Louis Theroux interviewed Intelligence Squared. Highly recommend Louis Theroux; having watched many of his youtube videos, I like the idea of “Diversity in Unity” as John Hume said but we need to engage with “Confronting Conformity.” Sam Altman … just so very ordinary, if you haven’t watched the video on canisgallicus.com, time to learn a little more about where our future is going.

Confronting Conformity with Louis Theroux | Intelligence …

YouTube·Intelligence Squared·2 Dec 2023

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Al Jazeera – Opinion. It is time to seek justice for environmental war crimes.

It is time to seek justice for environmental war crimes.

Ongoing efforts in Ukraine to document and prosecute atrocities linked to the environment can help with accountability in other war zones.

Streets are flooded in Kherson, Ukraine on June 7, 2023 after the walls of the Kakhovka dam collapsed [AP/Libkos]

War is horrific for people, communities and nations. The abuses they suffer demand our immediate attention, compassion and action. While some violations are clear and there are mechanisms and institutions to investigate them and offer recourse, others are not so apparent. One example of the latter is environmental war crimes.

We are only beginning to understand the full extent of wars’ impact on air, water and the natural environment; on soils and agriculture; on energy and water infrastructure; and ultimately, on public health and safety. The challenge is that much of this cannot be easily seen and has not yet been sufficiently studied, and it is likely that the victims of this less visible side of war may be far greater in number than imagined.

Where there are crumbled buildings, there may be deadly asbestos and silica dust dispersed into the air. Where there are landmines and unexploded ordnance, or damaged industrial sites, there may be leaks of heavy metals and other potent pollutants, some of which last for generations. Where lakes and farm fields are poisoned, food security suffers.

Today’s international law already includes tools to prosecute war crimes that do disproportionate damage to the environment, but prosecutions for such crimes have been rare in either local or international courts. Reparations for this damage has also been far too limited, with claims in international tribunals meeting evidentiary roadblocks.

There are some positive signs that this could change. The UN General Assembly brought attention to this issue in an important resolution in 2022 on the protection of the environment in relation to armed conflicts, which notes the responsibility of states to provide full reparations for environmental damage due to wrongful acts in war. On March 1, the UN Environment Assembly passed a consensus resolution that called for better data collection on the environmental damage associated with armed conflict.

The prosecutor of the International Criminal Court, Karim Khan, also recently announced that his office is developing a comprehensive policy on environmental crimes, with a firm commitment to advance accountability for these crimes.

A real challenge is to track environmental damage even while a conflict is under way. But this is essential in order to protect public health and take urgent measures to limit damage, such as stopping active leaks of deadly pollutants into rivers or farmland. Documenting the damage is also important in order to ensure full reparations are eventually paid, as is required if it is caused by illegal acts of war, and so that individual perpetrators can be held to account.

An important contribution in this area is emerging in Ukraine.

Russia’s full-scale invasion of Ukraine has had a terrible impact on the natural environment. Ukraine is a country with impressive biodiversity and important nature reserves, but the war has devastated many areas. Soils and waterways have been polluted with chemicals, while farmland, forests and green spaces have been ravaged by shelling, fires and floods.

The destruction of the Kakhovka dam a year ago, presumed to have been an intentional act by the occupying Russian forces, flooded villages and farmlands and caused widespread ecological damage all the way to the Black Sea.

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On top of this, one-third of Ukraine’s territory is now suspected to be contaminated with landmines or unexploded ordnance, surpassing any other country in the world, according to the International Campaign to Ban Landmines.

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We have been part of an effort to bring these environmental concerns to the world’s attention by joining a bold initiative by the president of Ukraine, Volodymyr Zelenskyy.

The president created the High-Level Working Group on the Environmental Consequences of the War in Ukraine, of which we are pleased to be members, and included environmental security as a core element of the Peace Formula that he proposed as a framework for ending the war.

This working group recently published a broad set of recommendations in an “Environmental Compact” (PDF) which points to three priorities.

First, there is a need to establish clear guidance for documenting environmental damage, employing modern technologies. By working with international partners to establish such standards, Ukraine can help guide how environmental damage is documented in all conflicts.

Second, with this data and evidence in hand, we must ensure criminal accountability and full reparations. There are important efforts already under way at the national and international levels, but there is space to expand them.

A national strategy for environmental justice, currently being developed by the prosecutor general in Ukraine, is a step in the right direction. At the international level, there should be more attention paid to these crimes in foreign courts, including through cases that apply universal jurisdiction.

Investigators and prosecutors should adopt a victim-centred approach to understanding environmental damage and the redress needed. Human rights investigations in Ukraine should give special attention to environmental damage and the risks to public health, as they assess rights violations.

Finally, the working group points to the imperative of sustainable reconstruction, incorporating development strategies that are friendly to the climate and to the environment. Efforts to apply these principles must begin now, as rebuilding is already under way in some parts of Ukraine.

Green justice and green recovery in Ukraine will be to the benefit of all countries affected by conflict around the world. When Russia launched its full-scale invasion of Ukraine two years ago, the Kremlin put the international legal order at risk. Its actions are a clear violation of international law and the UN Charter. The future of this international order, and the expectation of justice for such flagrant violations, will be determined by how the world continues to respond to this aggression, including the terrible and disproportionate attacks on the environment.

We all know that environmental threats do not stop at borders. The risk of a significant nuclear radiation disaster that hangs over Ukraine – due to the Russian occupation of the Zaporizhyya Nuclear Power Plant, Europe’s largest – is one worrying example of the regional threat. Another is the war’s impact on the Black Sea, where environmental damage is having deadly effects on sea life and impacts all countries bordering this important body of water.

Now that the world is awakening to the scale of environmental crimes in conflicts, we must work to ensure that accountability follows, addressing both individual crimes and the responsibility to repair the harm by the perpetrator state.

Justice is due in Ukraine. And justice is due equally in all conflicts where force exceeds agreed legal limits. Let us work together for a green, just and peaceful future for those nations now suffering such attacks.

The views expressed in this article are the authors’ own and do not necessarily reflect Al Jazeera’s editorial stance. 


  • Margot Wallström Former Minister of Foreign Affairs of Sweden. Margot Wallström is the former Minister of Foreign Affairs of Sweden and the Co-Chair of the High-Level Working Group on the Environmental Consequences of the War.
  • Mary Robinson Former President of Ireland. Mary Robinson is Chair of The Elders and was the first woman President of Ireland and former UN High Commissioner for Human Rights. She is a member of the High-Level Working Group on the Environmental Consequences of the War.

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Sam Altman is the co-founder and CEO of OpenAI, the AI research and deployment company behind ChatGPT and DALL-E. Interesting view of the present, lucky time, full of hope. We need this as the world engages in wars; AI and beyond now is the time to start … it follows the Internet and now is the time to create the next milestone. Option he might take if he was young again it would be AI research he would choose to work in. You can learn so much from setting up your own company.

342,534 views 1 May 2024

Sam Altman is the co-founder and CEO of OpenAI, the AI research and deployment company behind ChatGPT and DALL-E. Altman was president of the early-stage startup accelerator Y Combinator from 2014 to 2019. In 2015, he co-founded OpenAI as a nonprofit research lab with the mission to build general-purpose artificial intelligence that benefits all humanity. In this conversation with Stanford adjunct lecturer Ravi Belani, Altman gives advice for aspiring AI entrepreneurs and shares his insights about the opportunities and risks of AI tools and artificial general intelligence.

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Russia as a vassal state of China: Average Russian does not want this. MI6 Christopher Steele on Frontline. Times Radio. “Under China’s Thumb” … hard pill for Russians to swallow. Add to this Russia’s reliance on military support from Iran and North Korea!

10th May 2024

Frontline | The War in Ukraine and Global Security “There’s a great degree of instability underneath him where people are jockeying for leadership.” Putin is losing the support of the Russian people as it seems his country is becoming “a vassal state of China”,says former MI6 officer Christopher Steele.

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Michael Comyn KC. Search Comyn and you will find a colourful character and much involved in the founding of the Irish Republic. However, this piece taken from Wiki shows that his interests went far beyond law. Ben Briscoe and Michael Comyn organised a very clever deal to get licences for 2800 acres in Wicklow, in search of Gold!!! Later in his life he was again in trouble with Lemass about the Government compulsarily taking his phosphate mines in Clare. In his 80’s, with Sean McBride as his senior counsel; and Brendan East he sued the Irish State and he won.

Corruption in the Republic of Ireland

From Wikipedia, the free encyclopedia

Political corruption
Forms and concepts
Bribery Cronyism Economics of corruption Electoral fraud Elite capture Influence peddling Kleptocracy Mafia state Nepotism Pyrrhic defeat theory Slush fund Simony State capture State-corporate crime Throffer
Anti-corruption
International Anti-Corruption Court Group of States Against Corruption International Anti-Corruption Academy International Anti-Corruption Day United Nations Convention against Corruption
Corruption by continent and country
Africa Angola Botswana Cameroon Chad Comoros Democratic Republic of the Congo Egypt Equatorial Guinea Eritrea Ethiopia Ghana Guinea-Bissau Kenya Liberia Mauritius Morocco Nigeria Senegal Sierra Leone Somalia South Africa South Sudan Sudan Tanzania Tunisia Uganda Zambia Zimbabwe Asia Afghanistan Armenia Azerbaijan Bahrain Bangladesh Brunei Cambodia China Cyprus Georgia India Indonesia Iran Iraq Israel Jordan Kuwait Kyrgyzstan Kazakhstan Lebanon Malaysia Myanmar Nepal North Korea Pakistan Philippines Singapore South Korea Sri Lanka Syria Tajikistan Thailand Turkey Turkmenistan Uzbekistan Vietnam Yemen Europe Albania Austria Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Kosovo Latvia Lithuania Luxembourg North Macedonia Northern Ireland Moldova Montenegro Netherlands Norway Poland Portugal Romania Russia Serbia Slovakia Slovenia Spain Sweden Switzerland Ukraine United Kingdom North America Canada Costa Rica Cuba El Salvador Haiti Mexico Nicaragua United States South America Argentina Bolivia Brazil Chile Colombia Ecuador Paraguay Peru Uruguay Venezuela Oceania Australia New Zealand Papua New Guinea
vte

Transparency International‘s 2023 Corruption Perceptions Index scored Ireland at 77 on a scale from 0 (“highly corrupt”) to 100 (“very clean”). When ranked by score, Ireland ranked 11th among the 180 countries in the Index, where the country ranked first is perceived to have the most honest public sector.[1] For comparison with worldwide scores, the best score was 90 (ranked 1), the average score was 43, and the worst score was 11 (ranked 180).[2] For comparison with regional scores, the highest score among Western European and European Union countries [Note 1] was 90, the average score was 65 and the lowest score was 42.[3]

During the years before the Celtic Tiger (1995–2007), political corruption was at its worst with many politicians suspected of corruption, while financial corruption was at its peak during the Celtic Tiger years.[4] In 2003 Ireland signed the United Nations Convention against Corruption treaty and ratified it on 11 November 2011.[5]

Politics

Pre-partition

The Acts of Union (1800), which saw the Kingdom of Ireland become part of the United Kingdom of Great Britain and Ireland, was marked by bribery on a scale not seen before in Ireland.[6][7] The Members of the Parliament of Ireland were induced by favours of titles and land to vote it out of existence.[8]

Local politics in 19th century Ireland came to be dominated by either Irish nationalist or unionist local councils. Both were known for their corruption, which surpassed that in Britain.[9][10]

1900–1940

The Irish Free State was established as, in all but name, an independent state in 1922. In the 1920s, politicians were even expected to reimburse the cost of meals, and some slept in their offices due to gunfire outside.[11]

One major case of corruption in Ireland happened in County Wicklow; dubbed the Wicklow Gold Inquiry, it involved the distribution of mining licenses in 1935. The Minister for Industry and Commerce at the time, Seán Lemass, granted a mining licence to the politicians Michael Comyn and Bob Briscoe. These licenses covered an area of 2,982 acres in Wicklow. They both leased the land to a British mining company in exchange for £12,000 and royalties on any gold found. An inquiry was launched due to Patrick McGilligan of Cumann na nGaedheal accusing Lemass of favouring members of the Fianna Fáil political party. The inquiry cleared Lemass of any wrongdoing due to the fact that he did not benefit financially.[11]

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Protesters attempt to storm Tesla’s factory near Berlin. Source: DW. Green/Environmental but what are transfer costs – the cutting down of forests has a very specific value to the environment? We must not forget lithium and all the other products mined and used for what is called “Green”.

Protesters attempt to storm Tesla’s factory near Berlin

Zac Crellin 10th May 2024

Environmentalists have long criticized Tesla for clearing forest in order to build its electric car factory outside Berlin. A police spokesperson said the situation remained “dynamic.”

https://p.dw.com/p/4fi2p

Protesters running past a police officer
Hundreds of people stormed the Tesla Gigafactory in Grünheide outside BerlinImage: Axel Schmidt/Getty Images

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Multiple people have been arrested after activists attempted to break into Tesla’s electric car factory outside Berlin on Friday, according to police. 

Regional broadcaster RBB reported that several hundred people ran toward the Tesla facility, with many people wearing masks and dressed in black.

“We are here today to draw attention to the Tesla factory in Grünheide for the environmental destruction here in Grünheide,” said Ole Becker, a spokesperson for the Disrupt Tesla alliance.

“But also for the environmental destruction in countries like Argentina or Bolivia, where lithium is mined that is needed for these batteries and that causes terrible environmental destruction for the people there, but also for the environment.

Hundreds of protesters running through a field
Activists were able to push past the outer fence of the factoryImage: Axel Schmidt/Getty Images

The protesters were reportedly able to overcome the outer fence of the Tesla Gigafactory but were stopped by police shortly after.

Protesters also disrupted operations at a nearby airfield in Neuhardenberg where unsold Tesla vehicles are being stored, while environmental group Robin Wood staged a protest outside a Tesla dealership in Berlin.

At least one protester and three officers were injured, according to authorities.

The situation remains “dynamic,” a police spokesperson told the German news agency dpa.

Protesters running past trees
Police and protesters faced off in the forest near GrünheideImage: Axel Schmidt/Getty Images

Police arrest protesters

Police responded to the disruption with a large contingent off officers. They arrested a number of people at two of the protest sites.

Brandenburg Police deployed water cannons, which were not used, as well as an armored vehicle.

“There are registered assemblies. We protect the freedom of assembly, of course,” a spokesperson said.

“But we are also responsible for public order and safety. That means we will also intervene when necessary. “

Activists plan days of action

On Friday afternoon, many of the protesters returned to their campsite on a nearby country road.

The activists have called for days of action against Tesla and its facilities in the German state of Brandenburg.

Police carrying off a protester near Berlin
Police also arrested several people at the Neuhardenberg Airfield where Tesla vehicles are storedImage: Patrick Pleul/dpa/picture alliance

“We will bring attention to the Tesla factory in a variety of ways to fight for a mobility transition for everyone,” Becker said.

“We need mobility. Everyone needs mobility. We need to get from A to B. And that’s why we want to fight for a genuine social mobility transition and not for a car-centered way of doing things — we want a public transport that is free and that everyone can use. And there will be many different events to achieve this.”

Environmentalists have long protested against Tesla’s factory in Grünheide because forest was cleared in order to build it.

Now, the company plans to expand the facility which would require more woodlands to be cleared.

Police and protesters facing off near the Tesla factory
Protesters have set up camp near the Tesla factoryImage: Michael Ukas/tnn/dpa/picture alliance

The far-left Volcano Group claimed to have sabotaged the factory by cutting the power supply in March.

Meanwhile, climate protesters have set up their own tree house camp in the forest that is scheduled to be cleared to make way for the factory expansion.

This article draws on information from the DPA and Reuters news agencies.

Edited by Louis Oelofse

While you’re here: Every Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing. 

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Polycrisis…”Knowledge is no load to carry” but people are determined to avail of it. Highly recommend Martin Wolf. We are in a time of geopolitics. People need to be aware in order to act.

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Powerful words: Hope, Altruism, Curiosity, Care, Tolerance, Kindness and so many ‘good’ labels. Today there is an article in The Guardian about Geel. Having Googled Geel, this goes back to “1969” Time article and maybe we should review it because mental illness is a blight in our country and festering out of control as psychiatrists, nurses just will not engage with what his a cinderella experience and are emigrating or choosing to work in different areas in medicine. Title from Time magazine has a catchy title. “Mental Illness: A Town for Outpatients.” There are many of us who could have been in long term care but escaped to a “village” within a urban setting that accepts us.

Mental Illness: A Town for Outpatients

Friday, Mar. 14, 1969

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On the surface, Geel looks like any other country town in northern Belgium. Its cobbled marketplace is surrounded by 15th century homes and shops; its neat brick farmhouses look much the same as they did in Brueghel’s day. What makes Geel different is the fact that 1,800 of its 30,000 inhabitants are mental patients — and that most of them are not confined to an asylum but cared for by normal families in the town. While this kind of outpatient care is still relatively new to psychiatry, the good people of Geel have been sheltering the sick in their homes for more than 500 years.

In Geel, one in seven families is responsible for the care of one or two mental patients, and about 85% of the families who take in malades can truth fully say that their parents and grandparents did the same. “Here no one is afraid of mental patients,” says Psychiatrist Herman Matheussen, 38, director of the program. When a schizophrenic plowing a field suddenly stops and begins gesticulating in a hallucinatory argument with an imaginary persecutor, his foster father may say calmly, “Joseph, why don’t you finish that furrow?”

Beheaded Virgin. Geel’s enlightened approach to mental care is the product of a 1,300-year-old religious legend. According to the story, an Irish Christian princess named Dympna fled from her widowed pagan father when he ordered her to marry him. He pursued her across the sea to Geel, where, insane with incestuous lust, he beheaded her. He instantly recovered his sanity, thereby establishing Dympna’s reputation as a virgin martyr with powers to cure the mad. The date of her canonization is uncertain, but in the 13th century a chapel in Geel was named for her. Mentally afflicted pilgrims to the chapel soon overflowed the small lodge built to house them, and the Geeloise peasants, cannily combining religious devotion with thrift, began to take the pilgrims as boarders.

Those who were not cured often stayed on. They were treated as human beings by their foster families at a time when the mentally ill almost everywhere else were banished from society to asylums of appalling squalor and cruelty. Originally, Geel’s boarding system for the mentally ill was supervised by officials of the Roman Catholic Church; since 1860, the Belgian government has had the responsibility of screening the patients and administering the program.

Carefully Screened. Mental hospitals and clinics from all over Europe refer patients to Geel. Two general practitioners and four psychiatrists observe new arrivals for two to three weeks in a small hospital; about half the applicants are rejected. Those who remain —some 50 a year—are the ones found suitable to Geel’s way of life, mostly nonviolent psychotics and people with subnormal intelligence. The carefully screened families who take them in receive a practical compensation: extra hands for simple work, plus stipends of 80¢ to $2 per day. “The first time they take a patient they are doing it for economic reasons,” says Matheussen, “but after five or six years, it becomes an act of humanity.”

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The Guardian: Demographics South Korea to US to UK. Will there be enough young people to cater for the needs of the elderly? This heading from The Guardian deserves attention. ‘I am starting to panic about my child’s future’: climate scientists wary of starting families

‘I am starting to panic about my child’s future’: climate scientists wary of starting families

A fifth of female climate scientists who responded to Guardian survey said they had opted to have no or fewer children

Damian Carrington

Damian Carrington

Fri 10 May 2024 06.00 CEST

“I had the hormonal urges,” said Prof Camille Parmesan, a leading climate scientist based in France. “Oh my gosh, it was very strong. But it was: ‘Do I really want to bring a child into this world that we’re creating?’ Even 30 years ago, it was very clear the world was going to hell in a handbasket. I’m 62 now and I’m actually really glad I did not have children.”

Parmesan is not alone. An exclusive Guardian survey has found that almost a fifth of the female climate experts who responded have chosen to have no children, or fewer children, due to the environmental crises afflicting the world.

Such decisions were extremely difficult, they said. Dr Shobha Maharaj, an expert on the effects of the climate crisis from Trinidad and Tobago, has chosen to have only one child, a son who is now six years old. “Choosing to have a child was and continues to be a struggle,” she said.

Maharaj said fear of what her child’s future would hold, as well as adding another human to the planet, were part of the struggle: “When you grow up on a small island, it becomes part of you. Small islands are already being very adversely impacted, so there is this constant sense of impending loss and I just didn’t want to have to transfer that to my child.”

“However, my husband is the most family-oriented person I know,” Maharaj said. “So this was a compromise: one child, no more. Who knows, maybe my son will grow up to be someone who can help find a solution?”

The Guardian approached every contactable lead author or review editor of all reports from the Intergovernmental Panel on Climate Change since 2018. The IPCC’s reports are the gold standard of climate knowledge. Of the 843 contacted, 360 replied to the question on life decisions, a high response rate.

Camille Parmesan

“When I was making my choice, it was very clear in the ecological community that human population growth was a problem” Camille Parmesan, who is based in France, said she was happy with the decision she made not to have children. Photograph: Lloyd Russell / University of Plymouth

Ninety-seven female scientists responded, with 17, including women from Brazil, Chile, Germany, India and Kenya, saying they had chosen to have fewer children. All but 1% of the scientists surveyed were over 40 years old and two-thirds were over 50, reflecting the senior positions they had reached in their professions. A quarter of the respondents were women, the same proportion as the overall authorship of the IPCC reports.

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The findings were in response to a question about major personal decisions taken in response to the climate crisis by scientists who know the most about it, and who expect global temperatures to soar past international targets in coming years. 7% of the male scientists who responded said they had had either no children or fewer than they would otherwise have had.

Most of the female scientists interviewed had made their decisions about children in past decades, when they were younger and the grave danger of global heating was less apparent. They said they had not wanted to add to the global human population that is exacting a heavy environmental toll on the planet, and some also expressed fears about the climate chaos through which a child might now have to live.

Dr Ruth Cerezo-Mota and the planet

Read more

The role of rising global population in the destruction of nature and the climate crisis has been a divisive topic for decades. The publication of The Population Bomb by Prof Paul Ehrlich in 1968, mentioned by several of the scientists in their survey responses, was a particular flashpoint. The debate prompted past allegations of racism, as nations with fast-rising populations are largely those in Africa and Asia. Compulsory population control is not part of today’s population-environment debate, with better educational opportunities for girls and access to contraception for women who want it seen as effective and humane policies.

Parmesan, at the CNRS ecology centre in France, said: “When I was making my choice, it was very clear in the ecological community that human population growth was a problem: preserving biodiversity was absolutely dependent on stabilising population.”

Prof Regina Rodrigues, an oceanographer at the Federal University of Santa Catarina in Brazil, who also chose not to have children, was influenced by the environmental destruction she saw in the fast-expanding coastal town near São Paulo where she grew up.

“The fact of the limitation of resources was really clear to me from a young age,” she said. “Then I learned about climate change and it was even more clear to me. I’m totally satisfied in teaching and passing what I know to people – it doesn’t need to be my blood. [My husband and I] don’t regret a moment. We both work on climate and we are fighting.”

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Harvard Public Health magazine Opinion. Hospitals can better help suicidal teens in the emergency room

A man sits in a row of waiting room seats while nurses and wheel chairs move through a busy hallway at a hospital.

Opinion

Hospitals can better help suicidal teens in the emergency room

A promising model of care gives patients and their parents skills for coping with crisis.

Harvard Public Health Magazine

Hospitals can better help suicidal teens in the emergency room

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Filed Under

Mental Health

Written by

Elizabeth Wharff

Published

May 6, 2024

Read Time

5 min

This article is part of PublicHealthin Action, a series from Harvard Public Health and The Studio that examines mental health programs across the U.S. that produce results.

In the late 1990s, when I was the director of emergency psychiatry at Boston’s Children’s Hospital, I became concerned about what was then a new problem: a huge increase in the number of suicidal adolescents coming to the emergency department who needed inpatient psychiatric treatment and for whom we had no beds—not just at Children’s, but anywhere in the region. They would wait in the halls, in exam rooms—wherever we could find space for them. Sometimes they waited for hours; other times, for days and weeks—a phenomenon we now call “boarding.” Then as now, lingering in the hospital was not good for the patients. And yet it continues: A 2020 study in the journal Pediatrics found that close to three in every five patients who sought mental health treatment at emergency rooms were boarded.

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I also noticed that the kids who most needed help—in particular, suicidal adolescents—often had to wait the longest for beds. Whenever I called hospitals to ask if they could take any of our boarding patients (a common practice), they didn’t say, “Send over the kids most in need of care.” Instead, they took the patients who were the least acute—because those patients would be the least strain on the hospital staff.

In emergency medicine, there is a concept called “triage,” in which the most acute patients get the most rapid and intensive care. For our most acute patients, suicidal adolescents, the opposite was happening: They had to sit and wait for care. I called this “reverse triage.” And I had the idea of trying to do some crisis intervention with these suicidal patients and their families.

Elizabeth Wharff
Elizabeth Wharff

Eventually, I developed a modular intervention, designed to be carried out in any emergency department with trained mental health clinicians. The intervention equips kids and their families with education about depression and suicide; helps them identify and develop coping skills; and aims to improve communication between parents and their child—all of which allows them to return home safely.

I called this Family Based Crisis Intervention, or FBCI. A critical part of FBCI is that every part of the intervention is done with both the adolescent and the parent. This way, the parent knows what to do if the child struggles after returning home. The parent becomes the child’s mental health coach.

An important part of FBCI is helping teens and their families come to what we call the “joint crisis narrative”—a mutual understanding of what led to the crisis. Usually, an adolescent’s story about what happened is different from the parents’ story: The teen will say, “I wanted to kill myself because my boyfriend dumped me.” And the parents will say, “We didn’t even know you had a boyfriend.” The adolescent will reply, “I never told you he was my boyfriend because you hate him.” So you have to help both sides communicate and understand each other better. And you also have to help the adolescent understand that the parents might seem angry because they’re so worried, or they’re fearful for the child’s safety.

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It’s also important to teach some cognitive-behavioral skills—like how to recognize when you’re engaging in all-or-nothing thinking and how to distract yourself from negative thoughts. So if a teen says, “I don’t want to live anymore because my boyfriend dumped me,” that’s an example of all-or-nothing thinking. You work with patients to challenge that idea, asking them if ending their life really seems like a good solution to feeling bad over the break-up. At home, parents can do things like ask about activities that might take a child’s mind off of what happened, like walking the dog, or watching a movie, or being with friends—all of those things can help.

Another crucial element of FBCI is developing a safety plan. To do this, we ask the adolescent what they would need to feel safe going home. Then we ask the parents what they would need to feel safe taking their child home. Then we work with them to develop a personalized set of safety measures—which might include locking up any medications and guns, as well as getting rid of sharp knives. We decide how the parent will monitor the child, maybe by checking in a certain number of times a day. We discuss what these teens can tell their parents if they are starting to feel bad; maybe it’s as simple as, “I’m feeling shaky.” And we talk about how parents can respond, maybe by saying, “Let’s try that coping skill we learned.” Often, when kids feel their parents understand them better, their hopelessness subsides and in turn, so does their suicidal thinking.

Research that shows the model is working. In a randomized trial, 62 percent of suicidal teens who received FBCI did not go on to be hospitalized (or were able to be discharged home) while 32 percent of adolescents who did not received FBCI went home. On the strength of such success, we’ve been able to expand the reach of FBCI by offering online training, which is available through OPENPediatrics at Boston Children’s Hospital to hospitals.

Parents’ feelings about FBCI are just as important. Even in our earliest studies, we found measures of parent satisfaction and empowerment were also very high. Most parents want to help their kids and want the tools to do that.

—As told to Maura Kelly

Top image: Chalongrat Chuvaree / iStock

Contributors

Elizabeth Wharff

Elizabeth Wharff

Elizabeth Wharff is a clinical research scientist at Boston Children’s Hospital and an assistant professor of psychiatry at Harvard Medical School.

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