The following article appeared in NAADAC News, Vol. 15, No. 2, June, 2005, a publication of the National Association of Addiction.

Challenges and Opportunities: What You Need to Know about Suicidal Clients
Ben Camp, MSEd

Your client has just told you that he has been feeling suicidal. To make it interesting, he told you in a group session with six other people present. Another client in group says, “I think about suicide all the time. In fact, I’ve tried it twice.” Panic has not set it, but as you formulate your intervention, you are thinking, “They didn’t teach me how to deal with this in counselor training!”

While it doesn’t help, you are not alone. Deutsch (1984) and Faber (1983b) conducted surveys of counselors’ perceptions of the most stressful client behaviors and both found that suicidal statements were at the top of the list. Yet recent surveys of colleges and university training programs reveals a virtual absence of specific training in how to deal with, let alone assess and manage, suicidal clients. The good news is this training is now available; the bad news is that addictive disorders are major contributors to suicidal behavior. Consider the following research:

• Addictive disorder and actual intoxication are among the greatest predictors [of suicide] (Moscicki, 1997, pgs. 499-517).
• Estimates place substance use disorder as a factor in almost 60 percent of completed suicides and alcoholics may constitute as much as 25-43% of all suicides (Henriksson et al., 1993; Murphy and Wetzel, 1990).
• For people with substance use disorders, the incidence of suicide is 20 times greater then the general population (Blumenthal 1988).

Suicide is a major public health problem, with approximately 30,000 Americans completing suicide each year and another 650,000 receive emergency care after attempting suicide. Most of these attempts and deaths occur while people are under the influence.

Question: How many of us entered the substance abuse treatment field expecting to work with suicidal clients? After all, isn’t this a mental health problem? Answer: Not any more. Suicidal behavior is more closely associated with substance abuse than mental disorders like depression and schizophrenia. And yet, few of us received any systematic training in the assessment and management of suicidal behavior.

This problem has now been identified at the level of social policy. The Surgeon General’s 2001 National Strategy for Suicide Prevention: Goals and Objectives for Action emphasizes the importance of instituting “training for all health, mental health, substance abuse and human services professionals concerning suicide risk assessment and recognition, treatment, management, and aftercare interventions.” Why? To save lives. Suicide is now the most preventable cause of death in America, and substance abuse counselors can and do play a key role.

Because of this major gap between professional practice expectations and counselor training program realities, Eastern Washington University, School of Social Work, Alcohol/Drug Studies Program, the Division of Educational Outreach and the QPR Institute worked together to address this curriculum deficit. Highly tested and evidence-based suicide risk assessment and risk management training programs offered by the QPR Institute were refined and customized for addiction counselor education both in the classroom setting and in blended online courses. This important training is now available nationally to diverse audiences.

On learning of these developments, NAADAC embraced these offerings and, by special arrangement with Eastern Washington University, is able to offer the new online basic QPR (Question, Persuade and Refer) gatekeeper training for suicide prevention at a discount, and NAADAC approval for CEUs for these programs.

In addition to a 10 Credit University-based Certificate Program, The Alcohol/Drug Studies Program at EWU provides a variety of online courses developed to match the level of community and staff interventions needed. These online courses include:

• QPR Gatekeeper Training for Suicide Prevention is a 2-hour emergency mental health intervention that teaches lay and professional gatekeepers to recognize and respond positively to someone exhibiting suicide warning signs and behaviors.
• QPR Suicide Triage Training Course for all "first responders" and professionals who assess and refer suicidal persons including law enforcement officials, teachers, clergy and correctional personnel.
• QPRT Suicide Risk Assessment and Training Course for professionals who evaluate and treat suicidal persons including substance abuse counselors, social workers, and psychologists.
• Native American Suicide Triage Training Course a basic introduction for suicide risk assessment with an emphasis on Native American populations.
  
  *QPR stands for Question, Persuade and Refer. It is designed to help people learn how to Question the validity of suicidal communications, and to Persuade and Refer someone at-risk to the next level of intervention.

These suicide risk assessment and management programs were developed by the multidisciplinary staff of the QPR Institute and model was selected as the basis for the EWU courses because it is considered “best practices” by the Joint Commission on the Accreditation of Health Care Organizations, received the J.J. Negley Associates, Inc. Presidents Award for Avoiding Suicide Malpractice, and QPR was highlighted as an example of best practices in suicide risk assessment in the U.S. Department of Health and Human Services (SAMHSA) Treatment Improvement Protocol - TIP 42 - Substance Abuse Treatment For Persons With Co-Occurring Disorders.

Ready or not, trained or not, comfortable or not, our suicidal clients are our clients. If we are to serve them well and keep them safe, we must learn this subject matter content, enhance our competencies, and make sure that all counselors and program staff members receive the necessary training to help save lives.

Additional course information is available online at http://www.ewu.edu/qpr .

Ben Camp, M.S.Ed.
Adjunct Faculty, Eastern Washington University
School of Social Work and Alcohol/Drug Studies Program,
Region 1 Representative for the Chemical Dependency Professionals of Washington State