Suicide Intervention Practices: What Is Being Used by Mental Health Clinicians and Mental Health Allies?

Abstract

Objective

Implementation of evidence-based suicide prevention is critical to prevent death by suicide. Contrary to previously held beliefs, interventions including contracting for safety, no-harm contracts, and no-suicide contracts are not best practices and are considered contraindicated. Little is known about the current use of best practices and contraindicated interventions for suicide prevention in community settings.

Methods

Data were collected from 771 individuals enrolled in a suicide prevention training. Both mental health clinicians (n = 613) and mental health allies (e.g., teachers, first responders) (n = 158) reported which best practices (i.e., safety plan, crisis response plan) and contraindicated interventions (i.e., contracting for safety, no-harm contract, no-suicide contract) they use with individuals who presents with risk for suicide.

Results

The majority of both mental health clinicians (89.7%) and mental health allies (67.1%) endorsed using at least one evidence-based practice. However, of those who endorsed using evidence-based interventions, ∼40% of both mental health clinicians and allies endorsed using contraindicated interventions as well.

Conclusion

Contraindicated interventions are being used at high rates and suicide prevention trainings for evidence-based interventions should include a focus on de-implementation of contraindicated interventions. This study examined only a snapshot of what clinicians and allies endorsed using. Additional in depth information about each intervention and when it is used would provide helpful information and should be considered in future studies. Future research is needed to ensure only evidence-based interventions are being used to help prevent death by suicide.

Highlights:

• The majority of both mental health clinicians and mental health allies use evidence-based practices for suicide prevention. This indicates good implementation rates of evidence-based interventions for suicide prevention.

• Approximately 40% of both mental health clinicians and mental health allies who endorsed using evidence-based practices for suicide preventions also endorsed using contraindicated interventions.

• A focus on de-implementation of contraindicated suicide interventions is warranted and should be part of the focus on suicide prevention efforts.

Keywords:

• Crisis response planning
• safety planning
• suicide
• suicide prevention

ACKNOWLEDGEMENTS

We would like to thank the mental health clinicians and their organizations for their enthusiastic engagement in this project and the important care they provide every day to veteran and non-veteran trauma survivors. The authors thank Julie Collins and Joel Williams, who provided editorial support for this manuscript, and Crystal Mendoza, Jeremy Karp, and Arthur Marsden, who provided project management support.

Additional information

Funding

Funding for this project was made possible by the Texas Health and Human Services Texas Veterans + Family Alliance grant program and the Boeing Corporation. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1T R002538 and KL2T R002539 (dcr). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Notes on contributors

David C. Rozek

David C. Rozek, PhD, ABPP, UCF RESTORES & Department of Psychology, University of Central Florida, Orlando, FL, USA.

Hannah Tyler

Hannah Tyler, PhD, ABPP and Brooke A. Fina, MSW, BCD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, CA, USA.

Brooke A. Fina

Hannah Tyler, PhD, ABPP and Brooke A. Fina, MSW, BCD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, CA, USA.

Shelby N. Baker

Shelby N. Baker, BA, BS, UCF RESTORES & Department of Psychology, University of Central Florida, Orlando, FL, USA.

John C. Moring

John C. Moring, PhD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, CA, USA.

Noelle B. Smith

Noelle B. Smith, PhD, Northeast Program Evaluation Center, Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.

Justin C. Baker

Justin C. Baker, PhD, ABPP and Annabelle O. Bryan, MA, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Annabelle O. Bryan

Justin C. Baker, PhD, ABPP and Annabelle O. Bryan, MA, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Craig J. Bryan

Craig J. Bryan, PsyD, ABPP, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA.

Katherine A. Dondanville

Katherine A. Dondanville, PsyD, ABPP, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, CA, USA.