Suicide And The Deficit In Training For Mental Health Professionals

This blog was written by Dr. Paul Quinnett, a clinical psychologist, trainer, and author with many years of experience in suicide training and prevention. This blog excerpts key findings from “Preventing Suicide Through Improved Training in Suicide Risk Assessment and Care: An American Association of Suicidology Task Force Report Addressing Serious Gaps in U.S. Mental Health Training” (W. Schmitz, et al., 2012), a white paper published by the American Association of Suicidology.

Suicide PreventionA veteran killed himself today. So did a high school girl. And so did someone’s grandfather. Of the estimated 100 Americans who will die today by suicide every day, some will be our clients. We know this because the National Institute of Mental Health reports that approximately 95 percent of those who die by suicide suffer from a treatable mental illness and/or a substance disorder, so the chances are that some of them will be in the care of a social worker. We might ask ourselves: If recovery is possible, is suicide preventable? The answer is yes, and research is increasingly supporting health care organizational goals of zero suicides. In 2001, the Substance Abuse and Mental Health Services Administration (SAMHSA) published the “National Strategy for Suicide Prevention,” which served to provide a framework for ending suicide. In 2002, the Institute of Medicine published a report called “Reducing Suicide: A National Imperative,”, and in 2003, the President's New Freedom Commission called for “improved training and education in the recognition and treatment of patients at risk for suicidal behaviors.” This call has just been repeated in the recently published National Strategy for Suicide Prevention (2012). All of these organizations have worked to raise awareness to the problem of suicide in this country, and each has offered suggestions for mental health practitioners to consider when working with at-risk clients and patients. Unfortunately, with few exceptions, these recommendations have not been adopted by the mental health community. Academic leadership in the fields of social work, psychology, counseling, substance abuse treatment, medicine and nursing have maintained the status quo when educating their students about working with suicidal patients. As a result, thousands of newly graduated professionals are entering their fields inadequately prepared to work with the most common cause of admission to psychiatric units and, increasingly, outpatient services. Ask yourself: “If my brother becomes suicidal today, where should I take him? Who is competent to treat him?”

A psychiatrist? A social worker? A licensed counselor? A psychologist? My family doctor?

Sadly, only certified psychiatry residencies include standards that require at least some coverage of suicide risk assessment, treatment, and management, and many in psychiatry leadership positions feel even this training is inadequate. In fact, except for in Washington (more to follow on Washington in another blog), suicide prevention training remains an elective. Multiple studies have found the following:

  • 50 percent of psychological trainees receive very limited didactic training (Dexter–Mazza and Freeman, 2003; Kleespies, et al., 1993).
  • 25 percent of a national sample of social workers reported only inadequate training (Feldman and Freedenthal, 2006).
  • Faculty, deans and directors of graduate social work programs reported that most students receive four hours or fewer of suicide-related education (Ruth, et al., 2009).
  • Only two percent of professional counseling and six percent of marriage and family therapy accredited training programs provided any suicide-specific courses (Wozny, 2005).

These studies show a dire lack of training among professionals in the field. The bottom line is this: the public’s trust in our suicide prevention knowledge and skills is misplaced; this no doubt accounts for why suicide malpractice is the leading cause of legal action against mental health professionals nationwide. When it comes to client suicide, consider that suicide is usually premeditated; people think before they act. Most suicidal people send warning signs of their intent before they attempt. This pause between idea and act, and the presence of detectable warning signs, provides all of us who serve potentially suicidal clients with a unique window of opportunity to intervene and prevent suicide. Yet research shows that approximately 19 percent of Americans who die by suicide have been seen by a mental health provider in the month prior to their death (many commit suicide on the same day as or day after their last appointment), and 32 percent had seen a mental health provider within a year of their death (Luoma, J. B.; Martin, K. E.; and Pearson, J. L., 2002). Are these last contacts missed opportunities to detect, assess and intervene? I think so. Because suicidal people are in great pain and come to us for relief, health care professionals have a critical and ethical role to play in preventing suicide. If we do not learn to speak calmly and confidently about suicide, and know what evidence-based actions will save lives, we are failing in our roles as merchants of hope — especially since we may be the only people standing between our clients and the dark. With another 100 Americans lost to suicide today, the race between education and tragedy is on.

__ Paul Quinnett, PhD A clinical psychologist and trainer for more than 35 years, Dr. Quinnett developed and managed a suicide prevention hotline, an emergency services department and a dozen mental health service delivery programs. He has authored seven books, many professional articles and book chapters. He was director of training for the Spokane Mental Health APA-approved psychology internship program for more than 20 years and has served on the board of the American Association of Suicidology. He was a founding board member of The Kristin Brooks Hope Center (1-800-SUICIDE) and The Suicide Prevention Action Network. He serves as clinical assistant professor in the Department of Psychiatry and Behavioral Science at the University of Washington School of Medicine. To help prevent suicide, he donated the French, Spanish and English electronic editions of his bestseller, Suicide: the Forever Decision to the world via the World Wide Web.__