Workshop on Advancing Training in Suicide Prevention Clinical Care - Full Summary

Overview

The National Institute of Mental Health (NIMH) conducted a two-day virtual workshop to assess the state of the science related to suicide prevention training (SPT) in clinical care with the ultimate goal of preventing suicidal behavior through improved training of providers. The workshop brought together panelists with wide ranging expertise in areas such as intervention development and testing, psychotherapy training, mental health services research, implementation science, health disparities research, suicide-related lived experience, and digital mental health.

Background

Previous research demonstrates that most individuals who die by suicide each year in the United States have had contact with the medical system. Thus, the clinical workforce must be adequately prepared to meet the demand to help individuals at elevated risk for suicide. Providers across all stages of their careers will treat patients with lived experience of suicidality; yet most clinician training programs do not offer rigorous preparation in suicide prevention clinical care best practices. This creates a system of care where providers don’t feel adequately prepared and may rely on ineffective strategies for assessing risk and providing treatment. This workshop sought to address research priorities related to: 

• Understanding the barriers and facilitators of successful training in suicide prevention clinical best practices,
• Characterizing approaches to optimize the clinical workforce to help suicidal individuals,
• Characterizing the added benefits and drawbacks of digital tools and technologies in suicide prevention, and
• Understanding how to create a system of care that reflects patient preferences and better support for clinicians.

Summary

Day 1 presentations covered three major topics:

• Universal Skills, Core Competencies, and Optimizing Clinical Workforces
• Creating a System of Care that Reflects Patient Preferences and Better Support for Clinicians
• Lessons Learned from a State-wide Suicide Prevention Training Project in Outpatient Behavioral Health Clinics

Presenters discussed a variety of opportunities to integrate training in suicide prevention clinical care, including graduate training programs and primary care clinics. Structuring ongoing training by modular competencies consistent with experimental therapeutic designs can help clinicians develop skills in the most important areas related to suicide prevention. Training in low-resource settings requires strategies to understand and address significant contextual challenges (e.g., presence of armed civil conflict, pervasive stigma regarding mental illness, general lack of providers and specialized trainings on suicide prevention, long-term systemic inequities and structural issues) that hinder efforts to translate conventional approaches to suicide prevention.

Training research on suicide prevention clinical care needs to evaluate reach, cost-effectiveness, and incentive programs. Fewer than half of clinicians report receiving training in suicide-specific treatments, many of whom also report less than optimal knowledge about warning signs, protocols for risk response, and confidence in ability to respond to a crisis. To better support clinicians, organizations should consider ways to improve communication and increase perceptions of organizational support during accountability reviews. Patient preferences for clinical care include an emphasis on clinicians’ ability to listen, and clinicians’ use of language that describes observable behaviors rather than assumptions about intention, as well as communication that provides specific suggestions when offering support during crisis periods.

A research team comprised of members from the Suicide Prevention Center of New York and the Center for Practice Innovations within New York’s Office of Mental Health shared their observations and results from a statewide implementation project of Zero Suicide in 165 outpatient behavioral clinicals and 280 affiliated satellites across New York State. Clinicians most commonly identified a need for more training supervision, and support as a barrier to providing effective care to suicidal clients. Despite significant improvements in training clinicians, clients often remained reluctant to disclose suicidal ideation and many of those identified as high risk never came back for a second visit.

Day 2 presentations covered three major topics:

• Barriers and Facilitators of Successful Training in Suicide Prevention Clinical Best Practices,  
• Added Drawbacks and Benefits of Digital Tools and Technologies in Suicide Prevention, and
• Paradigm Shifting Opportunities

Implementation science frameworks can help inform training strategies by identifying barriers and facilitators of the provision of suicide prevention clinical care best practices in real-world healthcare settings. Presenters noted an emphasis on quality of care as well as administrators’ support of training efforts as crucial facilitators to increasing patient engagement and sustainability of suicide prevention programming. Training in cultural competencies related to suicide prevention clinical care is needed to create systems of care approaches that are appealing to minority populations and address the unique factors that contribute to their suicide risk.

Tools and technologies built to support training, practice, and maintenance of high-quality counseling skills can be readily applied to suicide prevention clinical care. Such training platforms may help reduce disparities in provision of evidence-based care in under-resourced areas. Adding digital elements to support intervention delivery has the potential to increase quality of care, reach, and effectiveness of evidence-based suicide prevention treatments. Virtual training platforms also may help modify clinician-level factors (e.g., emotional self-awareness, verbal empathic communication) that impact quality of care and effectiveness of treatment.

While efforts to implement evidence-based suicide prevention clinical care have increased in health systems, the trainings used for such efforts are often not evidence-based, rarely address the clinical care process, and often teach practices that are infeasible in real-world practice. Trainings typically neglect the importance of partnerships across regions and sectors. Some exceptions do exist, such as a robust program to train VA clinicians in the Safety Planning Intervention. Current policy initiatives to enhance clinical training for providers exist, such as state mandates for training in suicide assessment, treatment, and management for health professionals. Going forward, policy and program developers should aim to identify best practices for scaling up clinical requirements through state legislation, licensing boards, educational programs, and accreditation requirements.

Presenters with suicide-related lived experience expertise offered remarks each day. They emphasized considerations for language that professionals can use to help destigmatize suicidal experiences, the importance of patient-centered care and peer specialist services, and the need to demand excellence in the field at every stage of care. The presenters also asserted that suicide care itself should be a standard practice rather than an addition to standard practice, and that individuals with lived experience and those receiving care should be considered active partners with their providers during the treatment and recovery journey.