Get More Comfortable Talking About Suicide with Your Clients
Suicide is always a tricky subject for people to navigate. Even as mental health professionals, we can get stumped sometimes. In all due honesty, most of us likely weren’t trained in grad school on how to deal with this subject. As a result, we have been ill prepared to do so.
At first glance, it seems like the odds are stacked against us. It seems like, for every question we get answers for, there are five more questions that pop up. We worry about doing the wrong thing. Was this the proper intervention? Did this make it worse? What if I overlooked a risk factor? How can I take best advantage of the protective factors in this person’s life? Should I discuss with my patient how suicide will impact those left behind?
We may worry about the liability of a death. Was I properly trained in this? Should I have just referred the client to a crisis hotline, where they get this every day and where they have resources at their fingertips to help? Maybe I can just send them to inpatient, where clients receive 24/7 observations. Inpatient providers deal with this for a living, and I’d rather overdo on precautions than underdo on them.
Some of this over-worrying may do more harm than good. It may even lead practitioners to do nothing at all, which can leave the problem to fester. If readers want any key takeaway from this blog post, let it be this: IT’S NOT ALL DOOM AND GLOOM.
More and more industry leaders are leaning toward tackling suicidal ideation head on, rather than treating it indirectly as a lethal yet generic symptom of mental illness. With this new focus, it puts the issue of suicidality out in the open, rather than keeping it hidden within a bunch of potentially irrelevant diagnoses.
For example, Dr. David Jobes developed a framework for suicide-specific treatment called the Collaborative Assessment and Management of Suicidality (CAMS). This framework has been tested across institutions that offer varying levels of care for individuals at risk for suicide. Here, clients work with their providers to develop a suicide-specific safety plan that does more than list coping resources and contacts for moments of crisis. In fact, it helps clients weigh reasons for living and dying, then uses motivational interviewing techniques to guide clients through “stages of change” in suicidal ideation to weigh more significance in living than dying.
Furthermore, Dr. Manaan Kar Ray developed a comprehensive framework called Proactive Detection (PROTECT). This framework addresses problem areas of clinical care, relational safety, and data collection to help providers deliver authentic, compassionate care that naturally drives clients to give them the data needed to make evidence-informed decisions on appropriate care provision. Here, he addresses many common questions and concerns clinicians have about caring for a suicidal client, including when someone is chronically suicidal and having an acute escalation in crisis.
The Education Development Center’s Zero Suicide Institute offers an academy that helps workplaces in varying disciplines implement suicide prevention approaches from the top down. Here, the institute works to provide a culture of taking suicide prevention seriously, training the C-suite, managers, administrators, direct care providers, and peer support staff on implementing the Zero Suicide framework in all departments to instill impactful, sustainable change throughout the agency.
These are some of the many examples of how industry leaders are helping providers to make lasting change in suicide care. As these individuals work tirelessly to promote such high-quality services that show significant returns on investment in the long term, I join them in sending the message that this work is vital and necessary to curb suicide rates. I founded Suicide Care Consulting Services to help inpatient providers reduce recidivism rates, also known as the “revolving door effect,” with a Warm Hand-Off Framework that keeps patients out in the community and engaged with providers, and with increased motivation to live. It also helps hospitals develop an efficient system for discharge, structured communication with community providers, and standardized follow-up protocols with former patients.
According to Roush, Brown, Jahn, Mitchell, Taylor, and Quinnett (2017), “Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals.” Many times, the provider’s fear, or discomfort with the subject of suicide prevents them from assessing the individual’s suicidal thoughts or suicidal behaviors. However, if we are going to make a dent in this worldwide pandemic, then this must change. Please do not be afraid to discuss suicide with your clients as oftentimes they are waiting for us to broach the topic as they don’t know how to do it themselves due to shame or fear. Be the one to ask. It could be the difference between life and death, quite literally. If you need help with developing more effective suicide risk assessment and management practices, please visit the Mental Health First Aid official website to discover courses you can take to help normalize the conversation for both yourself and the clients you serve. Don’t let the next time you think or talk about suicide prevention be September 2023. We must talk about it every single day. We must set the tone that it’s normal to discuss even at the water cooler.
In closing, please remember that there is always hope. We can all do our part in curbing suicide. Learn more about what we do, so that you can feel armed, prepared, and fearless to take action when the time arises.
References
Roush, J.F., Brown, S.L., Jahn, D.R., Mitchell, S.M., Taylor, N.J., Quinnett, P., & Ries, R. (2017 September 15). The Impact of Fear of Suicide-Related Outcomes and Comfort Working with Suicidal Individuals. The Journal of Crisis Intervention and Suicide Prevention, 39(1). Doi: https://doi.org/10.1027/0227-5910/a000478
Guest Blog Article Written by: Yvette Bonilla
Yvette is a licensed social worker, consultant, and an avid proponent for change in suicide care and care transitioning from psychiatric inpatient care systems. As an attempt survivor, she knows firsthand the need to find hope and sense of purpose to see the beauty of life. Yvette is also a foodie and a seafood lover! She is also the Founder and CEO of Suicide Care Consulting Services which is a consulting firm that helps psychiatric inpatient providers implement a “warm hand-off” framework to transition patients safely back home, hospitals see lowered rates of suicides and re-admissions, and patients can face life's challenges with pride and feel satisfied with their care.
