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 suicide
1. 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: