Now I I, I know that there is an argument in the qualitative research 419 00:48:43.400 --> 00:48:48.360 literature that ensuring quality is an ethical matter, but I would 420 00:48:48.360 --> 00:48:52.320 like to hear your views regarding that link. 421 00:48:52.320 --> 00:48:58.480 What was your rationale for placing research quality under ethics 422 00:48:58.480 --> 00:49:08.600 and how do you see the tool connected in your study? 423 00:49:08.600 --> 00:49:11.880 That's some, I think, multifaceted question I'm trying to make. 424 00:49:11.880 --> 00:49:16.280 Make maybe little bit of bullet point, some list, small list in my mind. 425 00:49:16.280 --> 00:49:21.240 So as I'm noticing that I may be talking on the 1st bullet point in response 426 00:49:21.240 --> 00:49:23.880 to what you're asking, can I just add something? 427 00:49:23.880 --> 00:49:28.440 It just occurred to me now that in most in in quantitative research and in positivist 428 00:49:28.440 --> 00:49:33.240 research, ethics and quality are two different things. 429 00:49:33.240 --> 00:49:37.320 And it's really, as far as I'm aware, in some parts of qualitative 430 00:49:37.320 --> 00:49:40.120 traditions where the two are seen as linked. 431 00:49:40.120 --> 00:49:43.040 So that's why I was surprised to see them LinkedIn your study. 432 00:49:43.040 --> 00:49:49.040 And I was wondering why. 433 00:49:49.040 --> 00:49:55.800 I think there are several reasons for why I'm noticing 434 00:49:55.800 --> 00:49:58.120 now that it feels very natural to me. 435 00:49:58.120 --> 00:50:04.960 I'm I'm now maybe having little bit of of trouble explicating kind of the ideas or or maybe 436 00:50:04.960 --> 00:50:10.840 I'm thinking about what are all the aspects kind of associated with it. 437 00:50:10.840 --> 00:50:19.640 But I think of course, I think it begins with, with kind of the investment that 438 00:50:19.640 --> 00:50:25.440 the, the investment of the participants is so obvious, of course, to me as qualitative 439 00:50:25.440 --> 00:50:29.440 researcher when I have sat with them through the interviews. 440 00:50:29.440 --> 00:50:36.640 And I think probably kind of the core reason of why, why it, it would seem difficult to me in 441 00:50:36.640 --> 00:50:45.680 my mind to, to separate the, the idea of, of quality and, and ethics 442 00:50:45.680 --> 00:50:52.600 has to do with that has to do with what I perceive as kind of duty to the, to the participants. 443 00:50:52.600 --> 00:50:58.160 They have invested in this research, shared their story so, 444 00:50:58.160 --> 00:51:01.280 so that it could do some good in the world. 445 00:51:01.280 --> 00:51:06.240 They, they have many of them explicitly said that they are participating 446 00:51:06.240 --> 00:51:10.760 in this research because they want to have their voice heard. 447 00:51:10.760 --> 00:51:15.080 They want others to have, have it better than they had or, 448 00:51:15.080 --> 00:51:17.920 or they they want their voice voice to matter. 449 00:51:17.920 --> 00:51:23.480 They want people in the society at large to understand better their perspective. 450 00:51:23.480 --> 00:51:29.880 So I think the first thing is, is kind of an ethical duty that I perceive that I, I was given 451 00:51:29.880 --> 00:51:37.480 through those interactions to make the best of what they had given me so that so that their 452 00:51:37.480 --> 00:51:44.880 voice could be heard in the ways ways that they wished that would be. 453 00:51:44.880 --> 00:51:51.720 But then of course, there's also, I think the other, other aspect of, of kind of the link 454 00:51:51.720 --> 00:51:56.440 between quality or, or specifically validity and, and ethics has to do. 455 00:51:56.440 --> 00:52:01.320 And maybe there's now I'm wondering if it's the post positivist talking in 456 00:52:01.320 --> 00:52:06.840 my mind that because there are, there is less of the regulation that goes with 457 00:52:06.840 --> 00:52:09.640 have you done the right, right thing with the numbers? 458 00:52:09.640 --> 00:52:18.720 Have you followed the procedure correctly so that so that 459 00:52:18.720 --> 00:52:24.240 these results are not fabricated in in that sense, there are less of kind of 460 00:52:24.240 --> 00:52:32.440 those obvious kind of objective criteria for, for whether whether 461 00:52:32.440 --> 00:52:40.800 what we have done in analysing the data, whether it was 462 00:52:40.800 --> 00:52:44.200 whether it was scientific. 463 00:52:44.200 --> 00:52:50.800 It's not, it's not word for here whether, whether it did justice to the data. 464 00:52:50.800 --> 00:52:54.520 Maybe that would be a better way to put it. 465 00:52:54.520 --> 00:53:02.400 So I think it's, it's even more kind of important to be aware of the that, that it's 466 00:53:02.400 --> 00:53:08.480 not, that's not question of following rules, but rather there needs to be like 467 00:53:08.480 --> 00:53:13.680 more, more of higher level ethical lens on what are we doing here now when we are 468 00:53:13.680 --> 00:53:16.440 analysing this data and writing this, this study up? 469 00:53:16.440 --> 00:53:24.240 And is it doing justice to, to the data that we that we actually have here? 470 00:53:24.240 --> 00:53:32.360 Yes, I'm hoping that is enough. OK. 471 00:53:32.360 --> 00:53:38.480 And I'm getting to the issue of sampling, which is a, yeah, difficult issue here. 472 00:53:38.480 --> 00:53:44.480 In terms of sampling, the percentage of eligible participants who actually 473 00:53:44.480 --> 00:53:50.200 took part in the study is indeed, as you say, worryingly small. 474 00:53:50.200 --> 00:53:53.760 Also, the actual number of participants in qualitative 475 00:53:53.760 --> 00:53:55.800 study at doctoral level is very small. 476 00:53:55.800 --> 00:54:00.440 I know it's enough for regular qualitative study, but usually in doctoral 477 00:54:00.440 --> 00:54:05.120 studies we have larger numbers of participants. 478 00:54:05.120 --> 00:54:12.120 Now you treat the problem of low participation percentage as threat to representativeness 479 00:54:12.120 --> 00:54:18.240 in accordance to the with the post positivist perspective, and indeed you get into great lengths 480 00:54:18.240 --> 00:54:23.600 to persuasively argue for the representativeness of the sample. 481 00:54:23.600 --> 00:54:29.240 Coming myself from an epistemological perspective that ranges between constructivist and 482 00:54:29.240 --> 00:54:35.280 constructionist, as I said earlier, my concern about the number of participants, the actual 483 00:54:35.280 --> 00:54:40.640 number and the percentage of participation would be quite different. 484 00:54:40.640 --> 00:54:46.960 I would wonder whether there is something in this population that hinders participation 485 00:54:46.960 --> 00:54:52.320 in studies generally and in this particular study specifically. 486 00:54:52.320 --> 00:54:59.920 And I would try then to address these issues in order to increase participation or to justify 487 00:54:59.920 --> 00:55:05.440 why there isn't participation at the end after I had addressed these issues. 488 00:55:05.440 --> 00:55:10.360 So I would like to ask you now from, of course, the studies done and completed, 489 00:55:10.360 --> 00:55:17.440 but you know from the perspective of today, if you see it from this perspective, 490 00:55:17.440 --> 00:55:21.840 why do you think there has been such low participation? 491 00:55:21.840 --> 00:55:25.560 And is there anything you could have done to mitigate 492 00:55:25.560 --> 00:55:34.680 these factors and increase participation? 493 00:55:34.680 --> 00:55:39.680 I think there are. 494 00:55:39.680 --> 00:55:47.920 I'm now thinking about from which direction to to begin to respond to that. 495 00:55:47.920 --> 00:55:50.320 I find myself actually a little bit surprised. 496 00:55:50.320 --> 00:55:52.300 Maybe I'll explicate that. 497 00:55:52.300 --> 00:55:59.920 I find myself little bit surprised at at the perspective that it's, it's as as 498 00:55:59.920 --> 00:56:05.760 I hear that you are saying that it's, it's kind of an exceptionally low engagement rate. 499 00:56:05.760 --> 00:56:07.620 I had not thought that. 500 00:56:07.620 --> 00:56:15.440 Of course, I have limited experience doing these kind of studies, but from some 501 00:56:15.440 --> 00:56:23.160 feedback, I think the, the one of the reviewers, the, the, the kind reviewer of the 1st paper, 502 00:56:23.160 --> 00:56:29.440 I think it was when I had, I had actually now it, it's all coming back to me. 503 00:56:29.440 --> 00:56:32.760 I had actually written it up much more apologetically. 504 00:56:32.760 --> 00:56:41.120 Kind of this, this both the low percentage of, of those 505 00:56:41.120 --> 00:56:45.080 who were invited into the study who were participating. 506 00:56:45.080 --> 00:56:48.480 Well, actually that not, not so much the absolute number. 507 00:56:48.480 --> 00:56:53.800 And then the reviewer said that this is a, this is great uptake for, for this kind 508 00:56:53.800 --> 00:56:57.680 of research that, that, that you should not, they did not say that you shouldn't 509 00:56:57.680 --> 00:57:00.600 apologise for it, but I thought that was kind of the point. 510 00:57:00.600 --> 00:57:03.600 And then I wrote it up, wrote it up again. 511 00:57:03.600 --> 00:57:08.200 So I'm little bit surprised to hear this, but but I'm sure it's true. 512 00:57:08.200 --> 00:57:13.160 And, and in that case, I, I think it has to do with the period or so of, 513 00:57:13.160 --> 00:57:21.200 of with the, with the characteristics of the group studied. 514 00:57:21.200 --> 00:57:28.040 We know that suicidal service users are hesitant to engage with services 515 00:57:28.040 --> 00:57:37.400 and and that could could be assumed to to also 516 00:57:37.400 --> 00:57:43.240 it's possible that they are also more hesitant to engage with with research. 517 00:57:43.240 --> 00:57:45.220 And also this. 518 00:57:45.220 --> 00:57:50.960 They were when they were invited into the study was of course very fragile, fragile. 519 00:57:50.960 --> 00:57:56.120 In their life that it was very it was very soon after the after the suicide 520 00:57:56.120 --> 00:58:04.720 attempt as to the the absolute number of participants 521 00:58:04.720 --> 00:58:13.160 being low. 522 00:58:13.160 --> 00:58:20.320 Now I'm trying to remember the actual the specific specific kind of question 523 00:58:20.320 --> 00:58:25.000 in that what can I can I can I have reround of that? 524 00:58:25.000 --> 00:58:33.040 No, no, the, the effectively I'm, I'm, I was asking if why, why you think 525 00:58:33.040 --> 00:58:41.000 there was low participation and what you could have done or how you could 526 00:58:41.000 --> 00:58:48.400 have designed the study possibly to have more participation. 527 00:58:48.400 --> 00:58:52.600 That's good question. 528 00:58:52.600 --> 00:58:58.800 I think we had, I was very fortunate to have have great collaboration 529 00:58:58.800 --> 00:59:04.560 with, with the people at MIELI who I think did good job at, at informing 530 00:59:04.560 --> 00:59:07.400 the, the patients about the about the study. 531 00:59:07.400 --> 00:59:11.560 And, and kind of I can, I can imagine that there has not 532 00:59:11.560 --> 00:59:13.640 been anything off putting about the way. 533 00:59:13.640 --> 00:59:16.880 Of course, sometimes the invitation to study can be such 534 00:59:16.880 --> 00:59:21.080 that it's very easy to, to pass it by. 535 00:59:21.080 --> 00:59:24.880 Of course there is the I think the very strict ethical 536 00:59:24.880 --> 00:59:27.280 considerations had something to do with it. 537 00:59:27.280 --> 00:59:32.880 And, and it was, I emphasised to the the actual therapists who were inviting the 538 00:59:32.880 --> 00:59:35.640 clients to the study that it needs to be completely 539 00:59:35.640 --> 00:59:38.040 voluntary. People cannot be pressured. 540 00:59:38.040 --> 00:59:40.440 Not that I would have thought that they would do this, but this is something 541 00:59:40.440 --> 00:59:46.280 that was very, very important kind of for the ethical and and of course 542 00:59:46.280 --> 00:59:48.880 it's possible to go to for the other way. 543 00:59:48.880 --> 00:59:54.320 So, so maybe that's something kind of the balancing between ensuring that people are participating 544 00:59:54.320 --> 01:00:01.120 voluntarily and then presenting the option to participate in, in ways that's that's kind of 545 01:00:01.120 --> 01:00:10.280 make people more likely to choose that they want to participate. 546 01:00:10.280 --> 01:00:15.440 That's maybe the first thing that that comes to mind. 547 01:00:15.440 --> 01:00:20.640 I'm not sure that I have other quick fixes that come to mind right now about 548 01:00:20.640 --> 01:00:27.840 the study design that would have increased participation. 549 01:00:27.840 --> 01:00:32.080 I don't know, perhaps promising people movie tickets, which 550 01:00:32.080 --> 01:00:39.240 is the the the standard procedure in in Finland. 551 01:00:39.240 --> 01:00:43.360 We don't know how that affects people's agency for the quantity. 552 01:00:43.360 --> 01:00:46.720 When you when you when you enter the quantitative 553 01:00:46.720 --> 01:00:48.780 research, you often get movie tickets. 554 01:00:48.780 --> 01:00:53.120 When I was psychology student and I I let them put EEG things 555 01:00:53.120 --> 01:00:56.080 on my head, which is not easy with my hair. I got movie tickets. 556 01:00:56.080 --> 01:00:59.360 So. But maybe, maybe not. 557 01:00:59.360 --> 01:01:01.160 Yeah. 558 01:01:01.160 --> 01:01:03.200 No, no, that, that's not what I had in mind. 559 01:01:03.200 --> 01:01:07.800 No, I was thinking more along the lines of, you know, maybe increasing the time 560 01:01:07.800 --> 01:01:14.720 of the, you know, data collection or considering whether, for example, getting participant, 561 01:01:14.720 --> 01:01:22.000 you know, doing the interviews closer to the the end of the treatment or later would 562 01:01:22.000 --> 01:01:23.840 increase participation, things like that. 563 01:01:23.840 --> 01:01:31.480 More like or doing this interview as part, you know, be seen by 564 01:01:31.480 --> 01:01:33.600 the participants as a kind of part of treatment. 565 01:01:33.600 --> 01:01:35.560 But, you know, there's different ideas. But OK. 566 01:01:35.560 --> 01:01:39.680 Yeah, that's it's kind of after the event, trying to 567 01:01:39.680 --> 01:01:44.520 think, trying to learn for the next time. Yeah, exactly, Exactly. 568 01:01:44.520 --> 01:01:48.920 Yeah. So I'm, I'm moving on to the studies. 569 01:01:48.920 --> 01:01:54.640 What I'd like to do is I have, you know, a kind of commentary of what for each study. 570 01:01:54.640 --> 01:01:56.720 Let's let's see them separately. 571 01:01:56.720 --> 01:02:02.160 I have commentary of what I see in each study and then 572 01:02:02.160 --> 01:02:04.880 you can comment and address questions. 573 01:02:04.880 --> 01:02:07.480 It's not so much questions as it's kind of, you know, comment 574 01:02:07.480 --> 01:02:11.560 on my thoughts at the end of each study. Yeah. 575 01:02:11.560 --> 01:02:16.480 So it's going to be slightly long, each one of them, not too long. 576 01:02:16.480 --> 01:02:18.280 OK. 577 01:02:18.280 --> 01:02:24.120 So the aim of the first study was to achieve an in depth understanding of service users views 578 01:02:24.120 --> 01:02:30.560 on whether and how services had facilitated or could facilitate their recovery. 579 01:02:30.560 --> 01:02:36.120 Given the low to moderate effectiveness of suicide prevention interventions in preventing 580 01:02:36.120 --> 01:02:42.280 repeat suicide attempts, asking recipients of these interventions what they found helpful 581 01:02:42.280 --> 01:02:47.680 is very good way of gaining information on what works, how to improve services and how 582 01:02:47.680 --> 01:02:52.640 to foster engagement with services in this population. 583 01:02:52.640 --> 01:02:56.120 The findings of the study are very interesting to me. 584 01:02:56.120 --> 01:03:01.640 Firstly, what I take from it is firstly, participants clearly have and are 585 01:03:01.640 --> 01:03:08.200 able to articulate personally meaningful recovery goals as well as the tasks 586 01:03:08.200 --> 01:03:10.560 they have set for themselves to achieve these goals. 587 01:03:10.560 --> 01:03:13.720 This is finding in itself, yeah. 588 01:03:13.720 --> 01:03:18.400 It is also interesting that the participants primarily evaluated services in relation to 589 01:03:18.400 --> 01:03:23.120 whether they help them in achieving these goals and pursuing their tasks. 590 01:03:23.120 --> 01:03:24.920 Yeah. 591 01:03:24.920 --> 01:03:29.440 So now the seven elements that according to participants were central for 592 01:03:29.440 --> 01:03:34.880 services to be helpful are the same as those stressed in most other studies 593 01:03:34.880 --> 01:03:37.600 of mental health service users perspectives. 594 01:03:37.600 --> 01:03:43.560 Service users generally value being respected as human being, being listened to. 595 01:03:43.560 --> 01:03:48.520 I'm just, you know, listing your categories being supported in exploring distressing 596 01:03:48.520 --> 01:03:56.960 experiences, continuity of care, collaborative care and decision making and comprehensive 597 01:03:56.960 --> 01:04:01.280 care that includes the social and familial context. 598 01:04:01.280 --> 01:04:06.240 So in that sense and also effectively, these are the elements of patient 599 01:04:06.240 --> 01:04:11.080 centred and recovery oriented service delivery. 600 01:04:11.080 --> 01:04:15.920 In this sense, this study corroborates pretty much all the previous qualitative 601 01:04:15.920 --> 01:04:20.440 studies of mental health service user perspectives on their care. 602 01:04:20.440 --> 01:04:25.400 It shows that suicide survivors share the same concerns and preferences for treatment 603 01:04:25.400 --> 01:04:30.920 as all the other mental health service users, and that therefore the new perspectives 604 01:04:30.920 --> 01:04:36.400 on suicide prevention that are based on patient centred and recovery oriented care 605 01:04:36.400 --> 01:04:38.680 are appropriate for this population. 606 01:04:38.680 --> 01:04:44.760 Yeah, so that's my reading really of what I take from that study. 607 01:04:44.760 --> 01:04:49.160 So I would like to ask your thoughts on this and more specifically how 608 01:04:49.160 --> 01:04:53.400 do you think that the links, because you don't make so many links with 609 01:04:53.400 --> 01:04:58.320 that kind of more the studies that I just mentioned. 610 01:04:58.320 --> 01:05:03.200 So how do you think that the links between your findings and similar findings 611 01:05:03.200 --> 01:05:08.680 in other fields of mental health care may be utilised to promote human centred 612 01:05:08.680 --> 01:05:11.920 in recovery oriented care in suicide prevention? 613 01:05:11.920 --> 01:05:14.920 Because I think for me, this is what I take from this study, 614 01:05:14.920 --> 01:05:17.600 but it's not really articulated yet. 615 01:05:17.600 --> 01:05:26.600 Yeah, I think you're completely right that that there there are many links 616 01:05:26.600 --> 01:05:33.600 and there is nothing kind of nothing noble in the findings in the sense of what has been found. 617 01:05:33.600 --> 01:05:38.280 Kind of the idea that you said that, that as rule, people appreciate even when 618 01:05:38.280 --> 01:05:44.600 they go in for somatic reasons, of course they, they appreciate being met by services 619 01:05:44.600 --> 01:05:48.760 as as with human beings and, and respected in that sense. 620 01:05:48.760 --> 01:05:50.720 Of course, there's nothing new about that. 621 01:05:50.720 --> 01:05:57.720 I think the the reason that I have not made those links more explicitly has been an 622 01:05:57.720 --> 01:06:03.440 attempt to keep the, the whole thing kind of contained in some way. 623 01:06:03.440 --> 01:06:13.080 I have made the choice to locate this research very, very firmly kind of in the suicide 624 01:06:13.080 --> 01:06:21.240 literature in suicidology, in part because I think there are less of those voices in suicidology 625 01:06:21.240 --> 01:06:29.280 than there are in, in, for example, in the, in the literature concerning psychotic 626 01:06:29.280 --> 01:06:35.680 experiences and the treatment of, of people with those experiences. 627 01:06:35.680 --> 01:06:41.960 And, and in hindsight, I think I, I could have made those links 628 01:06:41.960 --> 01:06:44.560 more explicit already in the, in the first. 629 01:06:44.560 --> 01:06:50.120 I think there they have been kind of, they are more present, not much very present, but 630 01:06:50.120 --> 01:06:56.360 more present in the summary than than in that first paper as to what we could do so that 631 01:06:56.360 --> 01:07:04.680 this consensus of service users on, on kind of their, their hopes for what service systems 632 01:07:04.680 --> 01:07:10.840 would look like would would be better, better accommodated. 633 01:07:10.840 --> 01:07:12.840 That's an excellent question. 634 01:07:12.840 --> 01:07:18.240 And part of the answer in my mind is that that we need to make better 635 01:07:18.240 --> 01:07:25.640 use of of the expertise of all of the, the different professions involved 636 01:07:25.640 --> 01:07:28.960 in responding to mental health crises. 637 01:07:28.960 --> 01:07:32.680 Because I think that right now we have lot of people with different 638 01:07:32.680 --> 01:07:35.480 perspectives working with these people. 639 01:07:35.480 --> 01:07:39.960 But then we also have service system that has one dominant logic, 640 01:07:39.960 --> 01:07:45.920 which is the logic of evidence based medicine, which is as wonderful 641 01:07:45.920 --> 01:07:48.880 logic as the logic of any of the other fields. 642 01:07:48.880 --> 01:07:51.000 But it's not, it can't do everything. 643 01:07:51.000 --> 01:07:58.640 And, and if everything we do needs to kind of bow to that logic, then we will not be able to 644 01:07:58.640 --> 01:08:06.680 make full use of the understanding that we have of, of these, for example, the interaction components 645 01:08:06.680 --> 01:08:11.880 of treatment or, or the ideas that that people are social beings. 646 01:08:11.880 --> 01:08:21.240 And, and somehow taking account of that in, in designing and and administering services, 647 01:08:21.240 --> 01:08:27.960 it will, it will be difficult if, if we have to kind of, if everything we do needs to kind 648 01:08:27.960 --> 01:08:36.320 of be able to be rationalised is not, not really the word I'm looking 649 01:08:36.320 --> 01:08:38.120 for. 650 01:08:38.120 --> 01:08:44.880 Let's see if I can find a better synonym in English. 651 01:08:44.880 --> 01:08:50.080 If it, if, if there has to be kind of an evidence based medicine argument 652 01:08:50.080 --> 01:08:54.560 for those things, it will hinder us from doing them. 653 01:08:54.560 --> 01:08:59.040 And, and, and if, if we have more freedom for the, for the different 654 01:08:59.040 --> 01:09:03.080 perspectives to work together, I think we will do better job of actually 655 01:09:03.080 --> 01:09:06.400 delivering what, what service users need. 656 01:09:06.400 --> 01:09:12.880 And I think that this is, it's very much a problem of implementation because in Finland in the 657 01:09:12.880 --> 01:09:17.520 healthcare service system, for example, in the city of Helsinki, where I have worked for long 658 01:09:17.520 --> 01:09:23.680 time before previously in the psychiatric services recovery oriented. 659 01:09:23.680 --> 01:09:28.040 The, the idea is that what we are doing is recovery oriented practise. 660 01:09:28.040 --> 01:09:32.160 And there's lot of of good ideas kind of brought in to that system. 661 01:09:32.160 --> 01:09:36.600 And, and kind of the consensus in many ways of what our, what we are doing 662 01:09:36.600 --> 01:09:43.080 is, is fairly congruent, I think with, with these findings and with, with 663 01:09:43.080 --> 01:09:47.040 recovery, recovery oriented ideas more generally. 664 01:09:47.040 --> 01:09:54.200 But then putting them to practise in that system, which is again dominated by, by the logic 665 01:09:54.200 --> 01:10:00.960 and the procedures that have to do with, with well, it's, it's struggle. 666 01:10:00.960 --> 01:10:04.640 That's another struggle. Yes, I know, I know. 667 01:10:04.640 --> 01:10:07.680 Yes. 668 01:10:07.680 --> 01:10:15.400 And one one particular point around study, one that I wanted to discuss is regarding 669 01:10:15.400 --> 01:10:20.600 exploring and making sense of distressing experiences. 670 01:10:20.600 --> 01:10:25.680 Because you, you have make comment in the publication of of the first 671 01:10:25.680 --> 01:10:30.840 study that the demand for exploration of the suicidal act may be considered 672 01:10:30.840 --> 01:10:33.960 as need specific to this population. 673 01:10:33.960 --> 01:10:39.040 And from what I have read in the relevant literature, the more broadly psychiatric 674 01:10:39.040 --> 01:10:43.560 literature, the need to explore and make sense of distressing experiences has been 675 01:10:43.560 --> 01:10:47.280 consistently articulated by psychiatric service users. 676 01:10:47.280 --> 01:10:50.440 The strongest example is engaging with voices and making 677 01:10:50.440 --> 01:10:53.680 sense of them in the Hearing Voices network. 678 01:10:53.680 --> 01:10:58.360 And typically, professionals do not engage with these experiences mainly because 679 01:10:58.360 --> 01:11:02.680 they see them within the medical model as meaningless symptoms. 680 01:11:02.680 --> 01:11:07.880 If I understand correctly, exploring the suicide attempt is discouraged in 681 01:11:07.880 --> 01:11:12.720 standard professional practise not only because within the medical model 682 01:11:12.720 --> 01:11:17.240 suicide attempts are considered symptoms of disorder, but also because 683 01:11:17.240 --> 01:11:20.760 it might be too distressing for professionals. 684 01:11:20.760 --> 01:11:23.840 So I wonder what your thoughts are on this topic. 685 01:11:23.840 --> 01:11:28.320 Were you surprised that the suicide survivor participants find exploration 686 01:11:28.320 --> 01:11:31.640 of their recent suicide attempt helpful? 687 01:11:31.640 --> 01:11:37.480 Why do you think the exploration of suicide attempts is discouraged by professionals 688 01:11:37.480 --> 01:11:41.800 and do you think this should change that exploration should take place? 689 01:11:41.800 --> 01:11:51.920 And generally or under what conditions would it be helpful or not helpful? 690 01:11:51.920 --> 01:11:55.680 I will try to make mental note of the three questions. 691 01:11:55.680 --> 01:12:00.280 Why is it helpful? Why is it No, I already lost them. 692 01:12:00.280 --> 01:12:04.480 Can you please repeat? I will take my pen and paper. 693 01:12:04.480 --> 01:12:08.480 No, it's why do you think it's discouraged by professionals? 694 01:12:08.480 --> 01:12:12.120 I mean that you've already answered pretty much in your thesis already, 695 01:12:12.120 --> 01:12:15.720 but so we kind of know why it's discouraged. 696 01:12:15.720 --> 01:12:20.000 But my question is, were you surprised by the by finding 697 01:12:20.000 --> 01:12:24.560 that the participants found that helpful? 698 01:12:24.560 --> 01:12:38.840 And so do you think that should take place more and under what conditions? 699 01:12:38.840 --> 01:12:46.800 OK, now I will be able to remember if I can read my handwriting. 700 01:12:46.800 --> 01:12:50.960 I, I was, it's difficult question whether I was surprised in, in some 701 01:12:50.960 --> 01:12:53.720 sense I was and, and, and in another sense I wasn't. 702 01:12:53.720 --> 01:12:57.920 But I think maybe the best answer is that the participants 703 01:12:57.920 --> 01:13:00.320 themselves were also surprised. 704 01:13:00.320 --> 01:13:06.560 We were, we were perhaps we kind of shared this surprise that it's not an easy task. 705 01:13:06.560 --> 01:13:09.320 It's not an easy task for professionals, but it's not also 706 01:13:09.320 --> 01:13:13.320 easy for for the service users themselves. 707 01:13:13.320 --> 01:13:16.840 And even though they emphasised that it's important, it was not something 708 01:13:16.840 --> 01:13:22.640 that they were very eager to do or, or that was unproblematic or, or 709 01:13:22.640 --> 01:13:24.880 it was actually very complicated matter. 710 01:13:24.880 --> 01:13:30.840 And I think that was something that for me, it was very impressive about ASIP, about the attempted 711 01:13:30.840 --> 01:13:34.760 suicide short intervention programme that the participants had gone through. 712 01:13:34.760 --> 01:13:37.160 And that was very impressive for them. 713 01:13:37.160 --> 01:13:46.000 I was that that ASIP seemed to make that task of of kind of 714 01:13:46.000 --> 01:13:52.200 looking right at quite of course, quite concretely in, in ASIP, you 715 01:13:52.200 --> 01:13:58.120 look at the, the video of the, the person's first. 716 01:13:58.120 --> 01:14:01.920 The ASIP clients first tell the story of their suicide attempt. 717 01:14:01.920 --> 01:14:04.200 It is videotaped and then they watch it together. 718 01:14:04.200 --> 01:14:07.760 The the video on the on the second session of ASIP. 719 01:14:07.760 --> 01:14:14.000 So it's very concrete, but it seemed that that the programme of ASIP was 720 01:14:14.000 --> 01:14:19.920 very effective in facilitating that difficult task, the task that these 721 01:14:19.920 --> 01:14:23.400 participants found both difficult and important. 722 01:14:23.400 --> 01:14:27.720 And I'm not sure that all of them would have thought that it was important 723 01:14:27.720 --> 01:14:31.480 beforehand, that it's important to remember that I was interviewing 724 01:14:31.480 --> 01:14:33.840 them after they had gone through ASIP. 725 01:14:33.840 --> 01:14:36.840 And at that point, all of them said that this is very important. 726 01:14:36.840 --> 01:14:45.320 This should be done. It should not be, it should not be skipped. 727 01:14:45.320 --> 01:14:49.200 And some of them had had that thought before Asif. 728 01:14:49.200 --> 01:14:56.080 Some of them had had been frustrated by by interactions before Asif in which 729 01:14:56.080 --> 01:15:01.200 they felt that professionals kind of tried to just hop over the suicide attempts 730 01:15:01.200 --> 01:15:07.360 and just like, let's move on now and, and let's, you know, but some of them went 731 01:15:07.360 --> 01:15:11.320 into Asif being quite hesitant or ambivalence. 732 01:15:11.320 --> 01:15:15.520 Of course, those who were most opposed to the idea would 733 01:15:15.520 --> 01:15:17.640 likely not have entered ASIP at all. 734 01:15:17.640 --> 01:15:24.080 So so there's also likely people who, for whom the, the barrier or 735 01:15:24.080 --> 01:15:27.840 threshold to do to do that kind of work is even higher. 736 01:15:27.840 --> 01:15:30.960 OK, so that's the answer to was I surprised? 737 01:15:30.960 --> 01:15:35.360 Then the other question was should it happen more and under 738 01:15:35.360 --> 01:15:38.760 what conditions? Yes, it should happen more. 739 01:15:38.760 --> 01:15:41.080 That that's an easy question. 740 01:15:41.080 --> 01:15:49.120 And I think the conditions here, I'm torn because I'm worried that 741 01:15:49.120 --> 01:15:53.520 now if I will explicate kind of the ideal conditions, then we will end up in 742 01:15:53.520 --> 01:15:59.840 the situation where I think we are often now in Finnish healthcare, because especially 743 01:15:59.840 --> 01:16:03.480 during crises, there are many professionals involved. 744 01:16:03.480 --> 01:16:09.440 Often that continuity of care is not great. 745 01:16:09.440 --> 01:16:14.400 And even when there is kind of sufficient services, there are 746 01:16:14.400 --> 01:16:17.240 many different professionals engaged in that. 747 01:16:17.240 --> 01:16:20.760 And, and the person can meet one person at the emergency services one 748 01:16:20.760 --> 01:16:23.960 day and then the next day they're in inpatient care. 749 01:16:23.960 --> 01:16:26.200 And there are other people there that they're working with. 750 01:16:26.200 --> 01:16:30.200 And then they're there for three days and then they go to and there's some in between kind 751 01:16:30.200 --> 01:16:34.480 of service checking on them, which all were appreciated by these people. 752 01:16:34.480 --> 01:16:38.600 They appreciated people checking up on them, even if it wasn't the the 753 01:16:38.600 --> 01:16:43.000 kind of ultimate place where they would be cared for. 754 01:16:43.000 --> 01:16:47.120 And then of course, the question of, of who should do it and when, when, 755 01:16:47.120 --> 01:16:53.400 when is the time to pause and do this work is difficult. 756 01:16:53.400 --> 01:16:59.960 And ideally, of course, it would be so that there is like one person or or few 757 01:16:59.960 --> 01:17:05.880 people that do this work with, with the, with the service user. 758 01:17:05.880 --> 01:17:09.400 But then I think it's bigger mistake to wait for that. 759 01:17:09.400 --> 01:17:14.480 I think it's bigger mistake, for example, during inpatient care to just 760 01:17:14.480 --> 01:17:18.360 think that, OK, let's not open this theme here because we will only be 761 01:17:18.360 --> 01:17:20.640 here for couple of days so you can talk about it. 762 01:17:20.640 --> 01:17:24.320 Then you will have the more long term treatment relationship somewhere else. 763 01:17:24.320 --> 01:17:28.400 So because I think this is often the thought in inpatient care and that's definitely 764 01:17:28.400 --> 01:17:33.880 something I have struggled with when I have worked as psychologist in, in context 765 01:17:33.880 --> 01:17:37.840 in which I've had very short contact with participants that what are the things that 766 01:17:37.840 --> 01:17:43.840 we go into right now and what are the things for later? 767 01:17:43.840 --> 01:17:47.200 OK. So yes, it should happen more. 768 01:17:47.200 --> 01:17:52.920 Ideally there would be context similar to ASIP to have at least 769 01:17:52.920 --> 01:17:56.320 few sessions to, to kind of pause on that. 770 01:17:56.320 --> 01:18:00.040 And then of course, there needs to be some kind of going back to that in 771 01:18:00.040 --> 01:18:02.960 the beginning of a, of a, of a new treatment relationship. 772 01:18:02.960 --> 01:18:08.720 Also, lot of the participants said that they had used that because they 773 01:18:08.720 --> 01:18:12.520 had their own, they called it their own story written that they got from 774 01:18:12.520 --> 01:18:17.120 ASIP kind of summary of, of, of the, the suicidal narrative that they had 775 01:18:17.120 --> 01:18:19.280 taken it and given it to the next professional. 776 01:18:19.280 --> 01:18:24.000 So it was kind of carried over over this these games. 777 01:18:24.000 --> 01:18:28.240 Ideally, there would be less of those transfers, but I think it's more important 778 01:18:28.240 --> 01:18:34.280 to not skip the work even if we do have the transfers. 779 01:18:34.280 --> 01:18:41.120 Sorry, just a, commentary that came to mind with this last, last comment 780 01:18:41.120 --> 01:18:44.960 of yours that some took the narrative to earlier. 781 01:18:44.960 --> 01:18:53.120 And I think it would be worth using narrative ideas there in the sense that the idea of owning, 782 01:18:53.120 --> 01:18:57.720 you know, not only developing, you develop your own narrative that you then collaborate with 783 01:18:57.720 --> 01:19:03.960 professional, but then you own that narrative that that's practised lot also in the Hearing 784 01:19:03.960 --> 01:19:12.000 Voices network, where people with the help of someone else, voice hearers end 785 01:19:12.000 --> 01:19:20.160 up with narrative of their, an explanation of their voice hearing that they can then 786 01:19:20.160 --> 01:19:24.320 own and carry on with them and continue working on it. 787 01:19:24.320 --> 01:19:29.040 So that's yeah, it's an interesting idea. 788 01:19:29.040 --> 01:19:34.120 OK, I'm moving on to the second study now here you will bear with me because it's 789 01:19:34.120 --> 01:19:38.480 kind of I saw the two studies really the 1st and the second related. 790 01:19:38.480 --> 01:19:42.480 So let me develop little bit my thinking about it and then 791 01:19:42.480 --> 01:19:47.600 then I'll I can I can repeat the questions after. 792 01:19:47.600 --> 01:19:49.580 Thank you. 793 01:19:49.580 --> 01:19:57.040 So, OK, so study two focused on participants evaluation of the ASIP 794 01:19:57.040 --> 01:20:01.920 programme that they had just completed shortly before. 795 01:20:01.920 --> 01:20:08.760 It's worth mentioning and keeping in mind that ASIP is based to large extent 796 01:20:08.760 --> 01:20:12.880 on the principles of patient centred and recovery on oriented care. 797 01:20:12.880 --> 01:20:18.480 I don't know if it does so explicitly if it says so, but reading it, I for me it may. 798 01:20:18.480 --> 01:20:22.440 Yeah, I, I saw all these principles there. Yeah. 799 01:20:22.440 --> 01:20:28.480 So this should be kept in mind when discussing the findings of this study, the second study 800 01:20:28.480 --> 01:20:34.560 because effectively the participants who had experienced both of treatment as usual and 801 01:20:34.560 --> 01:20:40.080 ASIP were asked to evaluate both of them in the same interview. 802 01:20:40.080 --> 01:20:45.400 And effectively what they did is what would be expected. 803 01:20:45.400 --> 01:20:50.640 And this is what they did is they used their experience of 1 intervention, mainly ACID, 804 01:20:50.640 --> 01:20:56.160 which was positive experience, to articulate what the helpful elements of care are 805 01:20:56.160 --> 01:21:00.560 and then evaluate the treatment as usual on the basis of this. Yeah. 806 01:21:00.560 --> 01:21:03.680 So it's like the findings of the two studies, I think are very 807 01:21:03.680 --> 01:21:07.040 connected because of the context of the interview. 808 01:21:07.040 --> 01:21:08.840 Yeah. 809 01:21:08.840 --> 01:21:15.800 So, so the elements of ACID that participants found helpful are once again 810 01:21:15.800 --> 01:21:20.080 very similar to the principles of recovery oriented practise. 811 01:21:20.080 --> 01:21:25.120 Those that stand out as the most important for all participants are 812 01:21:25.120 --> 01:21:29.360 firstly, the establishment of a therapeutic relationship that of course 813 01:21:29.360 --> 01:21:32.560 includes trust, respect, active listening. 814 01:21:32.560 --> 01:21:36.000 You know, I'm linking it back to the seven elements of the study. 815 01:21:36.000 --> 01:21:43.080 One second, exploration of the suicidal act that corresponds to the more general demand 816 01:21:43.080 --> 01:21:48.240 of service users for making use, making sense of distressing experiences. 817 01:21:48.240 --> 01:21:55.080 And 3rd, safety planning that goes back is linked to collaborative care. 818 01:21:55.080 --> 01:21:56.920 Yeah, which, yeah. 819 01:21:56.920 --> 01:22:03.720 So that that on the other hand, the two aspects of ASIP that were found, or 820 01:22:03.720 --> 01:22:10.680 rather the two aspects in which ASIP was found lacking where firstly, not 821 01:22:10.680 --> 01:22:14.720 seeing through participants in their recovery journey. 822 01:22:14.720 --> 01:22:18.040 In other words, not providing enough continuity of care. 823 01:22:18.040 --> 01:22:20.440 That's the way I read it at least. 824 01:22:20.440 --> 01:22:27.720 And secondly, not including in the treatment the users social and familial environment. 825 01:22:27.720 --> 01:22:35.800 Now in the discussion of the second study, you link the 826 01:22:35.800 --> 01:22:39.080 two, you try and link the findings of the two studies. 827 01:22:39.080 --> 01:22:44.840 Yeah, the the participants develop evaluation of ASIP and 828 01:22:44.840 --> 01:22:47.960 the participants evaluation of other services. 829 01:22:47.960 --> 01:22:53.240 And you say that from the 7th elements of care that participants found helpful, 830 01:22:53.240 --> 01:22:58.360 four were consistently reported as being present in ASIP. 831 01:22:58.360 --> 01:23:00.160 Yeah. 832 01:23:00.160 --> 01:23:05.360 So that was the experience of being valued, support in exploring suicidality, 833 01:23:05.360 --> 01:23:12.800 support in exploring making meaning of their experiences and psychological 834 01:23:12.800 --> 01:23:14.780 continuity and predictability. 835 01:23:14.780 --> 01:23:18.160 Yeah, these were the four elements that were present in ASIP. 836 01:23:18.160 --> 01:23:25.400 And then you say that two of the seven were not relevant to ASIP and that is 837 01:23:25.400 --> 01:23:31.600 responsiveness to client needs and involving clients in medication decisions 838 01:23:31.600 --> 01:23:38.680 and one element of the seven accounting for clients relationship context were 839 01:23:38.680 --> 01:23:41.640 found lacking in both treatment as usual and ACID. 840 01:23:41.640 --> 01:23:49.960 I'm just reminding you this because I I actually disagree with that evaluation to studies because 841 01:23:49.960 --> 01:23:56.400 in my, in my view, responsiveness to client needs is characteristic of ACID. 842 01:23:56.400 --> 01:24:00.400 At at least I saw it in the description of ACID. 843 01:24:00.400 --> 01:24:06.040 And also if you broaden the element of involving client, the one of the seven 844 01:24:06.040 --> 01:24:09.320 elements was involving clients to medication decisions. 845 01:24:09.320 --> 01:24:16.360 But if you broaden that to mean involving clients in treatment decisions, which is effectively 846 01:24:16.360 --> 01:24:22.320 collaborative care, that is also an element of ACID in the broader sense. 847 01:24:22.320 --> 01:24:24.120 Yeah. 848 01:24:24.120 --> 01:24:29.360 So on the other hand, I'm not sure that ACID provides adequate continuity of care 849 01:24:29.360 --> 01:24:33.720 in the sense that it provides psychological continuity within the programme and 850 01:24:33.720 --> 01:24:39.280 in the short space of the programme, but then it doesn't provide continuity after 851 01:24:39.280 --> 01:24:43.920 that or kind of link with other with other services. 852 01:24:43.920 --> 01:24:52.440 So in that sense, yeah, these are my thoughts that actually I, I, 853 01:24:52.440 --> 01:24:58.320 I kind of thought differently about the links between the two studies. 854 01:24:58.320 --> 01:25:06.360 And I wonder whether if there was stronger connection 855 01:25:06.360 --> 01:25:14.080 with the literature on service user perspectives on care generally and stronger 856 01:25:14.080 --> 01:25:19.360 connection with patient centred and recovery oriented professional practises and services. 857 01:25:19.360 --> 01:25:24.640 Whether you had had better connection there then that would allow 858 01:25:24.640 --> 01:25:31.440 you to translate terms from one study to the other. 859 01:25:31.440 --> 01:25:39.640 And so I know earlier you said that you try to restrict yourself 860 01:25:39.640 --> 01:25:47.960 and focus on suicidology research, but I do, I do think that if you had located this study 861 01:25:47.960 --> 01:25:54.680 in the broader context of service users experiences and patient centred recovery oriented 862 01:25:54.680 --> 01:26:04.040 care, that would have allowed you the theoretical framework to translate concepts. 863 01:26:04.040 --> 01:26:09.080 Yeah, translate what they say, the participants say to the theory, to theoretical 864 01:26:09.080 --> 01:26:13.160 concepts and then transpose them from one study to the other. 865 01:26:13.160 --> 01:26:20.320 And also, I think that locating this study in the broader recovery oriented 866 01:26:20.320 --> 01:26:29.720 movement would also allow you to have stronger 867 01:26:29.720 --> 01:26:34.520 effectively promote the implementation through recommendations while you 868 01:26:34.520 --> 01:26:39.000 have the backup of the whole kind of broader literature and movements. 869 01:26:39.000 --> 01:26:43.040 But for that, we'll talk about, we'll talk about that 870 01:26:43.040 --> 01:26:45.000 when we get to the implementation later. 871 01:26:45.000 --> 01:26:48.040 But at the moment, these were my thoughts really that. 872 01:26:48.040 --> 01:26:54.640 So I wonder what you think about my my reinterpretation of your findings. 873 01:26:54.640 --> 01:26:58.000 And but more generally, I think it's an issue of linking it up 874 01:26:58.000 --> 01:27:01.640 to the theory of recovery in patient centred care. 875 01:27:01.640 --> 01:27:05.960 Yeah, I don't disagree. 876 01:27:05.960 --> 01:27:11.240 I, I think it's true that there could have been lot of benefits 877 01:27:11.240 --> 01:27:19.160 in, in linking it to that, to that literature. 878 01:27:19.160 --> 01:27:24.120 Yeah, I think there's, there were also benefits to finishing 879 01:27:24.120 --> 01:27:26.920 this project at some point in my life. 880 01:27:26.920 --> 01:27:32.440 So, so that's, I think that would be my response to that, that 881 01:27:32.440 --> 01:27:35.560 perhaps those are next steps I could think. 882 01:27:35.560 --> 01:27:42.800 But then I do I do have clarification for kind of I do have defence 883 01:27:42.800 --> 01:27:46.680 for for what I have done with the interpretation of the findings 884 01:27:46.680 --> 01:27:50.960 that you were summarising from study two. 885 01:27:50.960 --> 01:27:59.000 And I will take your, your comments as a critique perhaps for not explicating, apparently 886 01:27:59.000 --> 01:28:06.680 not explicating well enough kind of the logic behind that interpretation. 887 01:28:06.680 --> 01:28:11.240 In, in kind of looking at which of the seven elements 888 01:28:11.240 --> 01:28:19.000 ASIP fulfilled or, or, or kind of covered. 889 01:28:19.000 --> 01:28:23.960 I was taking the perspective of what were the service users expecting 890 01:28:23.960 --> 01:28:27.040 from ASIP, which is supposed to be brief intervention. 891 01:28:27.040 --> 01:28:32.840 Because there's this idea that ASIP is not supposed to do from the perspective of, of 892 01:28:32.840 --> 01:28:37.360 the developers of ASIP, but also from the perspective of, of ASIP's users. 893 01:28:37.360 --> 01:28:43.000 I think that was one finding that was both surprising to me and important that 894 01:28:43.000 --> 01:28:48.840 that the that the service users, even though they protested kind of the lack of 895 01:28:48.840 --> 01:28:57.040 continuity of care, that very few of them in any way kind of expressed 896 01:28:57.040 --> 01:29:04.400 that that that us it being short intervention and not kind of then evolving 897 01:29:04.400 --> 01:29:11.680 into other kinds of care within that same same frame. 898 01:29:11.680 --> 01:29:13.740 It was not problematic for them. 899 01:29:13.740 --> 01:29:17.840 They found that that this was something that had had clear idea for some. 900 01:29:17.840 --> 01:29:20.560 It was part of the reason that they were willing to enter 901 01:29:20.560 --> 01:29:22.680 Asif that OK, it's only three times. 902 01:29:22.680 --> 01:29:26.040 I can maybe do that, especially because they're promising me that I can 903 01:29:26.040 --> 01:29:29.360 come in one time and then decide if I want to come in again. 904 01:29:29.360 --> 01:29:34.880 Many of them were were were quite hesitant about they were they were afraid that they would 905 01:29:34.880 --> 01:29:42.160 be that they would have to commit to long term care and, and were hesitant about that and and 906 01:29:42.160 --> 01:29:47.240 found it important that there was available this short intervention. 907 01:29:47.240 --> 01:29:52.560 And here we are now coming to to my defence, which is that let 908 01:29:52.560 --> 01:29:56.800 me try to remember they felt that the continued. 909 01:29:56.800 --> 01:30:00.560 They felt that it was important that in OSIP there was the two year follow 910 01:30:00.560 --> 01:30:04.920 up and they felt that OSIP was in itself continuous enough. 911 01:30:04.920 --> 01:30:12.000 Then they protested that, OK, now I'm emerging from OSIP with clarified understanding of 912 01:30:12.000 --> 01:30:16.520 what I need, what I need to work on, and I am expecting these other services. 913 01:30:16.520 --> 01:30:20.840 For most of them, it was psychiatric outpatient care. 914 01:30:20.840 --> 01:30:27.800 They were enrolled there and they were expecting, In my mind, this was kind of very justifiable 915 01:30:27.800 --> 01:30:34.120 expectation that OK, these services will now help me work on on this stuff. 916 01:30:34.120 --> 01:30:37.600 It's not the job of ASIP, it's the job of these other services. 917 01:30:37.600 --> 01:30:43.280 And then they were frustrated when if that did not happen. 918 01:30:43.280 --> 01:30:45.260 So that was the logic there. 919 01:30:45.260 --> 01:30:47.760 And then there is in Finland, there is the attempt to 920 01:30:47.760 --> 01:30:50.880 include the loved ones in the in, in US. 921 01:30:50.880 --> 01:30:56.520 But but that's that's clear implementation issue that none of these participants 922 01:30:56.520 --> 01:31:03.640 had taken that up, that even though the idea is there, there needs to be more, 923 01:31:03.640 --> 01:31:07.840 more thinking about how to actually make it happen. 924 01:31:07.840 --> 01:31:09.640 Yeah, yeah. 925 01:31:09.640 --> 01:31:16.200 I think the two elements missing from ASIP in my sense, continuity of care, not 926 01:31:16.200 --> 01:31:22.480 in the sense of ASIP itself continuing their care, but of having better links and 927 01:31:22.480 --> 01:31:26.160 referrals to the other services that would continue care. 928 01:31:26.160 --> 01:31:28.720 That something that ASIP needs to think about. 929 01:31:28.720 --> 01:31:36.360 And the second is, yeah, making more active efforts of including the loved ones, because 930 01:31:36.360 --> 01:31:40.520 it's one thing if you say that they might, if they want, they could bring in their 931 01:31:40.520 --> 01:31:43.560 loved ones in the fourth session, as far as I remember. 932 01:31:43.560 --> 01:31:52.080 But clearly more, more attention needs to be paid in 933 01:31:52.080 --> 01:31:54.280 into encouraging people to bring in their loved ones. 934 01:31:54.280 --> 01:31:56.300 So that's yeah. 935 01:31:56.300 --> 01:32:00.200 So in that sense, there's very clear which we're going to get later. 936 01:32:00.200 --> 01:32:08.120 I very clear recommendations can come out of this study regarding 937 01:32:08.120 --> 01:32:14.680 both FASIP and other such interventions. 938 01:32:14.680 --> 01:32:19.680 OK, study three, I don't have as much to say about study 3, so that's OK. 939 01:32:19.680 --> 01:32:25.880 So, the study third study explores the recovery related agency of 940 01:32:25.880 --> 01:32:29.560 suicide attempt survivors and the perceived role of interactions 941 01:32:29.560 --> 01:32:33.840 with services in facilitating or hindering it. 942 01:32:33.840 --> 01:32:38.800 This, in my view, is the most innovative part of the thesis. 943 01:32:38.800 --> 01:32:44.120 The results highlight the complex and multifaceted nature of agency and 944 01:32:44.120 --> 01:32:48.320 its inextricable relationship with professional practises. 945 01:32:48.320 --> 01:32:52.560 It is interesting how the professional practises that participants described 946 01:32:52.560 --> 01:32:58.040 as promoting their agency are pretty much the same as those identified 947 01:32:58.040 --> 01:33:00.600 earlier as helpful elements of their recovery. 948 01:33:00.600 --> 01:33:04.640 So you can see how all these are connected. 949 01:33:04.640 --> 01:33:09.400 I find very interesting the discussion of the findings in relation to Pandura's individual 950 01:33:09.400 --> 01:33:18.080 proxy and collective agency and this seeing it as proxy agency. 951 01:33:18.080 --> 01:33:22.520 The concept of of proxy agency shows the creativity in the active stance of 952 01:33:22.520 --> 01:33:27.360 service users in figuring out ways to get to coach professionals and services 953 01:33:27.360 --> 01:33:32.120 to support them in pursuing their recovery goals. 954 01:33:32.120 --> 01:33:36.120 The linguist self determination theory is also very interesting showing how 955 01:33:36.120 --> 01:33:41.680 they interplay between autonomy, relatedness and competence can be both theoretically 956 01:33:41.680 --> 01:33:46.320 enhanced by the concept of agency and how they can all be supported through 957 01:33:46.320 --> 01:33:50.000 appropriate professional practises. 958 01:33:50.000 --> 01:33:57.720 Now in my view, the innovativeness in this study lies in three things, demonstrating 959 01:33:57.720 --> 01:34:04.440 the Co construction of service user agency in service settings, stressing the crucial 960 01:34:04.440 --> 01:34:11.880 role of professionals in supporting recovery related agency and finally and most importantly, 961 01:34:11.880 --> 01:34:18.400 alerting professionals to the flexible and responsive way that they have to operate 962 01:34:18.400 --> 01:34:21.880 in order to promote client agency. 963 01:34:21.880 --> 01:34:23.680 So these are my thoughts. 964 01:34:23.680 --> 01:34:27.880 It's a, it's complex study and it really has something very new to say 965 01:34:27.880 --> 01:34:32.840 about agency, the relationship between agency recovery and what professionals 966 01:34:32.840 --> 01:34:38.760 can do to promote recovery related agency. 967 01:34:38.760 --> 01:34:44.920 So I would like to hear what from you, what you think about your study, what might have 968 01:34:44.920 --> 01:34:50.960 surprised you in this study, whether you learn something you have not thought about before 969 01:34:50.960 --> 01:34:56.880 here and also the conclusions you derive from this study. 970 01:34:56.880 --> 01:35:03.680 Now I need my pen again. Let's see what So can you repeat? 971 01:35:03.680 --> 01:35:08.200 Yes, whether what you have, what you have learned really from this study, 972 01:35:08.200 --> 01:35:15.120 whether you learn something you didn't expect or didn't know. 973 01:35:15.120 --> 01:35:17.560 And yeah, I think that's the main thing. 974 01:35:17.560 --> 01:35:24.200 What what did you, what did you come out with yourself from this study? 975 01:35:24.200 --> 01:35:28.320 What did you learn? 976 01:35:28.320 --> 01:35:31.400 Thank you for that question and, and, and for your kind 977 01:35:31.400 --> 01:35:33.000 words. I think you had your first question. 978 01:35:33.000 --> 01:35:34.320 What do you think about this study? 979 01:35:34.320 --> 01:35:36.460 And I was going to say that I'm proud of it. 980 01:35:36.460 --> 01:35:38.880 I, I'm, I'm happy with that, with that study. 981 01:35:38.880 --> 01:35:42.760 It's the one I struggled with with the most. 982 01:35:42.760 --> 01:35:49.160 It was also, I think the, the big surprise for me was during the interviews. 983 01:35:49.160 --> 01:35:57.280 It was not kind of then, then not so much perhaps in the, in the process of actually 984 01:35:57.280 --> 01:36:04.880 doing that part of the, the OR kind of working on study three, but rather that, that when 985 01:36:04.880 --> 01:36:13.000 I was doing the interviews, this was what, what surprised me and, and, and kind of 986 01:36:13.000 --> 01:36:19.040 also excited me about, about the interviews was the window, which was new. 987 01:36:19.040 --> 01:36:23.240 And that was of course what I was looking for when I went into this, this research. 988 01:36:23.240 --> 01:36:28.800 I wanted to better understand what's going on in the minds of of service users. 989 01:36:28.800 --> 01:36:31.160 It's different perspective when I'm the professional. 990 01:36:31.160 --> 01:36:39.560 I had of course, and of course, I had tried to kind of to 991 01:36:39.560 --> 01:36:47.240 engage my patients in conversations about how is what we're doing here working out for you, you know, the, the idea. 992 01:36:47.240 --> 01:36:53.640 But it's different kind of perspective when they are, when in those interviews, they 993 01:36:53.640 --> 01:36:58.240 were narrating completely from their own perspective what was going on. 994 01:36:58.240 --> 01:37:06.360 And I think I, I think I was very surprised and also impressed by the kind 995 01:37:06.360 --> 01:37:12.960 of the sheer amount of labour that they put into, into their engagement with services, 996 01:37:12.960 --> 01:37:17.400 kind of the work that they were doing to get the help that they needed. 997 01:37:17.400 --> 01:37:25.800 And then at some, in some cases to protect themselves from what, what was experienced 998 01:37:25.800 --> 01:37:31.880 as harmful or, or, or well, harmful responses in one way or another. 999 01:37:31.880 --> 01:37:35.120 So I was very impressed kind of by what that I was. 1000 01:37:35.120 --> 01:37:37.840 I was so grateful to have that window and, and very 1001 01:37:37.840 --> 01:37:42.560 impressed by, by what it was showing me. 1002 01:37:42.560 --> 01:37:45.160 And that was kind of the first thing that I was really 1003 01:37:45.160 --> 01:37:47.080 intrigued about in, in the interviews. 1004 01:37:47.080 --> 01:37:51.240 Well, then we decided to kind of write up the 1st 2 pieces first or, 1005 01:37:51.240 --> 01:37:55.000 or because I also thought that it's the most complex. 1006 01:37:55.000 --> 01:38:02.960 It's, it's the most difficult to kind of do justice to, to how, how can I kind of this finding 1007 01:38:02.960 --> 01:38:07.880 that's here, that this is how these people talk about these, these interactions. 1008 01:38:07.880 --> 01:38:11.600 How can that be kind of turned into research paper 1009 01:38:11.600 --> 01:38:15.400 that that would be useful to somebody? 1010 01:38:15.400 --> 01:38:20.800 So then I got back to it after I had written up the, the 1st 2 papers. 1011 01:38:20.800 --> 01:38:24.280 And that was good choice, I think in, in in many ways. 1012 01:38:24.280 --> 01:38:28.040 Because of course, my, my own thinking had evolved and I had learned 1013 01:38:28.040 --> 01:38:35.000 lot in, in writing the, the 1st 2 pieces. 1014 01:38:35.000 --> 01:38:40.280 And then then maybe the, the most important kind of learning journey. 1015 01:38:40.280 --> 01:38:45.120 Then when I was actually doing the, the work, analysing that data from 1016 01:38:45.120 --> 01:38:51.880 that perspective and then writing up the report was kind of trying to 1017 01:38:51.880 --> 01:38:55.480 get some kind of handle on the aspects of agency. 1018 01:38:55.480 --> 01:39:02.200 And, and of course that's another concept with, with so many uses and, and so many 1019 01:39:02.200 --> 01:39:06.920 definitions and, and kind of trying to understand what it's doing here. 1020 01:39:06.920 --> 01:39:15.480 And what I think, what I'm happy about is that I think, 1021 01:39:15.480 --> 01:39:18.960 I'm not sure if anybody would agree. 1022 01:39:18.960 --> 01:39:22.760 I, I, I'm interested to hear from the audience if some of them have 1023 01:39:22.760 --> 01:39:25.480 actually opened the book and, and read that thing. 1024 01:39:25.480 --> 01:39:31.840 But what I think is, is, was what I'm proud of is that I think that that the result 1025 01:39:31.840 --> 01:39:36.600 is kind of pretty simplistic in, in, in some ways that it's, it's simple kind 1026 01:39:36.600 --> 01:39:43.280 of simple idea that that's that's their kind of that, that, that the the concept 1027 01:39:43.280 --> 01:39:47.640 of agency that I had found very complex and very difficult to in some way, they're 1028 01:39:47.640 --> 01:39:50.280 both intriguing and difficult to engage with. 1029 01:39:50.280 --> 01:39:55.440 What I'm hoping that that has been done there, at least in my mind, it's kind of been 1030 01:39:55.440 --> 01:40:01.920 broken down into more accessible aspects or, or parts in some ways. 1031 01:40:01.920 --> 01:40:06.480 And, and it's helped me as professional to think about the work that we do lot. 1032 01:40:06.480 --> 01:40:13.400 So I'm hoping it will do that for some other people too. 1033 01:40:13.400 --> 01:40:17.200 Yes, it's not that that don't think it's simplistic at all. 1034 01:40:17.200 --> 01:40:20.760 I mean all the the, the it's, it's, it's really. 1035 01:40:20.760 --> 01:40:25.320 Good how all this complexity which is there in the paper of the notion 1036 01:40:25.320 --> 01:40:28.960 of agency and the notion of recovery and what professionals can do 1037 01:40:28.960 --> 01:40:34.760 is kind of put into this scheme of the four. 1038 01:40:34.760 --> 01:40:41.320 The scheme seems simple, but it actually, you know, it, it kind of condenses very complex 1039 01:40:41.320 --> 01:40:47.160 material and I think it's good guide for professionals in, in terms of what how they 1040 01:40:47.160 --> 01:40:51.720 should be dealing with agency and in the service of recovery. 1041 01:40:51.720 --> 01:40:59.800 OK, so towards the end, moving to the discussion, I would like to 1042 01:40:59.800 --> 01:41:03.880 commend you on the very articulate, systematic and informed way you 1043 01:41:03.880 --> 01:41:07.680 have structured the discussion of the thesis. 1044 01:41:07.680 --> 01:41:12.320 I absolutely agree with your evaluation of the problems and adverse effects 1045 01:41:12.320 --> 01:41:16.280 that the dominance of the medical model and the corresponding evidence based 1046 01:41:16.280 --> 01:41:20.760 practise and evidence based medicine have brought to mental health practise 1047 01:41:20.760 --> 01:41:24.480 generally and suicidology in particular. 1048 01:41:24.480 --> 01:41:29.720 And I agree with you that it is misfortunate that psychology did not exert the influence 1049 01:41:29.720 --> 01:41:35.840 it could as more as central mental health profession in rebalancing the clinical 1050 01:41:35.840 --> 01:41:40.680 and research perspectives in a more psychosocial direction. 1051 01:41:40.680 --> 01:41:44.960 I can see how the emphasis on adopting positive perspective in your 1052 01:41:44.960 --> 01:41:49.760 published work might be necessitated by that dominance. 1053 01:41:49.760 --> 01:41:55.200 However, other perspectives are gaining ground as you describe. 1054 01:41:55.200 --> 01:41:58.080 So how do you think? 1055 01:41:58.080 --> 01:42:04.520 My question is, how do you think you might be able to foster shift towards how do you 1056 01:42:04.520 --> 01:42:10.080 think we might be able to foster shift towards more person oriented and psychosocially 1057 01:42:10.080 --> 01:42:18.600 oriented clinical research and how did you try to do it in your work? 1058 01:42:18.600 --> 01:42:26.400 Do you mean my work as psychologist or or by in in this work this work? 1059 01:42:26.400 --> 01:42:33.400 That's an excellent question. 1060 01:42:33.400 --> 01:42:39.600 I have to say for my part, it's really, really difficult, it's really, really difficult 1061 01:42:39.600 --> 01:42:47.840 question and one I have spent lot of time reflecting on, on kind of trying to understand 1062 01:42:47.840 --> 01:42:53.880 what the what the problem is, why, why it's so difficult. 1063 01:42:53.880 --> 01:42:59.920 Because of course we do have, we have a lot of, we have lot of agreement, 1064 01:42:59.920 --> 01:43:06.160 lot of consensus also across the professions about, about the important 1065 01:43:06.160 --> 01:43:09.320 aspects of, for example, mental health care. 1066 01:43:09.320 --> 01:43:13.280 And I, I, I find that often it's, it's actually little bit difficult. 1067 01:43:13.280 --> 01:43:20.640 It's frustrating and it's difficult to understand why they are not better kind of manifested 1068 01:43:20.640 --> 01:43:28.160 in, in what we do that there is, I think there is actually very little in anything I 1069 01:43:28.160 --> 01:43:32.600 have written that that anyone would would disagree with. 1070 01:43:32.600 --> 01:43:39.560 But perhaps the, the, the disagreement is as to, I, I mean, in, in kind of the finding that 1071 01:43:39.560 --> 01:43:47.600 it's important to, I don't think anybody disagrees with medicine as science, definitely does 1072 01:43:47.600 --> 01:43:53.640 not disagree with the idea that it's important to treat service users or patients as, as human 1073 01:43:53.640 --> 01:43:57.920 beings and, and respectfully and, and so on and so forth. 1074 01:43:57.920 --> 01:44:02.320 But of course the relative emphasis that's given to the different aspects 1075 01:44:02.320 --> 01:44:10.680 of care varies and, and I think it's not, it's not really, I think also 1076 01:44:10.680 --> 01:44:14.920 sometimes kind of medicine gets the blame unfairly. 1077 01:44:14.920 --> 01:44:17.040 It's not really their job. I think. 1078 01:44:17.040 --> 01:44:23.680 I think there's, there's the problem is that we're not dividing labour as 1079 01:44:23.680 --> 01:44:28.600 well as we could, that that we have these different fields of science because 1080 01:44:28.600 --> 01:44:32.880 there are different important questions, for example, in suicide prevention 1081 01:44:32.880 --> 01:44:37.040 or in mental health that we need to address. 1082 01:44:37.040 --> 01:44:42.520 And then what we need is dialogue between the experts. 1083 01:44:42.520 --> 01:44:49.400 And then how we can achieve that is try. I don't, I don't know. 1084 01:44:49.400 --> 01:44:51.200 I'm trying today. 1085 01:44:51.200 --> 01:44:53.400 I've been trying in, in writing these papers. 1086 01:44:53.400 --> 01:44:56.840 I know there are lot of other people trying. 1087 01:44:56.840 --> 01:45:06.160 Of course it would help as as was stated in my, in my opening, opening statements, 1088 01:45:06.160 --> 01:45:10.680 that it would help to have sufficient resources for, for mental health work. 1089 01:45:10.680 --> 01:45:18.760 Because lot of kind of, I think we retreat to, to more authoritative and more kind of 1090 01:45:18.760 --> 01:45:26.040 simplistic and, and more, more more of a strict kind of medical model kind of thinking. 1091 01:45:26.040 --> 01:45:32.000 When we're, we're kind of pushed for resources and, and we don't feel safe 1092 01:45:32.000 --> 01:45:35.320 as professionals, we're uncomfortable as professionals. 1093 01:45:35.320 --> 01:45:41.440 And then it becomes kind of more of nuisance that service users actually have their own 1094 01:45:41.440 --> 01:45:46.680 point of view and their intentional subjects that come into contact with us. 1095 01:45:46.680 --> 01:45:48.740 And, and we can't go around that. 1096 01:45:48.740 --> 01:45:50.960 And, and when we're in a hurry, we want to go around that 1097 01:45:50.960 --> 01:45:52.880 because we know what's good for them. 1098 01:45:52.880 --> 01:45:56.920 And then we want to kind of skip the part where, where we need to form 1099 01:45:56.920 --> 01:46:00.160 mutual understanding of, of what needs to happen. 1100 01:46:00.160 --> 01:46:02.380 So that's one big part of it. 1101 01:46:02.380 --> 01:46:07.280 So in summary, let's try to have dialogues. 1102 01:46:07.280 --> 01:46:11.480 Of course, I'm hoping that that people from from different 1103 01:46:11.480 --> 01:46:14.240 professions will engage in that dialogue. 1104 01:46:14.240 --> 01:46:17.040 There's work to be done within the professions and then 1105 01:46:17.040 --> 01:46:21.000 then across kind of the boundaries. 1106 01:46:21.000 --> 01:46:24.560 And then we need more resources to make it easier. 1107 01:46:24.560 --> 01:46:38.600 It's much easier to to have dialogues if you're not in horrible hurry. 1108 01:46:38.600 --> 01:46:47.080 OK, I in the, in the, I don't know how much time do we have little bit more time or OK, 1109 01:46:47.080 --> 01:46:53.000 now I'll, I'll go through the different topics that you mentioned in your discussion. 1110 01:46:53.000 --> 01:46:57.760 The recognition of relationality as being at the heart of both the development 1111 01:46:57.760 --> 01:47:03.000 of mental health problems, including suicidality, and the recovery from them 1112 01:47:03.000 --> 01:47:06.560 is pointed out in the second section of the discussion. 1113 01:47:06.560 --> 01:47:09.320 This points to the need for services to take into account and 1114 01:47:09.320 --> 01:47:13.040 support the service users relational contexts. 1115 01:47:13.040 --> 01:47:18.360 So, what would the recommendations be from this study regarding strengthening 1116 01:47:18.360 --> 01:47:23.240 the services inclusion of user social contexts and relationships? 1117 01:47:23.240 --> 01:47:25.040 Do you have more? 1118 01:47:25.040 --> 01:47:28.920 I know you discuss it, but would there be more specific 1119 01:47:28.920 --> 01:47:34.280 recommendations you can get from your study? 1120 01:47:34.280 --> 01:47:36.140 That's good question. 1121 01:47:36.140 --> 01:47:40.360 I have steered clear in, in, in the discussion mostly of very specific 1122 01:47:40.360 --> 01:47:46.760 recommendations because I think that that what works kind of how, how 1123 01:47:46.760 --> 01:47:50.680 those ideas can be put to work is so contextual. 1124 01:47:50.680 --> 01:47:55.280 That, that, and the Finnish service system is such that there's lot going on. 1125 01:47:55.280 --> 01:48:01.680 And, and, and how to implement that has to be kind of put into has to kind 1126 01:48:01.680 --> 01:48:08.680 of happen in relation to the, the context of existing services. 1127 01:48:08.680 --> 01:48:13.560 1 simple recommendation, of course, is, is that in ASIP, it's wonderful that there is the 1128 01:48:13.560 --> 01:48:17.360 option to bring loved ones along, but there needs to be more of push. 1129 01:48:17.360 --> 01:48:19.600 This is the, the participants words. 1130 01:48:19.600 --> 01:48:24.640 There needs to be more of push to towards it. 1131 01:48:24.640 --> 01:48:30.320 Of course it's voluntary, but but there there are different ways to help people kind of 1132 01:48:30.320 --> 01:48:37.920 overcome that that challenge that they perceived inviting their loved ones along being 1133 01:48:37.920 --> 01:48:43.360 So perhaps for the audience, it's important to explicate that that that many of the participants 1134 01:48:43.360 --> 01:48:45.560 said that they thought it would have been important. 1135 01:48:45.560 --> 01:48:47.620 They were worried about their loved ones. 1136 01:48:47.620 --> 01:48:51.800 They were, there were conflicts and, and things going on there that that they thought would 1137 01:48:51.800 --> 01:48:57.040 be important to address, but that there was kind of it felt difficult to invite the loved ones 1138 01:48:57.040 --> 01:49:03.320 along for, for and one reason for this was that that they kind of wanted to protect them at 1139 01:49:03.320 --> 01:49:07.480 the same time as they wanted to engage with them and and so forth. 1140 01:49:07.480 --> 01:49:11.240 So that's kind of simple specific recommendation. 1141 01:49:11.240 --> 01:49:17.280 Well, then we have in Finland, I think there is much opportunity because we have the current 1142 01:49:17.280 --> 01:49:25.400 situation in Finland is such that we have, we have kind of fairly 1143 01:49:25.400 --> 01:49:32.920 good infrastructure and developing infrastructure for providing psychotherapy in mental health. 1144 01:49:32.920 --> 01:49:38.480 But then we have this overwhelming dominance of the individual. 1145 01:49:38.480 --> 01:49:43.880 We have, we have this idea, we do not have the idea that people can be treated 1146 01:49:43.880 --> 01:49:46.760 in couples relationships or in family relationships. 1147 01:49:46.760 --> 01:49:54.080 We are pushing everybody toward individually focused interventions resulting in 1148 01:49:54.080 --> 01:49:58.080 those interventions being backed up and, and people having to wait. 1149 01:49:58.080 --> 01:50:04.320 And then we have reserve of, of professionals who are specifically 1150 01:50:04.320 --> 01:50:07.680 skilled in working with couples and families. 1151 01:50:07.680 --> 01:50:10.960 We have couples and family therapists who are, who are very 1152 01:50:10.960 --> 01:50:14.200 much under used in, in the current system. 1153 01:50:14.200 --> 01:50:19.880 So, so by kind of thinking about locally, thinking about how can we, we kind 1154 01:50:19.880 --> 01:50:27.880 of engage with that expertise with that, how, how can we make better use of, 1155 01:50:27.880 --> 01:50:34.720 of the, the people that we already have here in Finland that, that are experts 1156 01:50:34.720 --> 01:50:37.160 in that, how can we make better use of that? 1157 01:50:37.160 --> 01:50:40.200 And we also have kind of the infrastructure for that. 1158 01:50:40.200 --> 01:50:48.960 What we need is for, for the idea of it's possible to address 1159 01:50:48.960 --> 01:50:55.680 mental health problems through relationships that treatment does not need to focus 1160 01:50:55.680 --> 01:51:02.560 only on what's happening in the mind or the brain of the of the service user. 1161 01:51:02.560 --> 01:51:10.960 And that's where I think we need to look outside kind of the very strict EBM frame 1162 01:51:10.960 --> 01:51:17.960 in the sense that that's I think big part of the problem, big part of why we are not making 1163 01:51:17.960 --> 01:51:25.440 good use at this moment of these these interventions is that that there's kind of there's tension 1164 01:51:25.440 --> 01:51:29.640 there that that's difficult when the diagnosis is put on the individual. 1165 01:51:29.640 --> 01:51:36.960 It's difficult then to make the recommendation to work on, on, on changing, 1166 01:51:36.960 --> 01:51:43.760 changing that through, through relational treatment. 1167 01:51:43.760 --> 01:51:50.240 Yes, I don't know if I have anything to add to that. 1168 01:51:50.240 --> 01:51:52.040 OK. 1169 01:51:52.040 --> 01:51:58.200 And, and the other two topics that you address in the in the conclusions 1 is service 1170 01:51:58.200 --> 01:52:06.880 integration, continuity of care both within services and, you know, integration, creating 1171 01:52:06.880 --> 01:52:10.280 pathways between services that ensure continuity of care. 1172 01:52:10.280 --> 01:52:14.120 This is big issue in mental health service literature. 1173 01:52:14.120 --> 01:52:17.400 It's something that's pointed out again and again by the participants. 1174 01:52:17.400 --> 01:52:25.720 So I wonder whether you your research can lead to specific 1175 01:52:25.720 --> 01:52:27.880 recommendations on that. 1176 01:52:27.880 --> 01:52:32.400 And the other is the agency issue again, you, you, you show how complicated 1177 01:52:32.400 --> 01:52:37.760 the issue of agencies and how important the role of professionals is for 1178 01:52:37.760 --> 01:52:42.800 constructing agency recovery oriented agency. 1179 01:52:42.800 --> 01:52:51.560 So again, I suppose more generally, my question is do you, have you thought about 1180 01:52:51.560 --> 01:52:59.400 or rather do you, can you think of any recommendations that would relate to these 1181 01:52:59.400 --> 01:53:04.400 two topics, you know, continuity of care and agency? 1182 01:53:04.400 --> 01:53:10.720 And more generally, I suppose the question is, do you intend to, as 1183 01:53:10.720 --> 01:53:17.880 the next steps, work towards translating the findings into more concrete 1184 01:53:17.880 --> 01:53:22.720 guidelines, recommendations for for practise? 1185 01:53:22.720 --> 01:53:25.200 I'm waiting for an invitation to do so. 1186 01:53:25.200 --> 01:53:31.640 So anyone in the audience working on national projects can call me. 1187 01:53:31.640 --> 01:53:34.600 Let's see, we'll see. We'll see about that. 1188 01:53:34.600 --> 01:53:36.860 Of course. Of course, that's the hope. 1189 01:53:36.860 --> 01:53:42.160 The hope is that that the service users voices and this work could affect what we actually 1190 01:53:42.160 --> 01:53:50.640 do in, in responding to suicidal service users as it comes to recommendations. 1191 01:53:50.640 --> 01:53:57.040 Of course, it's not novel finding that we have problems with the continuity of care. 1192 01:53:57.040 --> 01:54:03.360 I think it's it's very much something that anyone working in in mental health services in Finland 1193 01:54:03.360 --> 01:54:08.760 or anyone who has tried to use them could, could have, could have reported. 1194 01:54:08.760 --> 01:54:17.920 I think what, what the kind of valuable perspective perhaps provided by this, 1195 01:54:17.920 --> 01:54:26.240 this research was, was kind of putting some on elaborating kind of on the process of, 1196 01:54:26.240 --> 01:54:28.040 of. 1197 01:54:28.040 --> 01:54:31.400 Because there is then also big discussion in Finland and internationally 1198 01:54:31.400 --> 01:54:35.840 on the role of brief interventions and, and their value and, and whether 1199 01:54:35.840 --> 01:54:40.640 they're and, and how they would best be used. 1200 01:54:40.640 --> 01:54:47.400 And, and kind of the point that I, I tried to make there in the in the discussion 1201 01:54:47.400 --> 01:54:52.520 is, is that it's very important that we have that many of these interventions can 1202 01:54:52.520 --> 01:54:56.760 be very useful, I suppose clearly useful in this context. 1203 01:54:56.760 --> 01:55:02.240 But if we only only look at that, then, then we will run into trouble. 1204 01:55:02.240 --> 01:55:04.960 We will invest in things that will not kind of pan out. 1205 01:55:04.960 --> 01:55:11.080 They will not have the, the, the intended results. 1206 01:55:11.080 --> 01:55:13.840 I'm happy. 1207 01:55:13.840 --> 01:55:16.080 It is my understanding, I worked for little bit. 1208 01:55:16.080 --> 01:55:20.040 There is this large scale development project in Finland going on 1209 01:55:20.040 --> 01:55:24.160 first line therapies where where the idea is to bring more of these 1210 01:55:24.160 --> 01:55:27.120 brief interventions into the healthcare system. 1211 01:55:27.120 --> 01:55:31.760 But also the very important idea that is at least the idea is there. 1212 01:55:31.760 --> 01:55:39.840 And I'm hoping that it will also be kind of realised in, in all of the implementation 1213 01:55:39.840 --> 01:55:46.080 is that there are processes for ensuring the continuity of care that, that, that the 1214 01:55:46.080 --> 01:55:51.640 big change is actually that after we, we do something with, with the service user, 1215 01:55:51.640 --> 01:55:54.960 then we check that did it help or do you need more help? 1216 01:55:54.960 --> 01:55:59.760 And then then we kind of give more help if, if people need it. 1217 01:55:59.760 --> 01:56:07.880 Whereas in, in the current circumstances, it's we do something and 1218 01:56:07.880 --> 01:56:12.640 then we assume it perhaps helped and then we assume that the person contact 1219 01:56:12.640 --> 01:56:15.520 services again and goes through the whole thing again. 1220 01:56:15.520 --> 01:56:17.500 If, if they need to. 1221 01:56:17.500 --> 01:56:24.160 OK, let me try to kind of get back to what I was saying. 1222 01:56:24.160 --> 01:56:29.720 OK, so we need to, we need to have, we need to kind of try to 1223 01:56:29.720 --> 01:56:36.080 make that a, central idea of, of service design. 1224 01:56:36.080 --> 01:56:40.600 What I think is perhaps concrete, a small but concrete recommendation 1225 01:56:40.600 --> 01:56:43.480 that can can be made based on this research is that. 1226 01:56:43.480 --> 01:56:47.040 And what was surprise to me and which is encouraging is that very 1227 01:56:47.040 --> 01:56:50.800 small gestures could have a very important meaning. 1228 01:56:50.800 --> 01:56:55.560 And and like I emphasise here, it's not so much about the continuity of care. 1229 01:56:55.560 --> 01:57:00.720 Of course, it's, it's nice if it's not so many people and so many places, 1230 01:57:00.720 --> 01:57:06.320 but actually the psychological continuity of care is not the same as 1231 01:57:06.320 --> 01:57:09.480 the actual continuity in the real world. 1232 01:57:09.480 --> 01:57:14.800 And there was much to be done to enhance the psychological continuity of care even 1233 01:57:14.800 --> 01:57:21.120 in the current kind of little bit of chaotic system and, and the little things kind 1234 01:57:21.120 --> 01:57:24.840 of calling to check up on, OK, we referred you to this service. 1235 01:57:24.840 --> 01:57:30.120 Did you go there and and is, are things now now kind of proceeding there was 1236 01:57:30.120 --> 01:57:33.440 very much appreciated and could very much make the difference. 1237 01:57:33.440 --> 01:57:37.640 And after for example, for after discharge from hospital, if somebody 1238 01:57:37.640 --> 01:57:42.920 called to check up on person who was waiting for the next thing to 1239 01:57:42.920 --> 01:57:45.160 start, that could make a really big difference. 1240 01:57:45.160 --> 01:57:48.040 So I think that's something that we can kind of very 1241 01:57:48.040 --> 01:57:53.280 easily capitalise on making those calls. 1242 01:57:53.280 --> 01:57:57.000 OK, Then I had another question to respond to. 1243 01:57:57.000 --> 01:58:02.840 So that's probably enough for, for question number one question #2 was recommendations 1244 01:58:02.840 --> 01:58:13.800 for prioritising the perspective of service user agency better 1245 01:58:13.800 --> 01:58:15.600 there? 1246 01:58:15.600 --> 01:58:18.120 I think again, as you, as you can see, I'm a, I'm 1247 01:58:18.120 --> 01:58:21.720 big believer in, in the power of ideas. 1248 01:58:21.720 --> 01:58:25.080 I'm kind of, it's, it's my idea. 1249 01:58:25.080 --> 01:58:33.280 Also, it's my hope that that not everything, for example, resulting from this 1250 01:58:33.280 --> 01:58:44.640 research needs to be packaged into kind of 1251 01:58:44.640 --> 01:58:52.800 now I'm again looking for the word, let's see that it doesn't need to be kind of ready to use recommendation. 1252 01:58:52.800 --> 01:58:58.240 But I have perhaps I have lot of trust in the agency of, of people listening and, 1253 01:58:58.240 --> 01:59:06.240 and into people working in these services that also just kind of prioritising that, 1254 01:59:06.240 --> 01:59:10.520 that, that if I can make the point that this idea needs to be prioritised, then people 1255 01:59:10.520 --> 01:59:13.080 will have good ideas on how to implement that in practise. 1256 01:59:13.080 --> 01:59:16.840 Maybe that's, that's kind of the help when it comes to agency. 1257 01:59:16.840 --> 01:59:24.240 I think there's, there's lot that we can do in how we train professionals, especially 1258 01:59:24.240 --> 01:59:27.920 in suicide prevention, which is of course the field here. 1259 01:59:27.920 --> 01:59:36.280 We have suicide prevention training traditionally emphasises 1260 01:59:36.280 --> 01:59:41.880 the role of the professional lot about what to do about risk assessment and 1261 01:59:41.880 --> 01:59:47.560 then what interventions to kind of deliver to the the patient and, and, and 1262 01:59:47.560 --> 01:59:52.720 what are the correct steps for for the professional to take. 1263 01:59:52.720 --> 01:59:55.840 And there I think we need shift in emphasis. 1264 01:59:55.840 --> 01:59:58.440 And that's something that's already happening, I think, 1265 01:59:58.440 --> 02:00:02.200 But we need more of shift in emphasis. 1266 02:00:02.200 --> 02:00:08.920 To kind of helping professionals accept the fact that that they have to work 1267 02:00:08.920 --> 02:00:14.480 with the persons agency, that there is no shortcut, that that however much we 1268 02:00:14.480 --> 02:00:19.600 may want to coerce people into wanting to live with the best of intentions, we 1269 02:00:19.600 --> 02:00:23.560 cannot do that under the Finnish mental health law. 1270 02:00:23.560 --> 02:00:30.480 We can keep people safe for short periods of time in specific situations, regardless 1271 02:00:30.480 --> 02:00:34.120 of their own intentions, but those are very short periods of time. 1272 02:00:34.120 --> 02:00:37.440 And if we want people to live their whole lives, we need 1273 02:00:37.440 --> 02:00:41.080 to somehow engage with their own agency. 1274 02:00:41.080 --> 02:00:46.880 We need to support them to form the intentions and acquire the power 1275 02:00:46.880 --> 02:00:50.600 to keep living and, and and keep themselves safe. 1276 02:00:50.600 --> 02:00:57.320 And I think that's kind of bringing that idea more to the forefront in training professionals 1277 02:00:57.320 --> 02:01:04.520 would help professionals relate to service users in more agency promoting ways. 1278 02:01:04.520 --> 02:01:10.000 And I also think it's win win because I think it's also easier to do this work if if you kind 1279 02:01:10.000 --> 02:01:14.720 of surrender to that idea that we're working with intentional human beings. 1280 02:01:14.720 --> 02:01:22.760 And, and even in suicide prevention, it's not my job to be an omnipotent authority 1281 02:01:22.760 --> 02:01:28.080 that, that comes in and fixes the situation, that it's not role that's kind of available 1282 02:01:28.080 --> 02:01:32.960 that, that it's, I don't need to play that role and I cannot play that role. 1283 02:01:32.960 --> 02:01:36.680 That it's enough to kind of engage with the person and, and try 1284 02:01:36.680 --> 02:01:39.240 to look for the way forward together with them. 1285 02:01:39.240 --> 02:01:47.120 I think it, it makes our, our work less stressful and, and more meaningful. 1286 02:01:47.120 --> 02:01:49.600 So I'm hoping to spread that idea. Thank you. 1287 02:01:49.600 --> 02:01:57.680 I, yeah, I, I, I can see your, your argument or your stance that, you 1288 02:01:57.680 --> 02:02:03.520 know, you don't want to, you don't want to have specific recommendations and you, you're 1289 02:02:03.520 --> 02:02:09.280 not in position to have specific recommendations from the position of the researcher. 1290 02:02:09.280 --> 02:02:14.600 But I, I do think given the novelty of this study in the Finnish context 1291 02:02:14.600 --> 02:02:18.280 and the applicability, you know, the kind of that it's an applied study 1292 02:02:18.280 --> 02:02:21.920 that has very direct repercussions for practise. 1293 02:02:21.920 --> 02:02:27.280 It would be worth, I mean, I would urge you to, you know, maybe in, in collaboration 1294 02:02:27.280 --> 02:02:35.800 with ASIP or Mielli or other services, it would be worthy next step to get 1295 02:02:35.800 --> 02:02:40.880 to, to translate this, the findings of this study into more specific guidelines 1296 02:02:40.880 --> 02:02:46.240 for, for good practise, you know, so that, that would be something I would recommend 1297 02:02:46.240 --> 02:02:50.360 that you you do as next step. 1298 02:02:50.360 --> 02:02:58.240 But now more kind of last question, which is if you were able to 1299 02:02:58.240 --> 02:03:04.520 do this study again, what would you change and what? 1300 02:03:04.520 --> 02:03:09.640 Yeah, like after the event, looking at it, what have you done differently? 1301 02:03:09.640 --> 02:03:13.120 What would you have done differently? 1302 02:03:13.120 --> 02:03:16.720 I would not have transcribed the interviews myself. 1303 02:03:16.720 --> 02:03:23.600 I think that that was, that was the most, most difficult and frustrating 1304 02:03:23.600 --> 02:03:28.280 and exhausting part of the research process. 1305 02:03:28.280 --> 02:03:33.640 Of course, it was also a, a, good way to really immerse myself in the data. 1306 02:03:33.640 --> 02:03:35.740 But I would not have done that. 1307 02:03:35.740 --> 02:03:38.200 I did it because it would have been, I thought at the time that it would 1308 02:03:38.200 --> 02:03:43.160 have been more of hassle because I didn't think of including in the, when 1309 02:03:43.160 --> 02:03:46.400 I was applying for the ethical approval and all that. 1310 02:03:46.400 --> 02:03:50.200 I didn't think to kind of put it in there that there will 1311 02:03:50.200 --> 02:03:52.160 be somebody transcribing them other than me. 1312 02:03:52.160 --> 02:03:56.240 And then I thought it's bigger work to go over that again. 1313 02:03:56.240 --> 02:04:03.880 So I have learned that on perhaps more important note, I think what I have regretted 1314 02:04:03.880 --> 02:04:12.680 most during this research process is not again, not 1315 02:04:12.680 --> 02:04:21.480 applying in the beginning for permission to contact the participants, afterwards to not. 1316 02:04:21.480 --> 02:04:27.880 It would have been wonderful to have the chance to re engage with them, perhaps 1317 02:04:27.880 --> 02:04:32.600 for some form of kind of member checking for for some form of presenting the 1318 02:04:32.600 --> 02:04:37.280 the results to them and and hearing their ideas on that. 1319 02:04:37.280 --> 02:04:41.720 And then also of course, another but related idea would have 1320 02:04:41.720 --> 02:04:47.760 been kind of follow up follow up interview. 1321 02:04:47.760 --> 02:04:53.640 I was, I think kind of had the fantasy at the time that lot of this was also 1322 02:04:53.640 --> 02:05:01.560 kind of lot of the, the participants offered like they, they made spontaneous 1323 02:05:01.560 --> 02:05:05.760 offers that you can contact me and, and I'll be happy to engage in more of 1324 02:05:05.760 --> 02:05:08.520 this kind of research and, and, and so on. 1325 02:05:08.520 --> 02:05:13.360 And then it was little bit of a surprise to me that, that the system was so 1326 02:05:13.360 --> 02:05:18.680 unflexible that, that I was not, it was not possible to do that. 1327 02:05:18.680 --> 02:05:22.720 So that's something that if I went back now to beginning this research that I 1328 02:05:22.720 --> 02:05:28.400 would kind of include that in that in the paperwork that was sent in for review 1329 02:05:28.400 --> 02:05:36.600 and that I that, that I received the, the permissions for. 1330 02:05:36.600 --> 02:05:41.400 I think that's the, those are the biggest things that there's lot of little things 1331 02:05:41.400 --> 02:05:49.120 maybe more to do with the process, but I'm also quite happy with that. 1332 02:05:49.120 --> 02:05:50.920 That's not very many. 1333 02:05:50.920 --> 02:05:55.880 So you were overall happy with it, content with the process? 1334 02:05:55.880 --> 02:05:57.680 OK. 1335 02:05:57.680 --> 02:06:02.280 I think I am ready to make the final statement. 1336 02:06:02.280 --> 02:06:14.640 Yes, 1337 02:06:14.640 --> 02:06:23.000 I have now completed the oral examination of the candidate and I'm satisfied with the responses provided 1338 02:06:23.000 --> 02:06:26.520 by Selma in our discussion. 1339 02:06:26.520 --> 02:06:31.080 As is evidenced in both the thesis itself and the oral examination that 1340 02:06:31.080 --> 02:06:36.280 took place today, Selma has displayed proficiency in both the theoretical 1341 02:06:36.280 --> 02:06:40.400 background and her chosen method of analysis. 1342 02:06:40.400 --> 02:06:46.000 She was able to navigate quite diverse and complex theoretical literature, to 1343 02:06:46.000 --> 02:06:52.240 present complicated concepts and debates in clear yet nuanced manner, and to 1344 02:06:52.240 --> 02:06:58.200 provide an accessible account of to wider readership. 1345 02:06:58.200 --> 02:07:00.840 The way she has analysed and interpreted the research 1346 02:07:00.840 --> 02:07:04.040 material is thorough and thoughtful. 1347 02:07:04.040 --> 02:07:09.200 She has made excellent use of qualitative research to systematically highlight 1348 02:07:09.200 --> 02:07:14.360 the suicide survivor perspectives on what helps them in the services that they 1349 02:07:14.360 --> 02:07:19.120 receive, producing significant knowledge that can be used for the development 1350 02:07:19.120 --> 02:07:22.680 of effective suicide prevention services. 1351 02:07:22.680 --> 02:07:27.760 Based on this, I present the thesis to the faculty for approval. 1352 02:07:27.760 --> 02:07:32.200 And I would like to congratulate you. 1353 02:07:32.200 --> 02:07:37.520 Thank you very much for for this interesting discussion 1354 02:07:37.520 --> 02:07:46.200 and and for all your comments, remarks. Thank you. 1355 02:07:46.200 --> 02:07:49.680 It's your first. You end it first. 1356 02:07:49.680 --> 02:07:52.720 And then I say copy. No, you should ask. 1357 02:07:52.720 --> 02:07:55.080 Oh, I should ask. You can't end it yet. 1358 02:07:55.080 --> 02:07:57.760 Oh, no. 1359 02:07:57.760 --> 02:08:03.040 We have rehearsed these lines lot, but still we don't remember them. 1360 02:08:03.040 --> 02:08:05.440 Let's see. I need to look up. 1361 02:08:05.440 --> 02:08:07.240 I'm so happy I survived. 1362 02:08:07.240 --> 02:08:11.040 But but now, Now I believe that I have not yet survived. 1363 02:08:11.040 --> 02:08:14.960 OK. 1364 02:08:14.960 --> 02:08:19.640 I solicit those people who have some critical comments regarding my 1365 02:08:19.640 --> 02:08:39.400 thesis to ask from to ask for an address from the 1366 02:08:39.400 --> 02:08:42.080 KUSTO.