Gaps remain in U.S. state policies on suicide prevention training

(Reuters Health) -

Most states don’t require suicide prevention training for healthcare professionals and those that do vary widely in the scope of their policies, U.S. researchers say.

Despite national recommendations in place since 2012, researchers found that as of 2017, only 10 states - California, Indiana, Kentucky, Nevada, New Hampshire, Pennsylvania, Tennessee, Utah, Washington and West Virginia - required mental and behavioral healthcare professionals to complete training in how to spot someone at risk for suicide and take preventive action.

Only three of these states - Nevada, Washington and West Virginia - include other types of healthcare professionals like nurses and physicians in mandated training. In Indiana, only emergency medical providers are required to have the training.

The notions that healthcare professionals are uniquely placed to help head off a suicide and that training to prepare them for that role should be mandatory date to the U.S. Surgeon General’s 2001 National Strategy for Suicide Prevention report, which urged states to develop comprehensive suicide prevention plans.

A subsequent report in 2012 recommended that credentialing agencies make sure new healthcare professionals achieve core competencies in suicide prevention appropriate for their respective disciplines, the study team notes in the American Journal of Public Health.

“Our hope is that by providing a snapshot of the current state of suicide prevention policies across the nation it will hopefully encourage other states to consider developing policies of this nature and will promote a greater consistency of training of providers,” said one of the study’s authors, Jessica Mackelprang, a lecturer in psychology at Swinburne University of Technology in Melbourne, Australia.

Suicide is the 10th leading cause of death in the U.S., according to the Centers for Disease Control and Prevention, claiming the lives of nearly 45,000 people in 2016.

Some past research has found that most people who attempt suicide have seen a healthcare professional in the weeks or months before their suicide attempt, the study team notes.

The researchers searched state databases and legislation tracking services to identity state policies related to suicide prevention and training for healthcare providers.

As of October 2017, they found, all 50 states had a suicide prevention plan, and 43 had one that had been issued or revised since 2012.

Five states: Missouri, Texas, New Jersey, Virginia and North Carolina, have suicide training bills under consideration. Connecticut, Maine and Minnesota had bills that failed to pass.

Researchers also found that the duration and frequency of training required under state policies varies widely, from one or more hours of training upon license renewal to six hours every six years.

Policies in seven states - Colorado, Hawaii, Illinois, Indiana, Louisiana, Michigan and Montana - just encourage training, but don’t require it.

The results provide a roadmap for what should be done, said Jane Pearson, chair of the National Institute of Mental Health Suicide Research Consortium, who wasn’t involved in the study.

“When there’s someone in crisis you have to gather information very quickly and if you’re not asking the exact right questions you can miss someone’s intentions,” she said in a telephone interview.

“You don’t have to be a perfect interviewer to save someone’s life, but you have to listen, respect and try to understand what got that person to view suicide as a solution. The most pressing goal is to increase the person’s will to live so it’s greater than their will to die, and buy time to get past the crisis so they have a chance to work on problem solving,” Pearson added.

“We need to train our clinicians better. People are still doing things that don’t work at all, like no-suicide contracts,” said Julie Cerel, president of the American Association of Suicidology and a psychologist at the University of Kentucky College of Social Work in Lexington who wasn’t involved in the study.

“It’s much better if people have access to evidence-based treatment that addresses suicide,” Cerel said in a telephone interview.

Washington was the first state to mandate suicide assessment, treatment and management training for all healthcare providers after Jennifer Stuber spear-headed the Matt Adler Suicide Assessment, Treatment and Management Act of 2012, named for her husband who died by suicide in 2011.

“I absolutely believe that if I had a better education and his providers had been better trained he might still be alive today,” said Stuber, an associate professor of public policy at the University of Washington School of Social Work in Seattle and faculty director of the suicide center she co-founded, Forefront.

SOURCE: Journal of Public Health, online April 19, 2018.

This version of the story has been refiled to correct typo in Swinburne University name in paragraph 6