A public health approach to suicide

Psychologists working one-on-one with potentially suicidal clients are obviously important, says Julie Goldstein Grumet, PhD, of the Suicide Prevention Resource Center. But it's not enough, especially as overall suicide rates have failed to budge.

"Those psychologists may be very skilled in working with people at risk, but they are still only making an impact on the one patient sitting across from them," says Goldstein Grumet, the center's director of prevention and practice and its only psychologist.

Helping psychologists and the rest of the behavioral health workforce take a more public health approach to suicide prevention is the center's mission. Funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), the center works to advance the National Strategy for Suicide Prevention by providing training, publications, a registry of best practices, a newly released research agenda and other resources for psychologists and anyone else with a stake in preventing suicides.

What's available

The center can help psychologists in many ways, says Goldstein Grumet:

• Technical assistance. "We're not a clinical service," says Goldstein Grumet. "We're not a resource center in the sense of, ‘I have a client, what should I do?'" But center staff can help if you're someone working on a public health intervention, such as a state suicide prevention coordinator or a Garrett Lee Smith Act grantee trying to develop a comprehensive suicide prevention plan.
• Training. The center also offers training, both in person and online. A one-day workshop called Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals, for example, offers research-informed skills training on how to work with suicidal clients. While there's a fee for that training, the center's webinars are free and available to anyone. The center's Research to Practice webinar series, for example, translates the science of suicide prevention into practical terms. "The idea is that researchers already know what's working and want to get it out faster to practitioners," says Goldstein Grumet. The center also offers self-paced online training on such topics as "Locating and Understanding Data for Suicide Prevention," "Counseling on Access to Lethal Means" and "Choosing and Implementing a Suicide Prevention Gatekeeper Training Program." In addition, the center provides a workshop kit to help schools, youth-serving organizations and others learn how to reduce suicide among lesbian, gay, bisexual and transgender youth. The center's website has links to webinars and additional resources from SAMHSA and other organizations.
• Best practices. The center maintains a registry of best practices in suicide prevention, such as gatekeeper programs that can teach everyone — whether they're parents, clergy members, teachers and coaches or even bus drivers — how to recognize suicide danger signs. "The programs in the registry have been submitted and vetted by peers," says Goldstein Grumet. "We don't promote any particular program; we inform people about what exists on the registry and how to use it." The registry also includes expert and consensus statements summarizing current knowledge and offering best practice recommendations as well as a section listing programs and practices that seem promising but have yet to undergo evaluation.
• Publications. The center offers several toolkits psychologists working in various settings could use. A geropsychologist might use "Promoting Mental Health and Preventing Suicide: A Toolkit for Senior Living Communities" to train nursing home employees how to be more mindful of suicide risks, for instance. Other toolkits include the "Suicide Prevention Toolkit for Rural Primary Care," "Preventing Suicide: A Toolkit for High Schools" and "After Suicide: A Toolkit for Schools." Psychologists in private practice can also find useful publications they can distribute to clients and family members, says Goldstein Grumet, explaining that the best practices registry has many vetted hand-outs suitable for use after a suicide attempt or in other situations.
• A research agenda. The center doesn't just help practitioners. The National Action Alliance for Suicide Prevention, a public/private partnership housed at the center, released a first-of-its-kind national research plan in February. "A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives" calls for focusing research on organizational settings and populations most at risk, giving funding priority to studies with the biggest potential impact on suicide rates and using common measures to make it easier to share or combine data across studies. The goal is to prioritize research that will contribute the most to reducing suicides by 20 percent in five years and 40 percent in a decade.

The center is always developing new resources, says Goldstein Grumet. Its latest project targets low-risk patients 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."

Rebecca A. Clay is a writer in Washington, D.C.