Suicide Intervention Skills: Graduate Training and Exposure to Suicide among Psychology Trainees.

Abstract

Suicide is a serious public health problem. More than 38,000 Americans completed suicide in 2010, making it the 10th leading cause of death in the United States (Centers for Disease Control and Prevention, 2012). One-third of individuals who complete suicide met with a mental health professional in the year prior to their death, and 20% had contact with a mental health professional during the final month of their life (Luoma, Martin, & Pearson, 2002). Providing care to clients at risk of suicide is common among mental health professionals, even during their graduate training years. As many as 99% of psychologists during graduate school treated one or more clients who endorsed suicidal ideation or suicidal behavior (Dexter-Mazza & Freeman, 2003; Kleespies, Penk, & Forsyth, 1993). One in six psychology interns has worked with a client who completed suicide (Kleespies, Becker, & Smith, 1990; Kleespies et al., 1993), and between 22% and 29% of psychologists have had a client who died by suicide (Chemtob, Hamada, Bauer, Torigoe, & Kinney, 1988; Pope & Tabachnick, 1993). These numbers have led some researchers to suggest that experiencing the death of a client by suicide is an “occupational hazard” among psychologists (Chemtob, Bauer, Hamada, Pelowski, & Muraoka, 1989). Death of a client by suicide may have serious personal and professional ramifications for clinicians, including viewing the client’s demise as a personal failure and feeling incapacitated with professional self-doubt (Foster & McAdams, 1999). Clinicians-in-training report more stress (Rodolfa, Kraft, & Reilley, 1988) and endorse more severe reactions after client suicide than do clinicians whose careers are more advanced (Kleespies et al., 1990). Trainees who have had a client die by suicide also describe feelings of failure, disbelief, self-blame, shame, shock, sadness, and depression (Hendin, Lipschitz, Maltsberger, Haas, & Wynecoop, 2000; Kleespies et al., 1993). Although some attention has been paid to the experiences of trainees who have had a client die by suicide, literature on clinicians’ personal experiences of bereavement resulting from suicide (e.g., suicide of a family member) is virtually nonexistent. Integrating formal training in suicide risk assessment and management within doctoral psychology curricula is fundamental to providing students with the requisite skills to treat high-risk clients. Preparing novice clinicians to assess and to treat competently individuals who are at risk for suicidal behavior has life-saving implications. Despite the frequency with which trainees provide care to clients who are at risk of suicide, there is a lack of graduate training in the assessment and management of suicidal clients. In the late 1980s, Bongar and Harmatz (1989) conducted a seminal study that revealed the dearth of training on the study of suicide in clinical psychology programs. Of the 92 doctoral programs surveyed, only 35% reported offering their students formal training in managing suicidal clients. Over a decade later, Dexter-Mazza and Freeman (2003) surveyed 131 predoctoral internship programs across the United States and found that training had only increased by roughly 10%. These findings suggest that there are likely large numbers of fledgling clinicians who are ill-equipped to assess or to treat their most at-risk clients, which highlights the need for increased training in graduate programs. This topic has received minimal attention in the literature over the last decade. In the past year, however, a resurgence of compelling arguments has emphasized the critical importance of effective training of professionals who will provide care to clients at risk of suicide. As stated by Schmitz and colleagues (2012), “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” (p. 3). The 2012 National Strategy for Suicide Prevention (see Supplemental Table 1) stressed the importance of integrating effective training in suicide prevention and intervention to curricula for clinicians-in-training (U.S. Department of Health and Human Services, 2012). A task force organized by the American Association of Suicidology recently provided recommendations to increase the accountability of mental health training and accrediting bodies as a means of rectifying this gap (Schmitz et al., 2012). Additionally, in 2012, Washington became the first state to pass a law mandating that mental health professionals complete training in suicide assessment, treatment, and management as part of their continuing education requirements. The purposes of the current study were (1) to investigate the relationships among training-related variables (e.g., year in graduate training, length of clinical practicum experience, formal training in suicide assessment) and competence to respond to suicidal client statements, (2) to determine the prevalence of personal experiences of bereavement by suicide among psychology graduate students, and (3) to examine the relationship between personal exposure to suicide and competence to respond to suicidal client statements. It was hypothesized that trainees who were more advanced in their graduate program or who had received formal training in suicide assessment and management would respond more skillfully to suicidal client statements than those with less training. It was also hypothesized that no differences would be observed between students who had or had not been bereaved by suicide.