An Educational Gap in Mental Health Care

Today, people who have lost the will to live and those who love them are in danger of falling through a gap in the mental health care system that doesn’t have to be there. The Economist, The New York Times, and The Washington Post have published articles this year about the continuing rise in the number of deaths by suicide. In USA Today’s “We tell suicidal people to go to therapy. So why are therapists rarely trained in suicide?”, author Alia Dastagir asks an extremely important question. These publications are not the only ones sounding an alarm. Among the other voices are survivors of suicide loss who have been asking similar questions for well over 15 years.

Some suicide prevention groups and organizations that focus on helping survivors of suicide loss are trying to change this situation. Ronnie Susan Walker, MS, LPCP, is the founder and executive director of the Alliance of Hope for Suicide Loss Survivors. In this nonprofit’s March 2020 newsletter, she said she has found that few graduate schools include suicide aftercare (or postvention) in their mental health curriculums and there is little continuing education in this area.

“Those of us who have already lost loved ones to suicide are keenly aware of the complexity and challenges associated with preventing suicide,” she wrote. “We know that ‘noticing signs,’ ‘calling an 800 number’ or ‘getting a loved one into treatment’ does not always work. Too many loss survivors have discovered that being in treatment or on medication does not ensure suicide will be prevented.” 

In her response to USA Today’s article, she elaborated on the crucial need for knowledge and support. “This lack of attention to the needs of suicide loss survivors has always occurred to me as a profound void in the arena of mental health support because the complex and traumatic nature of suicide catapults family and friends onto a challenging grief journey. In the initial aftermath, those closest are almost 10 [times] more likely to have suicidal thoughts than the general public. They are also more likely to leave their jobs or drop out of school.”

Dastagir cites several sources that shed light on how people experiencing suicidal impulses are treated (or not treated), including the American Foundation for Suicide Prevention, whose findings indicate there are no national standards in the United States that require mental health professionals, either in their education or their careers, be trained in how to treat suicidal people. Only nine states mandate training in suicide assessment, treatment and management for health professionals.

All medical personnel and certainly mental health professionals need specific training on both suicide prevention and aftercare for loss survivors. While clear guidelines and preparation are not a guarantee that any suicide can be prevented, having such tools would greatly benefit all concerned, including first responders and law enforcement who, in some areas, do have access to such training. 

What does this look like in real life? Most of the time, assessment begins with a primary care physician, who might start medication for depression. A patient could see a psychologist, social worker, marriage and family therapist or others, but a psychiatrist might have the most related educational training. 

Even emergency admission to treatment centers can result in only brief sessions with multiple psychiatrists. Aftercare can find patients losing quality help through doctors’ career changes, relocation, and retirement or their own decisions to move closer to family members for support. All of this can be overwhelming for someone who is struggling.

What can you do to determine the education and experience level of your providers?

  • Research available options in your area to check qualifications (and reviews) online or call before making an appointment to ask specific questions.
  • Find out if a provider has experience working with people and family members who are experiencing the same issues that bother you.
  • Discuss confidentiality and ask who would receive reports.
  • Ask about experience with trauma situations and policies regarding suicide.
  • Check where this provider has admitting privileges.
  • Determine if medications can be prescribed if needed (this is not always an option) and what the provider’s opinion on medications is.
  • Ask questions about insurance accepted.
  • Make an appointment with your first choice and give the relationship a few tries before looking for someone else. Therapy takes time. Finding a good match is important.
  • Be patient with yourself and your process; understand why you might need to work with more than one professional at a time. For example, a psychiatrist may provide medication oversight while you work through issues with a counselor or therapist.
  • Find out all you can about your condition and how various professionals can help. 


America’s suicide rate has increased for 13 years in a row. (2020 Jan 30). The Economist.

Friedman, R. (2020 Jan 6). Why Are Young Americans Killing Themselves? New York Times.

Wan, W. (2020 Jan 9) More Americans Are Killing Themselves At Work. Washington Post.

Dastagir, A. (2020 Feb 27). We Tell Suicidal People To Go To Therapy. So Why Are Therapists Rarely Trained in Suicide? USA Today.

Walker, R. (2020 Mar 3). Why Are Therapists So Rarely Trained in Suicide? Alliance of Hope.

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