Behind closed doors in a break room, conversations unfold. They talk about the patient who was recently admitted. "Too bad it didn't work out this time," they joke. The patient in question has schizoaffective disorder and a history of repeated suicide attempts. Collaboration with various health services has been challenging, and the patient has previously been aggressive towards healthcare personnel.
Mental Health and Mental Disorders
Mental health is a complex concept that can change in line with the various life situations an individual faces. According to the World Health Organization (WHO), the concept of mental health can be understood as a state of experienced well-being, in which the individual is able to realize their abilities, cope with normal life stresses, work fruitfully and productively, and contribute to others and to their community (WHO, 2022a). This is a description that, however, implies good mental health.
Mental disorders cannot be defined unambiguously, as there is no single agreement on what constitutes such disorders (Dahl, 2025). According to WHO's (2022b) definition of mental disorders, this involves a significant disturbance in an individual's cognition, behavior, or emotional regulation. Furthermore, mental disorders are accompanied by subjective distress or impairment in important functions (American Psychiatric Association (APA), 2022).
Schizoaffective Disorder
Schizoaffective disorder is a severe mental illness characterized by a combination of symptoms of schizophrenia, such as hallucinations, delusions, and thought disorders, as well as symptoms of mood disorders, such as depression or mania (APA, 2022). Therefore, there must be the presence of both schizophrenic and affective symptoms simultaneously or the symptoms must occur within a few days of each other (ICD-10, 1999). The prevalence is relatively low, estimated to be between 0.3–0.8% of the world population, and the disorder can entail significant challenges related to functional level, quality of life, and the need for long-term treatment and follow-up (Malaspina et al., 2013).
According to a systematic review and meta-analysis, schizoaffective disorder is expected to be associated with suicide rates where approximately 44% plan and have ideas about suicide attempts, and approximately 9.4% of the patient group attempt to take their own lives (Álvarez et al., 2022).
Healthcare Personnel's Attitudes
Healthcare personnel's attitudes are crucially important for the quality of treatment for patients with mental disorders, such as schizoaffective disorder. Positive attitudes, characterized by empathy, openness, and respect, can help strengthen the patient's coping ability, reduce stigma, and foster a trusting therapeutic relationship. A supportive and non-judgmental environment can contribute to better treatment conditions, which in turn can increase the likelihood that the patient will complete and adhere to treatment and experience a greater degree of hope and quality of life (Corrigan et al., 2014).
Patients with severe mental disorders, such as schizoaffective disorder, can be particularly vulnerable to stigma and discrimination. If healthcare personnel meet this patient group with skepticism, distance, or preconceived notions, it can reinforce the patient's feelings of shame, distrust, and social isolation (Corrigan et al., 2014). This can weaken the relationship and reduce treatment outcomes, for example, by the patient withdrawing, avoiding seeking help, or, in the worst case, becoming aggressive or threatening.
Healthcare personnel therefore have a central role in challenging their own prejudices and becoming aware of how personal attitudes can influence clinical practice. Reflection on one's own perspectives on mental health and meeting patients with equality can contribute to holistic treatment and better interaction with the patient, relatives, and interdisciplinary collaborators.
Meeting Patients with Repeated Suicide Attempts
One's own attitudes can be put to the test when encountering patients with a history of repeated suicide attempts. Such patient encounters can evoke strong emotions in healthcare personnel – everything from frustration to hopelessness. If these emotions are allowed to control the interaction, it risks creating distance from the patient or a perception that the attempts are seen as burdensome, rather than an expression of serious suffering and pain. It can be demanding to provide life-saving treatment to patients who have attempted to take their own lives. Repeated suicide attempts can be the patient's way of expressing suffering, and healthcare personnel's role is to meet this pain without judgment, and to understand the act as part of an overall symptom burden. This can help reduce any self-blame in the patient (Hovland, 2025).
Validation
In the acute phase after a suicide attempt, the patient may be affected by strong psychotic symptoms, mania, or deep depression (APA, 2022). The presence of healthcare personnel can be crucial for creating calm. Body language, tone of voice, and the ability to be clear, yet friendly and non-threatening, can help reduce anxiety and unease. Being grounded, maintaining calm, and radiating security can be important tools in the acute phase. It is also central to be aware of not engaging in conflict with the patient's experiences, but rather acknowledging the feelings behind them – for example, by validating that the experiences feel real to the patient, even if one does not share the same perception of reality.
Using active listening, empathy, and curiosity can help build a sustainable relationship. Emotional availability and professional proximity are considered important factors in the different phases of the patient's journey. The ability to meet the patient as an individual also involves meeting each person with sensitivity, security, and respect, which in turn can influence the patient's experience of validation.
Peer Support
Reflecting on one's own interactions and reactions through peer support can be important for processing emotions that may arise in interactions with mentally ill patients with multiple suicide attempts and fluctuating disease courses. It is essential to create an open and supportive work culture where dialogue and understanding among healthcare professionals allow for fallibility and emphasize learning. This will also lead to change work that can contribute to reducing stigma and better management of complex patient groups with high symptom burden from their diagnoses and recurring patterns of suicide attempts.
REFERENCES
Álvarez, A., Guàrdia, A, González-Rodríguez, A., Betrui, M., Palao, D., Monreal, J-A., Soria, V. & Labad, J. (2022). A systematic review and meta-analysis of suicidality in psychotic disorders: Stratified analyses by psychotic subtypes, clinical setting and geographical region.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental
disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Dahl, A-A. (2025). What are mental disorders? In M-T. Gonzalez (Ed.). Mental disorders –
professional understanding and therapeutic approach. 4th ed. (pp. 8-13).
ICD-10 mental and behavioral disorders – clinical descriptions and diagnostic
guidelines. (1999).
WHO. (2022a). Mental health.
https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
WHO. (2022b). Mental disorders.
https://www.who.int/news-room/fact-sheets/detail/mental-disorders
Written by Julianne Kvernstuen
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