ADVERTISEMENT
Talking about suicide, once taboo, now seen as plus for prevention
For decades, behavioral healthcare providers have struggled to find effective ways to assess and treat suicidal clients. And, all the while, both they and the general public have been handcuffed by persistent myths and misconceptions about suicide, says David Covington, chief of adult services at Magellan of Arizona (Phoenix, Ariz.) and a member of the executive board of the National Alliance for Suicide Prevention.
3 myths about suicide1. One pervasive myth holds that “there’s nothing you can do to help a suicidal person. If you stop them in one place, they’ll go to another,” says Covington. This myth helps to explain why, despite 50 years and 1,500 suicides, the Golden Gate Bridge has yet to install a safety net system. (Note: A 1978 study by Richard Seiden, PhD, MPH of the University of California at Berkeley, examined whether those prevented or restrained from committing suicide were really determined to find another way. Over a 34-year period, over 90 percent of these attempters remained alive or if dead, died due to non-violent causes.)1 2. Another myth, long held by professionals, holds that those who talk of suicide fall into two groups—those who are “really serious,” and those who are “seeking attention.” This myth “gets [professionals] into a circular kind of behavior,” says Covington. “There’s a tendency to settle for the deaths that occur, and get frustrated with the rest because maybe they’re not really suicidal.” 3. A third myth holds that talking about suicide makes it more likely. This, says Covington, has prevented generations of parents, teachers, and mentors from reaching out to help young people, in particular, for fear that such a conversation might only make the issue worse. |
He adds that such mythology has contributed to “a culture in behavioral healthcare nationwide that views crisis intervention and suicide intervention as a niche specialty—a secondary or tertiary focus—rather than a core element of the mission.” He maintains that the lofty status accorded to crisis intervention makes many front-line counselors and therapists fearful about discussing suicidal thoughts with their clients. Instead of “getting into the pain” within the established therapeutic relationship, uncertain professionals risk further isolating their troubled clients by referring them away to specialists or calling for police-assisted hospital admissions.
New methods and training empower behavioral health staff and “community helpers”
A foundational principle of the National Strategy for Suicide Prevention, which was published in 2001, is that suicide prevention must be addressed as a public health issue—an issue that reaches not only throughout the healthcare system, but well into the community.
For this reason, the NSSP has emphasized the development of standards and curricula for improving training not only for professionals, but also for “natural community helpers” or “gatekeepers” whose positions in the community would enable them to recognize and provide a first response to individuals who display warning signs for suicide. To support these training needs, a range of clinical and gatekeeper training programs were developed by organizations like the American Association of Suicidology, QPR Institute, and LivingWorks.
At Magellan of Arizona, a workforce survey showed that half of therapists and many employees feared that they might not have the skill to help a client with serious mental illness who expressed suicidal thoughts. But, as part of an initiative to dramatically reduce the risk of suicide among its clients with serious mental illness, Magellan of Arizona elected to provide LivingWorks’ two-day ASIST (Applied Suicide Intervention Skills Training) to all employees, some 2,100, who served these clients at 20 sites throughout its regional service area. (For more details about this and other perspectives on suicide prevention, see the May/June issue of Behavioral Healthcare.)
At the recent American Association of Suicidology Conference, Centerstone Research Institute presented an evaluation of a statewide effort in Tennessee to train, then measure the impact of 18,000 gatekeepers using a relatively brief program developed by QPR Institute. The goal, explains CRI’s Jennifer Lockman, was to “train community members to recognize signs of suicidal risk in young people, then respond using a question-persuade-refer, or QPR model. Gatekeeper trainees were selected from elementary, secondary, and higher education; juvenile justice, nursing and other fields with exposure to youths from ages 10 to 24.Like other, more-detailed programs such as ASIST, Lockman says that the two-hour QPR gatekeeper training begins with instruction about warning signs that could indicate suicidal thinking. Gatekeepers are trained to engage the young person in conversation and, when appropriate:
- To ask the suicide question directly to understand whether there are specific suicide plans,
- To ask about and listen to person’s problems and concerns, then try to persuade them that help is available, and,
- To refer them to help, a step that teaches the gatekeeper to personally escort, introduce, and connect the youth to a helping resource, then follow up later by asking the youth whether the expected help had been received.
“This strength of this approach is that it teaches gatekeepers that they encounter people every day who may be at risk for suicide and that we all play a role in taking care of each other and ensuring that we get help when needed,” she concludes.
CRIs evaluation focused on changes in a number areas, measured before training, immediately after training, and six months later:
- Procedural knowledge of suicide prevention, including:
o Facts about suicide prevention
o Warning signs of suicide
o How to ask someone about suicide
o Methods to persuade someone to get help
o How to locate and get help
- Self efficacy, measured in terms of their sense of comfort, responsibility, preparation, and ability to engage with and assist suicidal youth.
- Attitudes and beliefs about the inevitability of suicide and the degree to which intervention and assistance are believed to help in preventing a suicide attempt.
Additional follow-up, also done six months after training, asked gatekeepers to quantify how they had used their training. Specifically:
- How many youth had they identified as having potentially suicidal behavior?
- How many had they helped by:
o Asking the suicide question
o Asking about specific suicide plans
o Listening to concerns and problems
o Persuading them to seek help
o Notifying appropriate referral resources
o Following up with the youth, after the referral
Among the findings, which are available at from lead researcher James Schut, PhD, via e-mail at jschut@trevecca.edu are these:
- Gatekeepers had high rates of post-training contact with suicidal youth.
- Gatekeepers with more procedural knowledge identified at-risk youth more frequently and accurately.
- Of those who identified youth, two thirds personally completed all helping steps, but providing help often involved work by multiple gatekeepers and resources.
- The “one size fits all” approach measured in the evaluation may be inappropriate given the structures and protocols of varying types of organizations, so modification of processes and procedures, especially when multiple individuals assist in the helping process.
References:
Richard H. Seiden, PhD. “Where are they now? A follow up studyof suicide attempters from the Golden Gate Bridge” viewed online at https://www.pfnc.org/PFNC-GGBSeidenArticle4.pdf.
