The client who sits across from you is despondent. It’s coming up on the anniversary date of his lover’s death, a death that was both a tragedy and a relief. Two years of unsuccessful treatments for a progressively painful cancer had been agony for them both. His partner died on what would have been their 23rd anniversary. They had loved each other and built a life. Your client is still grieving. He wonders if he can go on. He thinks that life without his partner isn’t worth living.
You worry. If you send this man home, will he make a suicide attempt or will the hour with you have been successful in moving him another step forward in the grieving process? Should you send him to the emergency room or make an appointment for the same time next week? What if you make the wrong call?
It’s impossible to do clinical work without at some point in our career having to face the possibility that a client will commit suicide.
Suicide is on the rise in the U.S. According to the American Foundation for Suicide Prevention, more than 41,000 suicides were reported in 2013. That same year, 2.7 million adults (ages 18 and older) made suicide plans and 1.3 million made a serious attempt. 494,169 people visited a hospital for injuries because of self-harm behavior, suggesting that approximately 12 people harm themselves.
Most chilling to my thinking about my own responsibility in these cases is that 45% of those who die of suicide talked to a mental health provider within a month of their death .
Whether you are a new therapist, new to private practice or have years of experience, if you work alone, the presentation of suicidality can be daunting. There is no supervisor on call. You can’t walk the individual down the hall to the clinic crisis team. The prescriber may be on the other side of town and unreachable. You and your client are on your own.
And yet, you, like most clinicians, are probably inadequately prepared to treat the suicidal client. Few graduate programs in counseling psychology include more than a few hours of training in suicide prevention, assessment and treatment.
In a 2012 report by an American Association of Suicidology Task Force, the authors found that only about half of students in accredited psychology programs received any training at all in suicide prevention. Further, only 2% of accredited counselor education programs and 6% of accredited marriage and family therapy programs offered a suicide-specific course in their curriculum.
Our job, as clinicians, is to provide support and to do everything we can to prevent a client from self harm and self destruction. If you are one of the thousands of clinicians whose training for suicidality was limited to a mention in a class or two, do take care of your patients and yourself by taking charge of your own education.