Training for Suicide Risk Assessment and Suicide Risk Formulation

Abstract

Suicide and suicidal behaviors are highly associated with psychiatric disorders. Psychiatrists have significant opportunities to identify at-risk individuals and offer treatment to reduce that risk. Although a suicide risk assessment (SRA) is a core competency requirement, many lack the requisite training and skills to appropriately assess for suicide risk. Moreover, the standard of care requires psychiatrists to foresee the possibility that a patient might engage in suicidal behavior, hence to conduct a suicide risk formulation (SRF) sufficient to guide triage and treatment planning. An SRA gathers data about observable and reported symptoms, behaviors, and historical factors that are associated with suicide risk and protection, ascertained by way of psychiatric interview; collateral information from family, friends, and medical records; and psychometric scales and/or screening tools. Based on data collected via an SRA, an SRF is a process whereby the psychiatrist forms a judgment about a patient's foreseeable risk of suicidal behavior in order to inform triage decisions, safety and treatment plans, and interventions to reduce risk. This paper addresses the need for a revised training model in SRA and SRF, and proposes a model of training that incorporates the acquisition of skills, relying heavily on case application exercises.

Does it get easier over time? Psychologists’ experiences of working with suicidal patients

“…Although therapist anxiety in such situations is expected and therapist trait anxiety may even help therapists to respond wisely (Brown & Range, 2005), practical training might enable therapists to cultivate ways to use and soothe their emotional arousal (anxiety, anger or other feelings) and think clearly, be empathic and act in the patient's best interest, even if the patient is rejecting and uncooperative (Cramer et al, 2013;Kene, Yee, & Gimmestad, 2018). Deliberate practice has been incorporated into a training program designed to increase psychiatrists' ability to assess the risk of suicide in psychiatric patients (Silverman & Berman, 2014). As well as teaching practitioners how to respond to difficult situations on a cognitive level, the deliberate practice may also represent a form of repeated emotional exposure (in the context of a caring training relationship) that might reduce the arousal experienced during an encounter with a suicidal patient to a functional level.…”

A multidisciplinary approach to therapeutic risk management of the suicidal patient

“… 31 However, psychiatrists consistently report the need for increased training on the care of patients who are suicidal. 32 – 34 Furthermore, while multidisciplinary mental health practitioners (eg, social workers, psychologists, case managers, counselors, psychiatrists, and psychiatric nurses) are often trained in suicide prevention and intervention techniques, many have not been provided with the specific training and/or experience to adequately apply such knowledge to clinical practice. This can become particularly challenging in acute crises wherein the anxiety attendant in working with a suicidal patient and making difficult clinical calls – as well as fear regarding potential medicolegal consequences stemming from poor outcomes – may interfere with optimal skill deployment.…”

Short‐ and Long‐Term Impact of an Undergraduate Suicidology Course

“…There has been encouraging growth in the attention to, and standardization of, core competencies for suicide risk assessment training (e.g., Cramer, Johnson, McLaughlin, Rausch, & Conroy, ; Rudd, Cukrowicz, & Bryan, ; Silverman & Berman, ; Suicide Prevention Resource Center, ). Despite the increasing awareness of the need to provide and standardize education in suicide assessment and intervention, many mental health providers still lack comprehensive training in suicide assessment, intervention, and prevention (Feldman & Freedenthal, ; Liebling‐Boccio & Jennings, ; Ruth, Gianino, Muroff, McLaughlin, & Feldman, ; Schmitz et al., ).…”