Conference Agenda

Gambling has been described as a ‘coercive commodity’, with products designed to encourage continued engagement despite the consumer’s knowledge that this is against their best interests. Industry insiders have been quoted as seeking to maximise ‘time on device’ and encourage customers to ‘play to extinction’ –i.e. to exhaust all available funds. Evidence of a positive relationship between gambling and suicide has emerged in the context of a rapid expansion of gambling globally.

Thirty-two interviews were conducted in Australia to understand the how gambling leads to suicidal distress. Participants included people who had survived gambling-related suicide attempts (n=23); been bereaved by gambling-related suicide (n=3); and professionals working in aligned areas (n=6). Interviews were analysed using reflexive thematic analysis to inform understanding of the mechanism of the relationship between gambling and suicide. Analysis was informed by social practice theory to move beyond individual responsibility framings.

People who experienced suicide attempts described ‘irrational’ or ‘robotic’ engagement with gambling. This led to deepening cycles of loss that eroded not only financial but often social and biological resources, their identity and agency, ultimately leading to suicidal ideation and attempts. Participants described trying to safely ‘defect’ from the social practice of gambling to break ‘neverending’ cycles of loss. However, the current system provides very limited and sometimes inappropriate support to reduce gambling. Attention to the commercial determinants of health shows how suicide prevention efforts can be undermined by economic operators, who effectively create a pathway to suicidality through measures that encourage customers to continue gambling, with devastating consequences.

There are many interventions and reforms that could be implemented to support people to control their losses, and defect safely from harmful gambling. Suicide prevention should be a priority in gambling provision and regulation, just as gambling is increasingly being recognized in the suicide prevention field.

Introduction
Formal and informal no-suicide contracts (NSCs) are a routine element of psychiatric practice, despite persistent criticism in psychiatric and suicidological research regarding their therapeutic effectiveness, diagnostic validity, and legal reliability. This near-universal use stands in sharp contrast to their contested status in theory. This presentation addresses this discrepancy by shifting the analytical focus from clinical efficacy to organizational practice.

Methods
The analysis is based on a six-month ethnographic, micro-sociological study of inpatient psychiatric settings in Germany. Data were generated through participant observation of everyday clinical routines, staff interactions, documentation practices, and case discussions, complemented by informal interviews and document analysis. Following a praxeological approach inspired by Garfinkel (1967), the study examines how NSCs are practically accomplished and embedded in organizational rationality.

Results
The findings indicate that NSCs are primarily concluded to meet organizational and documentary requirements rather than therapeutic goals. Psychiatric documentation operates as a central coordination device in which heterogeneous demands—therapeutic, diagnostic, administrative, economic, and legal—must be translated into standardized and unambiguous records. In this context, NSCs function as a practical tool for producing a credible and documentable distancing from acute suicidality. They enable clear categorization, facilitate decision-making, and support internal communication across professional and institutional boundaries. Additionally, NSCs contribute to processes of responsibilization by temporarily reallocating decision-making responsibility to patients within a highly regulated clinical environment.

Conclusions
The persistence of no-suicide contracts can be explained by their organizational utility rather than their clinical effectiveness. NSCs stabilize documentation, manage uncertainty, and support institutional accountability. Understanding these contracts as organizational devices helps to clarify the enduring gap between theoretical critique and clinical practice.

Introduction
Psychiatric suicide prevention is oriented toward preventing a future, potentially catastrophic event. To act preventively, suicidality must be anticipated and governed in the present. This temporal and practical orientation produces a central paradox: the very techniques designed to prevent suicide may themselves contribute to the production of suicidality. This presentation examines this paradox as a constitutive feature of psychiatric suicide prevention.

Methods
The analysis is based on a six-month ethnographic, micro-sociological study of inpatient psychiatric settings in Germany. Data were collected through participant observation of clinical routines, staff interactions, case discussions, and documentation practices, complemented by document analysis. The study follows a praxeological approach to examine how suicide prevention is practically enacted.

Results
Across different preventive domains, the findings reveal a recurring paradoxical pattern. Whether through an excess of therapeutic attention or through intensive disciplinary and controlling techniques, preventive practices may themselves induce, intensify, or enable suicidality. Psychopharmacological interventions illustrate this ambivalence particularly clearly: medications intended to reduce depressive symptoms may increase drive before mood improves, or become means for self-harm themselves. At the institutional level, the psychiatric clinic emerges as a preventive hotspot in which the density of suicidality increases the risk of contagion. In each case, suicide prevention does not merely respond to pre-existing risk but actively reshapes and sometimes amplifies it. Suicidality thus appears as both the object and the product of preventive practice.

Conclusions
These dynamics do not indicate isolated misapplications of preventive techniques. Rather, they point to a practical paradox at the core of psychiatric suicide prevention: preventing suicide requires interventions that may simultaneously generate new risks. Suicide prevention therefore operates through system-immanent feedback effects in which the production of risk continuously reactivates preventive action.

The Power-Threat-Meaning Framework (PTMF) represents a paradigm shift in understanding emotional distress and suicidality. Instead of emphasizing psychiatric diagnoses and interventions, the PTMF enables a more meaning-oriented, comprehensive, and context-sensitive approach, with significant potential to strengthen suicide prevention. Within this framework, suicidality is understood as a response to painful experiences and adverse life circumstances - challenges that threaten various fundamental needs, such as feeling safe and valued, having control over important aspects of life (including our bodies and emotions), having basic physical and material needs met, being engaged in meaningful activities, and experiencing justice. PTMF highlights the importance of addressing power imbalances and relational, social, and systemic conditions (e.g., inequality, trauma, and marginalization) that frequently underlie experiences of emotional pain, hopelessness, and entrapment. By focusing on personal narratives and collaborative meaning-making, PTMF encourages interventions that are compassionate, empowering, and context-sensitive, fostering hope and recovery.

This presentation will outline the Power-Threat-Meaning Framework as an approach to improving suicide prevention and demonstrate its practical application through a self-empowerment course developed and scheduled for piloting in Spring 2026 for individuals with mental health and/or substance use challenges. The course aims to provide a new understanding of the participants' experiences and challenges, which may contribute to increased self-worth, empowerment, hope, and enable new ways of acting and relating to other people. Participants will explore and reflect upon key aspects of the PTMF, relate these to lived experiences, and enhance awareness of personal strengths and access to resources. Data will be co-created throughout the course, and initial findings will be presented.

Despite growing evidence highlighting the lack of predictive validity in structured risk assessments and the false messaging that suicide is reliably preventable, the field continues to utilize prevention training models that inadvertently set clinicians up for profound moral injury by linking professional competence directly to patient survival. This systemic failure, where flawed frameworks prevail over empirical reality, creates conditions that increase risk for both patients and clinicians.

This paper examines areas of unintended harm caused by this enduring paradigm. Utilizing case vignettes and drawing upon qualitative and quantitative findings from extensive work with over 200 clinician-survivors, the severity of consequences are brought to life. The data illuminates how distorted responsibility compromises clinical judgment, intensifies risk, and leads to occupational impairment, with clinicians suffering unnecessary personal and professional consequences. Subsequent patients are at increased risk when clinical judgment becomes acutely compromised and unsupported providers struggle to return to sound decision-making. Furthermore, the reliance on inadequate tools of suicide prevention was repeatedly found to inadvertently result in decreased clinical vigilance in identifying patients at risk who do not fit this narrow framework with potentially lethal consequences.

This presentation offers a corrective lens: one that distinguishes competence from outcome, clinician skill from patient behavior, and responsibility from impossibility. It proposes a more honest, sustainable model of training—one that prepares clinicians not only to intervene by supporting patients through suicidal crises where possible, but to navigate the cases where prevention is neither the sole outcome nor the only measure of professional worth.

Background

Activism can play a vital role in shaping or challenging responses to suicide, yet is under-examined and with little research to understand how activists contribute to understandings of suicide prevention. This presentation explores the intersection of activism and suicide from qualitative analysis of 20 UK campaigns.

Methods

A web-based search for publicly available campaigns with a clear orientation to raising public awareness and/or advocating for policy change related to suicide was conducted. The purposive sample focused on key areas of suicide activism rather than representativeness, capturing diverse and sometimes disruptive viewpoints, including both prominent and less visible campaigns.

Abductive qualitative analysis, drawing on Bacchi’s ‘What the problem is represented to be’ approach was undertaken using NVivo, and guided by three research questions: How do activists (1) make sense of suicide and engage it in their work? (2) understand their work in relation to notions of ‘liveability’ and ‘unliveability’? (3) contest and/or reproduce hierarchies of liveability?

Results

Preliminary findings suggest activists often reframe suicide as a collective issue of justice, rather than an isolated personal tragedy. Activism can highlight how conditions of ‘unliveability’, such as structural inequality, political violence, and social exclusion - render some lives as disposable. Activists frequently further contest the depoliticised language of suicide prevention by situating deaths within broader struggles against oppression, and using political activity to address cultural and structural conditions that contribute to suicidality. Simultaneously, some activist campaigns can (partially) replicate/reinforce dominant, medicalised understandings of suicide as primarily a matter of individual mental illness. For example, reflecting policy discourses of ‘surveillance’ and ‘risk’ that can obscure broader social, political, and economic contexts.

Conclusions

Exploring activists’ complex engagements with suicide broadens sociological understandings of social and political contestation of suicide and underscores the importance of collective strategies in confronting conditions that produce vulnerability to suicide.