With the exception of psychiatrists, most mental health professionals have received very little, if any, training in graduate school on suicide-related topics:
“Competence in the assessment of suicidality is an essential clinical skill that has consistently been overlooked and dismissed by the colleges, universities, clinical training sites, and licensing bodies that prepare mental health professionals.”
The above statement comes from W.M. Schmitz Jr., Psy.D., and colleagues. They authored a report for the American Association of Suicidology on the state of suicide prevention training in graduate programs for future psychologists, social workers, counselors, and other mental health professionals.
Their verdict?
“The typical training of mental health professionals in the assessment and management of suicidal patients has been, and remains, woefully inadequate.”
Some Startling Statistics about Suicide-Related Education
Summarizing from previously published research, the task force reported that roughly half of students in accredited psychology programs received any didactic training at all in preventing suicide. Often, this training was very limited.
Additionally, only 2% of accredited counselor education programs and 6% of accredited marriage and family therapy programs offered a suicide-specific course in their curriculum.
The task force also reported findings of a national survey that my colleague Barry Feldman, Ph.D., and I conducted. In our study, 60% of social workers said they had received some instruction on suicide prevention in their graduate school program. Of those, 75% received fewer than 4 hours of training.
I would have to agree with the task force’s overall verdict: These numbers are woefully inadequate.
Good News and Bad News about Suicide-Related Education
The good news is that most psychiatry programs provide suicide prevention training to future psychiatrists: A national study found that 91% of psychiatry programs train students in suicide risk assessment and intervention. (OK, I’m disturbed that this number is not 100%, but I am viewing the glass as 91% full rather than 9% empty.)
The bad news is that many other mental health professionals may be unprepared to help a client whose life is in danger, based on the amount of training (if any) that they received in graduate school.
What Training is Needed in Suicide Assessment and Intervention?
Suicide assessment and intervention skills are so important that every mental health professional should be well versed in them. A person’s life is at stake. When working with a suicidal client, the professional should know how to:
- Conduct a suicide risk assessment, which requires uncovering suicidal thoughts in a person; identifying warning signs, risk factors, and protective factors for suicide; appropriately documenting the assessment; and engaging in safety planning
- Create a treatment plan that addresses a person’s triggers for suicidal thoughts, as well as modifiable risk and protective factors
- Determine the most appropriate level of care for the client, including when hospitalization is needed – without overreacting or underreacting
- Apply evidence-based interventions to help clients cope with suicidal thoughts, avoid acting on them, identify reasons for living, and feel hopeful again
- Understand the different theoretical explanations for why suicide occurs and how to best intervene
- Avoid power struggles with clients whose primary goal is to end their pain, versus the therapist’s goal of averting suicide
- Identify important ethical and legal issues that arise when treating suicidal people, especially those related to confidentiality, informed consent, client self-determination, duty to protect laws (depending where one lives), and involuntary hospitalization
- Explore cultural influences and stigma that might affect how clients’ views on suicide in general, their own suicidal thinking, and help-seeking
- Coordinate care and seek corroborative information from the client’s other health care providers, family, friends, or anyone else with important information related to client safety
(This list of skills is based on many sources, including my own experiences helping suicidal people as a crisis worker and as a psychotherapist, various sets of core competencies identified for suicide assessment and intervention, and books such as The American Psychiatric Publishing Textbook of Suicide Assessment and Management, and The Practical Art of Suicide Assessment.)
What Can You Do to Improve Your Skills in Treating Suicidal Clients?
If you are a mental health professional and want to increase your knowledge and skills in suicide prevention, you have many options. These include continuing education workshops, online courses, professional conferences, webinars, practice guidelines, and other avenues for independent learning.
I will provide specific information about each of those options in my next post, so please stay tuned!
Copyright 2014 Stacey Freedenthal, PhD, LCSW. All Rights Reserved. Written for www.speakingofsuicide.com
This is so true! I’m finishing my MA in mental health at Webster Univ and because I plan to specialize in this field, I have written and presented papers on suicide, The instructors warn about liability, the students say anyone who talks about it must be committed…it’s shocking! It’s why I’ll specialize. The other issue is not talking to students about what will happen if they lose a patient to suicide. These kids are totally unprepared. It’s not discussed at all. Don’t know how to change it but I’ve certainly been surprised that we are not prepared for one of the worst things that can happen to you as a counselor. Thanks for continuing to bring this to the forefront. So many people never get to see an actual psychiatrist, rather they see a therapist and an ARNP…it’s got to change.
A long overdue path to treatment for clinical social workers.
Stacey, I love that you are addressing this here! It might be interesting to note that suicide has actually been researched in peer-reviewed journals very little compared to depression, anxiety, and a whole host of other mental health-related topics.
Excellent point, Tamara! It is also true that research funding for suicide is quite low, especially in comparison to many other causes of death that do not claim as many lives each year (for example, certain types of cancer).
Thanks for commenting!
What the hell are they thinking….
Good question, Marilyn! I should have written about some of the reasons why suicide prevention is not covered in graduate school training. A big part of it is time – so much to cover, so little time. But suicide prevention is so important that it should be one of the non-negotiable topics to cover in any training program for future mental health professionals.
Stacey, great post! Do you know if there have been similar studies for medical students in general? I’d love to connect I’m hoping to put together an outline for a proposed suicide prevention training for a pilot program at Boston University medical school.
Hi Anne, thanks for the feedback. I think perhaps your best starting point would be this article:
Teaching medical professionals about suicide prevention: what’s missing? By L. Sher
The article addresses the question generally and also has citations to other related studies.
Good luck with your pilot program!