Status on Suicide Deaths in the USA
Suicide represents a significant public health concern and professional hazard for mental health providers. Statistics show that 1 in 4 of mental health providers (psychologists and mental health counselors) will have a client die by suicide at some point in their career while 1 in 2 of psychiatrists experiences such loss.
According to the Centers for Disease Control and Prevention (CDC) WISQARS Leading Causes of Death Reports, in 2019, suicide was the tenth leading cause of death in the United States. Among individuals between the ages 10 and 34, suicide was the second leading cause of death and the fourth leading cause of death among individuals between the ages 35 and 44.
Although the general suicide rate was 3% lower in 2020 than in 2019 as per the study conducted by the Center for Disease Control and Prevention National Center for Health Statistics, the report indicated increased deaths among people of color. For example, deaths among Black girls and women ages 10 to 24 increased more than 30% from 1.6 to 2.1 per 100,000 people, Black boys and men in the same age group experienced a 23% increase from 3.0 to 3.7 deaths per 100,000 people, Hispanic women within this age range saw an increase of 40%, Hispanic men a 20% increase, Asian women experienced a 30% increase in suicide deaths, from 4.9 to 6.2 per 100,000. The Harris poll conducted in 2020 by The National Action Alliance for Suicide Prevention among others, found that minority groups identified barriers to talking about their suicide with others due to lack of knowledge and vocabulary.
The upward trend in suicide deaths among children and young individuals, especially girls and young women of color is concerning given that historically, suicide deaths had been higher among men. In 2019, men died of suicide 3.63x as often as women, White males accounting for nearly 70% of suicides in the US States.
Suicide Assessment: What Are the Key Components?
Although many therapists have been trained in assessing risks, it is worth refreshing our memories on this topic since burnout is real in our profession, particularly in the times of Covid-19, and can cloud our judgment and clinical effectiveness.
As part of suicide prevention, effective suicide assessment is essential and consists of the following elements.
Ideation:
Ask the client about suicidal thoughts, frequency, intensity, and duration in the last 48 hours, week, past month, and the lowest point
Plans:
Inquire about the timing, location, lethality, availability, preparatory acts toward self-harm
Means:
Ask the client direct questions about the means to carry out the plan
Intent:
Help clients articulate the level of control they have over their thoughts
Risk and Protective Factors:
Explore factors that may reduce or enhance the risk of suicide. Risk factors may include past suicide attempts and/or a family history of violence and suicide attempts. Protective factors may involve a support system, future goals, religion, or having dependents.
As a rule of thumb, if the ideation, plan, and means are present, the client can be considered vulnerable to committing suicide, and the clinician must act to their best ability to safeguard client safety.
Suicide Preventing and Intervention*
It is worth noting that research has found that a suicide contract has not proven to be effective toward preventing suicide. It may give the therapist a false sense of security.
Depending on the level of risk, several interventions can be considered. For example, the therapist may increase the session frequency, refer to appropriate resources, and/or involve significant others in the treatment. If the client has access to the means, the therapist must address ways in which the client gets rid of the means (e.g., pills, weapons). Finally, if the client presents with out-of-control features, impulsivity concerns, or significant vulnerability (e.g., depression with insomnia, isolation), hospitalization may be the necessary intervention to keep the client safe till the urge to die passes.
When working with individuals of minority groups, efforts should be taken to build rapport, provide psychoeducation about suicide, and address issues of fear and shame around suicidality.
It is worth noting that an in-depth assessment of and safety planning with the client is vital to ensuring ethical risk management. Importantly, therapists should document their assessment, thinking through the reasoning of the intervention and actions taken to manage risks, as well as any follow up with clients or relevant stakeholders. Finally, consulting with peers or supervisors and documenting such engagement can strengthen the therapist’s ethical risk assessment and liability.
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*Disclaimer: Please note that this article is a summary of suicide assessment and intervention and should not be used as the sole source of guidance for risk management. Please consult National Action Alliance for Suicide Prevention, National Suicide Prevention Lifeline, and the like.
