Suicide can be the most dangerous issue that psychologists and other mental health professionals face with their patients, but training in suicide risk assessments is lacking, according to a task force report and summit organized by the American Association of Suicidology (AAS).
The summit, held Jan. 9 in Washington, D.C., brought mental health professionals, patient safety organizations and others together to highlight the issue. "We just know that so many psychologists, as well as other mental health professionals, are inadequately trained or not trained at all in suicide prevention, assessment and management," says William "Bill" Schmitz Jr., PsyD, president of the association and chair of its task force on suicide risk assessments. "It's not a focal point of training institutions that are trying to train in so many core areas, but the neglect of this issue leaves psychologists ill-prepared to deal with the worst possible treatment outcome — death."
Patients often are just asked if they have suicidal thoughts, says Lanny Berman, PhD, executive director of AAS. "If the patient says no, the typical assessment tends to end right there," he says. "The reality is that many people won't admit to having suicidal thoughts, but some of them will die by suicide."
There also is a common misperception that only patients who suffer from depression are at risk for suicide, but about 40 percent of people who die by suicide are not clinically depressed, Berman says. A wide range of conditions can increase the risk of suicide besides depression, including post-traumatic stress disorder, eating disorders and bipolar disorder.
In 2010, there were more than 38,000 suicides in the United States, a 3 percent increase from the previous year, according to the Centers for Disease Control and Prevention. Suicide was the 10th-leading cause of death across all ages and the third-leading cause of death for youth ages 15 to 24. Half of the individuals who died by suicide used firearms, but poison was the most common method used by women.
After three years of study, the AAS task force published its 52-page report last year. The task force called for accrediting organizations, state licensing boards, and new state and federal legislation to require suicide-specific training for mental health professionals. Kentucky and Washington state have already passed similar legislation. Several other states require suicide prevention training for school personnel but not for mental health professionals. AAS sponsors some continuing-education courses in suicide risk assessments.
Many psychology graduate students are trained only on suicide statistics and risk factors, not in clinical methods of conducting meaningful suicide risk assessments, says APA President Nadine J. Kaslow, PhD. "As health-care professionals, the deaths we're most likely to encounter are from suicide," says Kaslow, an Emory University professor and chief psychologist of Atlanta's Grady Health System who has studied suicide in youth and adults.
Suicide risk assessments need to include an open conversation with patients about potential means for suicide, such as guns in the home, Schmitz says. Then efforts can be made to restrict access to those means, along with the development of a crisis response plan. "Part of it is making sure it's OK for patients to talk about suicide," he says.
— Brendan L. Smith
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