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Selma, Karl loman, Petrus,
dilal Suter Welcome to the public

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examination of Selma
Karl Loman's dissertation.

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Co constructing recovery in Switzerland.

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Crises service users
perspectives on healthcare and

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crisis services after suicidal attempt.

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The opponent is Professor Virginia.

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professor as the opponents appointed

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by the faculty please
present the comments that

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you see my dissertation has given
grounds for is it on dear gustos dear

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members of the faculty of psychology
dear doctoral candidate dear ladies

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and gentlemen first of all I would like to 

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thank the faculty of psychology for inviting
me to examine Selma Gaily-Luoma's thesis and

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particularly.

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Professors Arnolai Tila and Yuka Holma
who have helped me through the process.

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I have long standing contact
with colleagues at the School

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of Psychology of the
University of Yuvascula.

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I have been following the work you
have been doing here on topics of

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clinical psychology and psychotherapy
and have been impressed with

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how systematic and how
innovative this work is.

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I have visited you Vascular before few
years ago and I'm pleased to be here again to

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see colleagues and to keep in touch with the
developments in research and clinical training

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that take place here and which
are always an inspiration for me.

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I am very happy to act as opponent in the
oral examination of Selma GAIL Roma's thesis.

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I had the opportunity to engage
with it as pre examiner and thus

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to appreciate the quality
of her research project.

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In all, Miss Alma GAIL Iluma's thesis
is original, well written and engaging.

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The dissertation explores the subjective views
and experiences of persons using suicide

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prevention service regarding the
healthcare services they have received.

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As such, it belongs to the growing
trend of suicidology research,

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which is particularly
developed in Finland.

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Although there has been extensive research
both internationally and in Finland

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on the epidemiology and risk factors
of suicidal behaviour, as well as on the

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effectiveness of suicide treatment and
prevention programmes, most of the studies

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have been guided by the dominant evidence
based medicine paradigm, neglecting

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the views and perspectives
of service users.

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Although internationally the inclusion of
service users perspective in healthcare services

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planning, evaluation and delivery is gaining
ground, it seems that in the field of suicide

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prevention and especially in
Finland, research is very limited.

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In this sense, this doctoral research
that focuses on suicide survivors,

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suicide attempts, survivors experiences
and views of their healthcare

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treatment is important and innovative.

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It generates new and valuable knowledge
for the development of effective and

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user friendly suicide prevention services
that address service users needs and concerns.

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In terms of my own positioning
with regard to this research, I am

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familiar with Physiology
but not an expert in it.

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My work focuses on the severe mental
disorders seen from clinical psychosocial

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perspective and on the development of
recovery oriented mental health services

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that are responsive to
service users needs and goals.

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Using mainly qualitative research, reading
through the thesis, I found lot of

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similarities between the field of suicide
prevention that is studied here and trends

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in the field of mental health
service provision generally.

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I will draw upon this background knowledge
when I comment on Selma's work later.

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The thesis makes use of all the advantages
of qualitative research on the effectiveness

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of clinical and psychosocial interventions,
it prioritises, respects and highlights service

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users perspectives and it investigates the
interactional processes that are involved in

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meaning making and in shaping
mental and social reality.

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The strength of the thesis, in my view, is
showing how how recovery is Co constructed in the

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context of suicide crisis services between
suicide survivors and professionals.

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The thesis demonstrates the relational
Co construction of recovery in two senses.

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Firstly, how the recovery of suicide
survivors is promoted through collaborative

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processes in the context of services
and interventions, and secondly, how the

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meaning of recovery from suicide attempt
and the reasons for the suicide attempt

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are constructed in the
therapeutic interactions.

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This of course stresses the role of services
and professionals in recovery, and the findings

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of this doctoral research may lead to very
specific suggestions about the ways in which

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professional interventions
can become recovery oriented.

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The other strength of the study is related
to your genuinely reflexive engagement with

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your doctoral work and the frankness with which
you depict your personal motivations, thoughts,

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and aims as mental health
professional and as researcher.

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In this work, I find some of the best examples
of reflexive analysis that avoids the confessional

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mode of simply noting one's personal input, but
really weaves yourself in its various roles and

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dimensions into the design,
execution, and writing up of the study.

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Moreover, this is done in a
very thoughtful and engaging way.

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The strengths of the thesis that I
described before at the same time

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bring to the four tensions
and open up issues for debate.

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In fact, most of the issues I would
like to discuss with candidate

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in the oral examination
centre around them.

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Before we begin our discussion, I
would like to suggest that in the

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examination we addressed each
other in first name terms.

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I hope this will help create a
setting more conducive to dialogue, and

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it's also in line with the egalitarian
values that for me, are very characteristic

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of the Finnish way of doing things.

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So let us begin the discussion.

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So starting from the introduction of
the theoretical background, I would like

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to commend you on the comprehensive, well
structured and clearly presented overview

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of suicidology research and specifically
suicide prevention interventions and

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research both internationally
and within Finland.

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Indeed, the sheer amount of research on suicide
as well as the long standing national programmes

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and initiatives to develop prevention and
intervention efforts make finding topic for original

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research on suicide prevention
in Finland rather difficult.

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On the other hand, the scarcity of
qualitative research on the perspectives

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of service of suicide
survivors is staggering.

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This of course creates ample space
for your study and makes your argument

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for the usefulness of qualitative
studies even more important.

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I find this lack of qualitative studies
surprising given the emphasis on qualitative

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care recovery oriented models of practise,
developing trusting and respectful care relationships

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and prioritising service users perspectives
that characterises mental health service

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delivery worldwide,
including suicide prevention.

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On the other hand, it can be
explained as you do when you discussing

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the findings of this study through
the continuing dominance of the medical

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model and corresponding
positivist research.

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So I would like to ask you, is the
scarcity of qualitative research on suicide

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an international phenomenon or
specific to the Finnish context?

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And could you elaborate a
bit more on what you think

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are the most likely explanations for it?

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Thank you for that question.

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I will try to make concise answer to it.

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I think internationally it has been an
international phenomenon as well, but I think

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internationally there has been in the last
maybe 20 years fairly rapid accumulation

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of qualitative research
on, on suicide prevention.

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And maybe in Finland we're
lagging little bit behind that.

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Of course, there was two years
ago doctoral thesis published on,

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on the experiences, service
experiences or, or service expectations

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of suicidal adolescents and their parents.

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So, so I'm not the first one to to this ball in
Finland either, but I do think that that there

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are for example, in the UK, they are a
little bit ahead of us in, in this sense.

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Also, I think that that there have been a
few qualitative research pieces on suicidal

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behaviour in Finland back during the
suicide prevention programme in in the 90s.

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But those were not so much focused on the interactions
between suicidal service users and services,

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but rather on the suicidal experience,
which is of course very valuable.

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And perhaps that's something that's also
has been going on in suicide research

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more widely, that there has been a
focus first on trying to understand the

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suicidal experience as it
happens inside the person.

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And then then there's shift in
emphasis towards how that is constructed

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actually between people
or or in relationships.

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You wanted reasons also.
I now remember.

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Let's see if I can give you reasons.

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Well, I do think I do think that suicide
prevention there, there is also kind of

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particular because of the risks
associated with suicidal behaviour.

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There is there has perhaps been more
of need to cling to the certainty that

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in some instances the idea
of of there being this kind

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of way of, of classifying and and then treating
kind of objecting these these diagnosable

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classes to treatments that have been proven
to be effective for those for those conditions.

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That it's maybe little bit harder
to let go of that idea in when there

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is the risk of suicide associated
with with the situation.

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That I think perhaps that is why the
recovery oriented ideas have maybe

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gained more ground or gained gained ground
faster in other fields of mental health.

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So yes, I do think that that we are
holding on in suicide prevention.

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We are more holding on to
the idea that that kind of

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maybe fantasy that that we can have have
the same kind of medical cures for these

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states as we can have for some some other
conditions outside of of the field of mental health.

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And I think it's not only
doctors that hold on to this hope.

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I think we are many of us psychologists
and, and other professions and

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lay people also kind of look at the
medical profession with great hopes

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for, for assessing risk
as precisely as possible.

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And then having the cure that has been proven
to be effective and and that can be delivered

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to the patients that they're suffering
patient, regardless of what that patient wants,

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because that is of course, often trouble that
that the suicidal person themselves are the

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least ambivalent about receiving
or or reaching for help.

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Thank you.

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Moving on to the method, you state
that the aim of your research was to

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produce rich understanding of suicide
attempt survivors perspectives on crisis and

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healthcare services and to communicate
these findings in ways accessible to relevant

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audiences, including healthcare
professionals and service developers.

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For this reason, you adopt A pragmatic approach
whereby the epistemological and methodological

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choices are driven by questions of generating
knowledge that is appropriate to the aims of

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the study, rather than purely
methodological appropriateness and fate.

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So the study design and analysis
were primarily influenced

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by the constructivist
interpretivist paradigm.

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That is right, given the emphasis of
this paradigm in producing contextually

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bound deep understandings of the way
that the study participants experience

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and make sense of the
phenomenon under study.

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At the same time, the study admittedly
utilises post positive stance in the sense of

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attempting to ensure that the knowledge
produced is systematically and as objectively

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as possible so that it is credible,
reliable and generalizable.

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And indeed, all three publications are
written in the style of post positivist

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research with no discussion
of your epistemological stance.

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The discussion is in the
summary of the thesis.

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In the third one, there's notable
change with the notion of Co construction

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being central, but there's still no
mention of constructivist epistemological

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stance in the publication.

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So I think that the choice of the
constructivist interpretivist paradigm

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is really fitting with the scope and
the aim of the study, and I wonder

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what the addition of post
positivism serves here.

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I can see how it would make sense, it
would make the study more credible in

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the context of the evidence based
service context that we live in, but I'm

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not sure it is necessary given the way
the wealth of interpretive constructivist

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work in the clinical
field internationally.

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There's also the personal perspective to
consider here as you reflexively discuss

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your original professional socialisation
in post positivist paradigms, positivist

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and post positivist paradigms before
engaging with relational constructivist

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understandings in clinical practise.

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So I would like your thoughts about this
pragmatic approach in what it serves.

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From my perspective, the question is why
you felt that you needed to complement the

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constructivist interpretivist paradigm
with post positivist paradigm.

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Maybe you can reflexively
discuss how you made that choice.

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Thank you.

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I think it's it's good phrasing
that I felt that I need to.

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I think this is actually a, a
large part of the answer that that

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this has of course been
also personal journey.

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And, and I feel in many
ways balancing act.

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And, and it is my, it's my experience that
working as psychologist in, in the Finnish mental

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health service is very much about balancing
act between very different kinds of discourses

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and, and very different kinds of different ways
of looking at, at the service users and, and

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what we, what, what are we trying
to do and, and, and all of that.

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And I think that part of what I've been
doing in, in conducting this structural

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research and, and writing up the
articles has been kind of working through

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that for myself to try to understand
kind of the different perspectives that

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have been in dialogue in my own mind.

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But I do hope that it has not
only been self-serving endeavour,

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but there is also kind of the idea.

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It has been my, it has been my hope
that this, because I think sometimes

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the problem can be that that
constructionist research can be conducted and

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written up in ways that are hard to
access if you are not already familiar

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with that, that discourse
or that, that world.

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That way.

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If you are not maybe to put it radically,
if you're not already kind of indoctrinated

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in that kind of thinking, it's very, it
can be very difficult to, to kind of get

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into it and, and, and for it to have the
kind of credibility that you think that

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there's something to take away from this.

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So it has been my hope that that in writing
up up this research that I could do it justice

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in the sense that that that I could actually
use use the constructionist methodology to to

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bring out insights that are rich and
and kind of open that kind of world.

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But that I could also kind of
package them in in an accessible form.

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And I think that that kind of acknowledging
the ideas of the post positivistic

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paradigm is necessary for that
because that's at least my imagination

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that this is what
readers will be thinking.

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They will want answers to these questions.

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They will want to know who are these fourteen
of the 104 and where are the other 90?

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How many is that?

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Who were they and why are they not
here and what would they have said?

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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.