The headline of a USA Today article two years ago posed a troubling question: “We tell suicidal people to go to therapy. So why are therapists rarely trained in suicide?”
The article by Alia Dastagir noted that people experiencing suicidal thoughts are routinely advised, “See a therapist.” Yet, the article reported, “training for mental health practitioners who treat suicidal patients—psychologists, social workers, marriage and family therapists, among others—is dangerously inadequate.”
Dastagir quotes this concerning statement from Paul Quinnett, a clinical psychologist and founder of the QPR Institute, an organization that educates people on how to prevent suicide:
“Any profession’s ethical standards require that you not treat a problem you don’t know, and yet every day thousands of untrained service providers see thousands of suicidal patients and perform uninformed interventions.”
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USA Today noted that no national standards require mental health professionals to be trained in how to treat suicidal people, either during their education or in their career; and only nine states mandate training in suicide assessment, treatment, and management for health professionals.
A survey for “Suicide Prevention and the Clinical Workforce: Guidelines for Training,” a 2014 task force report by the National Action Alliance for Suicide Prevention, found that only 19 percent of responding institutions of higher education reported that their clinical degree programs required specific course work entirely about suicide prevention. Seventy-five of 80 state credentialing and licensing boards reported they did not require specific training in suicide prevention prior to initial licensure or certification, and all 80 said that there was no specific training requirement for continuing education in suicide prevention.
Clearly, much work needs to be done to prevent suicides, judging from death statistics. Suicide is the second leading cause of death among Americans aged 10-34 and the 10th leading cause of death overall. While rates for other causes of death have remained steady or declined, the U.S. suicide rate increased 35.2% from 1999 to 2018.
In 2009, Quinnett kickstarted a discussion among colleagues about inadequate clinical training in suicide prevention, which inspired the American Association of Suicidology (AAS) to set up a task force to study the issue.
It issued a damning report in 2012, declaring that “the lack of training required of mental health professionals regarding suicide has been an egregious, enduring oversight by the mental health disciplines… The current state of training within the mental health field indicates that accrediting bodies, licensing organizations, and training programs have not taken the numerous recommendations and calls to action seriously.”
The report said, in part:
“We establish that mental health professionals regularly encounter patients who are suicidal, that patient suicide occurs with some frequency even among patients who are seeking treatment or are currently in treatment, and that, despite the serious nature of these patient encounters, the typical training of mental health professionals in the assessment and management of suicidal patients has been, and remains, woefully inadequate.”
The report said that only the field of psychiatry seemed to be “attempting to ensure that their trainees are, at a minimum, exposed to the skills required to properly conduct a suicide risk assessment and address suicidality in treatment.”
The report cited Quinnett’s definition of competence in the field:
“The capacity to conduct [a] one-to-one assessment/intervention interview between a suicidal respondent in a telephonic or face-to-face setting in which the distressed person is thoroughly interviewed regarding current suicidal desire/ideation, capability, intent, reasons for dying, reasons for living, and especially suicide attempt plans, past attempts and protective factors. The interview leads to a risk stratification decision, risk mitigation intervention and a collaborative risk management/safety plan, inclusive of documentation of the assessment and interventions made and/or recommended.”
The AAS report noted the U.S. surgeon general’s “call to action” in 1999 for competency in suicide risk assessment and management, as well as the 2001 National Strategy for Suicide Prevention’s goals for improved graduate school training in suicide care and more suicide care recertification and licensing programs for mental health professions.
The report said that while some states mandate continuing education in topics such as ethics, “there is no similar requirement to ensure that mental health professionals are using current information to assess and treat suicidal patients.”
The report noted the irony that in some places school employees are required to take gatekeeper training to make referrals to mental health professionals for potentially at-risk youth but there is no such requirement for the mental health professionals. “It is incomprehensible that, in many states, a teacher is now required to have more training on suicide warning signs and risk factors than the mental health professionals to whom he or she is directing potentially suicidal students,” the report said.
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The task force said there are inherent dangers in referring suicidal people to mental health professionals who are not adequately trained. If these individuals do not feel they receive effective treatment, the report said, they may drop out, become discouraged about the usefulness of treatment, and become at even higher risk for suicide.
The task force made five recommendations “to ensure that mental health professionals are properly trained and competent in evaluating and managing suicidal patients, the most common behavioral emergency situation encountered in clinical practice.”
- Accrediting organizations must include suicide-specific education and skill acquisition as part of their requirements for postbaccalaureate degree program accreditation.
- State licensing boards must require suicide-specific continuing education as a requirement for the renewal of every mental health professional’s license.
- State and federal legislation should be enacted requiring health care systems and facilities receiving state or federal funds to show evidence that mental health professionals in their systems have had explicit training in suicide risk detection, assessment, management, treatment, and prevention.
- Accreditation and certification bodies for hospital and emergency department settings must verify that staff members have the requisite training in assessment and management of suicidal patients.
- Individuals without appropriate graduate or professional training and supervised experience should not be entrusted with the assessment and management of suicidal patients.
The Sophie Fund asked Quinnett on March 8 whether any progress had been made in implementing the recommendations in the decade since the report was issued.
“I am unaware of significant changes in the training of clinicians at the graduate level where It needs to happen. There are a few people here and there teaching a seminar or maybe one class in one school of social work or psychology, but to my knowledge any training to really prepare students for practice is offered only though postgraduate seminars, workshops, and proprietary offerings. Practitioners continue to behave as if they don’t need this training. Thus, the consumer, in my view, remains at avoidable risk.”