Abstract
Gatekeeper training (GKT) is one of the most widely used suicide prevention strategies. It involves training people who are not necessarily clinicians to be able to identify people experiencing suicidality and refer them to appropriate services. While there is a dearth of research that supports the causal link between GKT and reduced suicide rates, this is likely the result of a variety of factors including training design, definitions of "gatekeepers," differing populations in which the gatekeeper (GK) operates, and other variables that may influence suicide rates. Despite this, research suggests that GKT improves people's knowledge, skills, and confidence in helping individuals who experience suicidal ideation and enhances positive beliefs about the efficacy of suicide prevention. However, there is no consensus on GK competencies to allow differences in effectiveness between various training programs to be measured, that is, knowledge, skills and abilities, attitudes, and self-efficacy attributes expected of a person resulting from the training. This paper discusses challenges in developing GK competencies. It uses developments in suicide prevention competencies for clinicians, vocational education, and training sector competencies, as well as empirical work in GKT, to propose minimum GK competencies that may be examined for further research and evaluation of programs.
Highlights
Over 800,000 people die by suicide globally each year (World Health Organization, 2020)
Gatekeeper training (GKT) plays a significant role in suicide prevention strategies, the evidence surrounding their impact on suicide rates and suicidal behavior is scant and the long-term outcomes of training programs are varied (Holmes et al, 2019; Yonemoto et al, 2019; Zalsman et al, 2016)
Theory of Planned Behavior (TPB) provides invaluable guidance on the importance of examining an individual’s attitudes toward interventions with suicidal persons, as they relate to future behavioral outcomes which may arise from GKT (Ajzen, 1991)
Summary
In discussing minimum standards for competencies for GKT, existing competencies for the professional workforce are relevant. The American Association of Suicidology (AAS) and the Suicide Prevention Resource Centre (SPRC)-led Task Force on Suicide Prevention developed a set of 24 competencies in seven domains of practice applicable to clinicians for assessing and managing suicide risk (Pisani et al, 2011) These domains include attitudes and approach, understanding suicide, collecting accurate assessment information, formulating risk, treatment and services planning, management of care, and legal–regulatory issues (SPRC, 2006). Other suicide prevention competencies have been proposed for psychology doctoral programs by Cramer et al (2013) They identified 10 core competencies including selfreflective practice, empathy, risk assessment, focus on immediate intent, determining risk, development of a treatment plan, notifying others, maintaining good documentation, self-care, and understanding the law. Competencies applicable to both professional and community GKs may include topics on attitudes toward at-risk individuals, the effectiveness of suicide prevention, and confidence and self-efficacy to work with at-risk individuals (Osteen et al, 2014)
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