Position in euthanasia trajectory.

Persons who suffer from unbearable psychiatric illness and a persistent death wish (chronic suicidality and/or a psychiatric euthanasia request) are an understudied subgroup of persons with Severe and Persistent Mental Illness (SPMI). They receive tailored care in Reakiro, a Belgian drop-in, care and expertise centre, where persons can enrol in existential counselling or peer support groups. Suicidology and psychiatric euthanasia literature identify several risk and protective factors that play a central role in the process of death wishes: meaning, hope, empowerment, suicidal ideation, existential anxiety, and psychosocial dysfunctioning. The aim of the study is to describe these central factors in this subgroup of persons attending Reakiro and compare them with other patient samples worldwide in order to position this subgroup in terms of severity of suffering. Another aim was to evaluate how the Reakiro care was experienced by the users. The Beck Scale for Suicide Ideation (M = 21.78, SD = 8.48), Netherlands Empowerment List (M = 113.39, SD = 20.42), Herth Hope Index (M = 24.15; SD = 5.40), Meaning In Life Measurement (M = 5.39, SD = 1.50), Existential Concerns Questionnaire (M = 62.13, SD = 12.11), and Outcome Questionnaire-45 (M = 98.93, SD = 20.50) showed very high suicidal ideation and severe suffering across all domains. The Reakiro sample scored almost exclusively worse on all factors compared with 20 samples worldwide. Users perceived Reakiro care as helpful, with individual counseling services as most helpful. Reakiro care seems to be a promising model appealing to this subgroup of persons with SPMI and a persistent death wish. These results should be interpreted with caution, as the cross-sectional design has several limitations. Replication or falsification with forthcoming longitudinal data is needed. Clinical implications of the results are discussed.