Most health professionals feel confident about screening for suicidality but less confident about performing more complex practices such as risk assessment and safety planning, a study in Psychiatric Services in Advance has found.
Celine Larkin, Ph.D., of the University of Massachusetts Chan Medical School and colleagues invited 5,559 clinicians in a large health care system to take a survey on suicide prevention practices and implementation, and only 1,224 responded. They included physicians, nurses, psychologists, social workers, residents, advanced practice providers, and medical assistants.
Participants were asked to rate their confidence in their ability to screen patients for suicidality, assess suicide risk severity, provide brief counseling to suicidal patients, help patients at risk create a personalized safety plan, and find referral resources. They also reported how many suicides they considered preventable; the proportion of all patients they personally screen for suicidal ideation; and the proportion of patients with suicidality whom they personally assess for risk severity, create a written personalized safety plan for, briefly counsel, and provide referrals to outpatient or community resources.
Overall, 65% of the participants reported that they were confident that they had the skills needed to screen patients for suicidality. However, fewer reported confidence in performing other suicide-related practices, as follows:
- Further assessment, 50%
- Providing referrals or resources, 43%
- Brief counseling, 38%
- Safety planning, 30%
Few participants reported personally delivering suicide-related services to all or most of their eligible patients, including 33% for screening, 36% for further assessment, 23% for brief counseling, 23% for providing referrals or resources, and 11% for safety planning. Behavioral health providers and health professionals who worked in emergency departments tended to have higher confidence in conducting a higher level of suicide-related practice.
Overall, 55% of participants endorsed the belief that most or all suicides were preventable, 49% agreed that universal screening for suicide would slow clinical care, and 19% believed that universal screening for suicide would result in increased psychiatric evaluations. Furthermore, 50% agreed that departmental leadership supported improvement in interventions for suicidal patients, and 45% felt that treatment of suicidal patients was a top priority in their department. In addition, 65% reported that they were using continuous quality improvement (CQI) methods in their work, and 53% reported that they had received formal performance improvement or CQI training.
“Our findings not only support the need for further training focused on attitudes and skills (ideally including live training and hands-on demonstration sessions) but also indicate the strong potential for CQI-type implementation strategies, such as small cyclical tests of change and audit-and-feedback strategies,” Larkin and colleagues concluded.
For related information, see the Psychiatric Services article “Suicide Risk Before Mental Health Treatment Initiation: Implications for Screening and Access to Care.”
