who come to the emergency
department but could be safe
to discharge with appropriate
treatment and discharge planning.
“Sometimes clinicians err
on the side of caution and send
people to the hospital, even though
they’re at relatively low risk,” says
Goldstein Grumet. “But being
admitted to the hospital isn’t
necessarily the best thing for them.”
Often patients are just held in the
hospital without getting treatment
specifically for their suicidality, she
points out. Or they’re discharged
back to the community with the
recommendation that they seek
mental health treatment, which
many don’t do or don’t even know
how to do.
Yet the month post-discharge
is typically a high-risk period for
suicide, Goldstein Grumet adds.
To change that dynamic, the
center convened an expert panel of
psychologists, physicians and other
clinicians to develop a protocol
hospital emergency departments can
use when deciding which suicidal
patients need to stay in the hospital
and which can be safely discharged.
“Emergency rooms are so
overcrowded, it would be a better use
of resources and dollars if they only
admitted people who are truly at
risk and need to be admitted to keep
them safe,” says Goldstein Grumet.
“Especially for those at lower risk,
it would be better in the long run
for them to learn how to manage
their suicidality as an outpatient by
working closely with a skilled mental
health professional.” n
Rebecca A. Clay is a writer in
For more information
about the Suicide
Center, visit www.sprc.org.
Psychologists need more training
in suicide risk assessment
Suicide can be the most dangerous issue that psychologists and other mental health
professionals face with their patients, but training in suicide risk assessments is lacking,
according to a task force report and summit organized by the American Association of
The summit, held Jan. 9 in Washington, D.C., brought mental health professionals,
patient safety organizations and others together to highlight the issue. “We just know that
so many psychologists, as well as other mental health professionals, are inadequately trained
or not trained at all in suicide prevention, assessment and management,” says William “Bill”
Schmitz Jr., PsyD, president of the association and chair of its task force on suicide risk
assessments. “It’s not a focal point of training institutions that are trying to train in so many
core areas, but the neglect of this issue leaves psychologists ill-prepared to deal with the
worst possible treatment outcome — death.”
Patients often are just asked if they have suicidal thoughts, says Lanny Berman, PhD,
executive director of AAS. “If the patient says no, the typical assessment tends to end right
there,” he says. “The reality is that many people won’t admit to having suicidal thoughts,
but some of them will die by suicide.”
There also is a common misperception that only patients who suffer from depression
are at risk for suicide, but about 40 percent of people who die by suicide are not clinically
depressed, Berman says. A wide range of conditions can increase the risk of suicide besides
depression, including post-traumatic stress disorder, eating disorders and bipolar disorder.
In 2010, there were more than 38,000 suicides in the United States, a 3 percent increase
from the previous year, according to the Centers for Disease Control and Prevention.
Suicide was the 10th-leading cause of death across all ages and the third-leading cause of
death for youth ages 15 to 24. Half of the individuals who died by suicide used firearms,
but poison was the most common method used by women.
After three years of study, the AAS task force published its 52-page report last year.
The task force called for accrediting organizations, state licensing boards, and new state
and federal legislation to require suicide-specific training for mental health professionals.
Kentucky and Washington state have already passed similar legislation. Several other
states require suicide prevention training for school personnel but not for mental
health professionals. AAS sponsors some continuing-education courses in suicide risk
Many psychology graduate students are trained only on suicide statistics and risk
factors, not in clinical methods of conducting meaningful suicide risk assessments, says
APA President Nadine J. Kaslow, PhD. “As health-care professionals, the deaths we’re most
likely to encounter are from suicide,” says Kaslow, an Emory University professor and
chief psychologist of Atlanta’s Grady Health System who has studied suicide in youth and
Suicide risk assessments need to include an open conversation with patients about
potential means for suicide, such as guns in the home, Schmitz says. Then efforts can be
made to restrict access to those means, along with the development of a crisis response
plan. “Part of it is making sure it’s OK for patients to talk about suicide,” he says. n
— BRENDAN L. SMITH