Every 11.7 minutes in the U.S., a person takes his or her own life. That figure, the latest available, makes suicide the 10th leading cause of death in this country. Rates have been rising every year for the past dozen years. It's nothing short of an epidemic.
Yet those most well placed to stop this public health crisis are not equipped to do so: few doctors and less than half of U.S. mental health professionals are trained in suicide prevention. According to a recent report from the American Association of Suicidology (AAS), only 50 percent of psychology training programs, fewer than a quarter of social work programs, 6 percent of marriage and family therapy programs, and 2 percent of counselor education programs teach their students how to spot individuals at risk for suicide and how to stop them from going through with it.
To get people through such a crisis, experts now have several methods available that have proved effective [“see “Preventing Suicide”]. Treatments focus on teaching patients how to identify and regulate their emotions and to learn to bear the feeling of distress. It's critical for those at risk to have a plan in place and to practice skills for calming themselves when suicidal thoughts return. Although most therapies involve weeks or months of sessions, even short interventions can work at a moment of crisis. One study, for instance, found that even a single session with a therapist trained in “crisis response planning,” which helps patients identify their own warning signs and come up with coping strategies, reduced suicide attempts in soldiers by 76 percent compared with other treatment methods. “A lot of people hold fast to the old adage: if someone wants to kill themselves, they'll find a way. But it's not true,” says psychologist William Schmitz, Jr., lead author of the report and a past president of the AAS. “We know if we get people through a suicidal crisis, most of them will never end up dying by suicide.”
Yet these interventions can only work when they actually reach the people who need them. One obvious way to make that connection is through mental health professionals—such as therapists, psychologists and social workers. About a third of those who commit suicide had come into contact with mental health services in the year before they died—and about a fifth had done so during the past month. Yet there are no national standards requiring these workers to know how to identify patients at serious risk of suicide or what techniques help them survive. If there were, perhaps some of those deaths could have been avoided.
Primary care doctors are in an even better position to help but are similarly lacking the tools to do so. They prescribe more than half of all psychotropic drugs, and 77 percent of people who die by suicide had contact with their primary care provider in their last year of life—45 percent in just the past month. Yet most physicians do not learn how to identify those at risk of suicide or what to do to help them.
These arguments have fallen on deaf ears at the guilds overseeing these professions, who often argue that their training programs are burdened by too many requirements already. But suicide prevention should be among those requirements. For some patients, it is the most significant and only service that really matters.
Things tend to change, however, when state governments take on the issue themselves. In September 2017 California became the most recent state to pass a law requiring suicide prevention training. To get a California license, a psychologist must complete six hours of education in suicide risk assessment and intervention. Nine other states have similar laws, and another four encourage this training but do not require it, according to the American Foundation for Suicide Prevention. Washington State is the only one, however, that extends the education requirement beyond mental health providers to all health workers, including doctors, nurses, and even dentists and naturopaths.
More states should follow in Washington's footsteps. Suicidal thoughts do not have to be a death sentence. Research has found treatments that work, and it's time to make sure people receive them.