Dear Colleague:

This brief letter has two purposes 1) to address an issue about which many of those in the healing arts are not fully aware, and for which very few are fully prepared, and 2) to offer assistance to clinicians who may lose a consumer to suicide.

• Many beginning clinicians are unaware that suicide is a leading cause of premature death for many of the emotionally distressed people they have been trained to serve. (World Health Organization, 1999)
• Over 90% of all completed American suicides are by persons with an Axis I disorder. (Multiple studies summarized by Morscicki, E.K. 1999, in The Harvard Medical School Guide to Suicide Assessment and Intervention, D. Jacobs, Editor.
• Fully one in six psychiatric patients who die by suicide dies in active treatment with a healthcare provider. (Bongar, 1991) The Suicidal Patient, Clinical and Legal Standards of Care, Washington, D.C.: American Psychological Association.
• Approximately 50% of those who die by suicide in America will have seen a mental health provider at some time in their life. (U.S. Department of Health and Human Services, 1999, Mental Health, a Report of the Surgeon General)
• Interns, residents and other novice clinicians have been found to experience higher rates of suicide among their clients than more seasoned clinicians (Bongar, 1999)
• Suicide malpractice is the leading cause of legal action against all behavioral healthcare providers, regardless of discipline. Thomas G. Gutheil 1999, in The Harvard Medical School Guide to Suicide Assessment and Intervention, D. Jacobs, Editor.
• Experiencing the loss of a client by suicide can be psychologically traumatic for the provider, and may even become a career-ending event.
• Unfortunately, few training institutions or graduate programs prepare students for this possible traumatic loss (Bongar, 1999).

In summary, the odds that you will lose a client to suicide at some time during your career may be slim, but they are not zero. Based on our collective experience as clinicians and researchers, we wish to offer you the following suggestions to assist you both now and in the future should someone in your care die by suicide:

• If you are new to the helping profession and have not yet had training in suicide risk assessment and risk management, we encourage you to seek out such training and provide yourself with the best knowledge base you can find. In the event a consumer of your service dies by suicide while in your care, you will at least be comforted by the fact that you had received relevant training in assessing and managing consumers at risk for suicide.
• If you are still in training (student, intern, resident, etc.), we encourage you to seek out a professor or instructor and request specific training in suicide risk assessment and management. One such source is through the Eastern Washington University – QPR Institute partnership (see web links below).
• We strongly encourage you to routinely inquire about suicide with every consumer of your service so that you that you can immediately assess any suicide potential that may be present.
• We strongly encourage you to seek supervision and/or consultation when you are serving someone known to be at risk for suicide. In the event of a bad outcome, you will be comforted by the fact that more than one professional was participating in the treatment plan.
• In the event that you may have already lost one or more clients to suicide, we invite you to seek assistance and support from informed other clinicians.

The loss of a client to suicide is something we all wish to avoid. We believe that through training, education and research, we can help create a therapeutic “climate of safety” for suicidal persons. Therefore, we wish to encourage you and all clinical providers to learn as much as possible about suicide, its etiology, the psychological and medical conditions that enhance risk, and about how those interventions and therapeutic endeavors that reduce risk and enhance protective factors.

We also believe that by sharing our experiences we can not only learn how to better prevent suicide among those we serve, but we may also learn important lessons for our own survival as clinicians.

The EWU-QPR staff and faculty

QPR Institute/Eastern Washington University course information