Key points

• • This chapter disrupts the academy by explaining how the experiences of people with lived experience of suicidal ideation should be considered and addressed in collaborative research on this topic.

• • People with lived experience must have agency and equality with project team members throughout the research and co-design processes, with the same people with lived experience involved throughout.

• • We should be encouraged to share our experiences to challenge traditional research-based and practice paradigms that often fail to legitimise subjective experience and experiential insight.

• • Suicide should not be viewed as a disease in search of a cure. Given the life experiences and circumstances of individuals with suicidal ideation, it can seem to be a perfectly rational choice, and their reality must be validated and respected as ‘normal’ before help is offered.

Introduction

Suicide is the leading cause of death for Australians aged 15 to 44 years (Australian Bureau of Statistics, 2020). Between 50 and 60 per cent of individuals who die by suicide ‘fly under the radar’, that is, without receiving formal mental health care (Johnston et al, 2009). Most have been in contact with services for physical health issues in the days or months preceding an attempt but did not receive help for their suicidal thoughts or mental health problems (Stene-Larsen and Reneflot, 2019). Little is known about individuals at risk of suicide who are not receiving mental health care.

In 2021, the Black Dog Institute, a mental health research organisation in Sydney, Australia, undertook a four-year research project to develop a person-centred service for individuals at risk of suicide but not in care. The project consisted of multiple phases and several stakeholders including a project manager, institute research teams, a design team, a lived experience team and representatives from external organisations. The project aimed to adhere to a co-design methodology and a governance structure was created with a Core Co-Design team established at the outset. At the time of writing this chapter (August 2022), the first three phases had been completed.

‘The Çatalhöyük evidence as a whole’, write Hodder and Pels, ‘gives many indications that, indeed, people began to link themselves to specific pasts, by burying pots, tools, humans and hunting trophies in ways that indicate particular memories rather than a generic reference to a group’ (2010, 182). Hodder draws on his multidisciplinary team’s impressive studies of a wide range of artifacts and practices – household symbols, pit-digging, burial, figurines, tools, decoration, and more – to argue that forms of remembering emerged or consolidated at Çatalhöyük that were neither merely routinized and habitual, nor merely traditional and generic, and that took as their objects neither repeated activities nor widespread factual knowledge. Rather, the new forms of social memory being constructed at Çatalhöyük were ‘conscious, specific, and commemorative’, as household groups ‘began to make specific connections between the present and the past’ (Hodder & Cessford 2004, 35; Hodder 2006, 143).

Descartes thought about memory in the distinct contexts of method, metaphysics, medicine, mortality, and morals. Keenly aware of the fallibility and instability of natural corporeal memory, he considered various ways to bypass it or avoid relying on it, but he also came to see its importance in understanding and dealing with the passions and the union of mind and body (see human being). His account of memory influenced Malebranche and associationist traditions but was subject to sharp attack from critics who saw it as dangerously materialist and chaotic.

In the Rules, Descartes worries that the intellect must rely on memory to connect the steps in a reasoning process. But “since memory is weak and unstable, it must be refreshed and strengthened” by a continuous and repeated “movement of thought,” until the thinker can intuit the whole series of operations, passing over them all “so quickly that memory is left with practically no role to play” (AT X 409, CSM I 38) (see deduction). Descartes was not attracted to artificial memory techniques, turning instead to anatomy and physiology to “explain what imagination, memory, etc. consist in” (AT I 263, CSMK 40). In the Treatise on Man, Descartes writes that “the effect of memory that seems to me to be most worthy of consideration here is that, without there being any soul present in this machine, it can naturally be disposed to imitate all the movements” of real humans (AT XI 15, G 157). So there is genuine memory in soul-less bodies: Descartes is consistent in attributing memory to animals (AT IV 310, CSMK 270).

Corporeal ideas are figures traced by animal spirits on the surface of the pineal gland. These occurrent impressions then leave traces “on the internal part of the brain … which is the seat of memory” (AT XI 176–77, CSM I 106; H 86–87; G 149–50). Flowing through the gaps between the tiny fibers of the brain, the spirits enlarge or alter these pores, continually bending and rearranging the fibers and tubes. When the movement of the spirits is stronger, long-lasting, or often repeated, these patterns “are retained there in such a way that by means of them the ideas that existed previously on this gland can be formed again long afterward, without requiring the presence of the objects to which they correspond.

Executive summary

Nature of the problem

• Environmental problems related to nitrogen concern all economic sectors and impact all media: atmosphere, pedosphere, hydrosphere and anthroposphere.

• Therefore, the integration of fluxes allows an overall coverage of problems related to reactive nitrogen (Nr) in the environment, which is not accessible from sectoral approaches or by focusing on specific media.

Approaches

• This chapter presents a set of high resolution maps showing key elements of the N flux budget across Europe, including N2 and Nr fluxes.

• Comparative nitrogen budgets are also presented for a range of European countries, highlighting the most efficient strategies for mitigating Nr problems at a national scale. A new European Nitrogen Budget (EU-27) is presented on the basis of state-of-the-art Europe-wide models and databases focusing on different segments of Europe's society.

Key findings

• From c. 18 Tg Nr yr−1 input to agriculture in the EU-27, only about 7 Tg Nr yr−1 find their way to the consumer or are further processed by industry.

• Some 3.7 Tg Nr yr−1 is released by the burning of fossil fuels in the EU-27, whereby the contribution of the industry and energy sectors is equal to that of the transport sector. More than 8 Tg Nr yr−1 are disposed of to the hydrosphere, while the EU-27 is a net exporter of reactive nitrogen through atmospheric transport of c. 2.3 Tg Nr yr−1.

• The largest single sink for Nr appears to be denitrification to N2 in European coastal shelf regions (potentially as large as the input of mineral fertilizer, about 11 Tg N yr–1 for the EU-27); however, this sink is also the most uncertain, because of the uncertainty of Nr import from the open ocean.

Executive summary

Nature of the problem

• Reactive nitrogen (Nr) occurs in different forms, arises from a wide range of activities and sources, and leads to environmental impacts over different spatial and temporal scales.

• Integrated approaches to N management are anticipated to provide more effective (larger decreases in unwanted emissions) and /or more efficient (less side effects, less costs) policy measures than policy measures based on single sources and pollutant species.

• There are many notions of integrated approaches, but as yet little consensus about the best integrated approaches. There is also little quantitative empirical evidence of the performance of these approaches in practice.

• The pitfall of integrated approaches is that they may be more complex to agree, leading to a delayed implementation.

Approaches

• Based on recent literature and a discussion among experts, the present chapter provides a conceptual framework for developing integrated approaches to N management.

• Whilst discussing the framework, various examples of existing partially integrated N management approaches have been considered.

• A package of key actions in different sectors is envisaged that, together, should contribute to further developing integrated approaches to N management in the future