A national survey of doctoral psychology education and training in suicide risk and violence risk assessment and management.

INTRODUCTION: When, in the judgment of a mental health professional, patient suicide risk and/or patient violence risk are considered imminent, they have been referred to as behavioral emergencies. Past surveys have suggested that education and training with these emergency situations have been inadequate. The present study was undertaken to obtain more current information on the training that psychologists receive in these areas of practice. METHOD: All directors of APA-accredited graduate psychology programs and all directors of APA-accredited predoctoral psychology internship programs were asked to complete an online survey inquiring about such training provided in their programs. RESULTS: Results indicated that both sets of directors rated such doctoral training in suicide risk assessment and management as very important. Internship directors, however, were significantly more likely than graduate program directors to state that psychologists should be required to complete continuing education courses on other-directed violence risk. Serious gaps in training were identified; that is, only 59.2% of psychology graduate directors reported that their program offered training in safety planning for suicide risk and only 25.4% reported that their program offered training in safety planning for violence risk. CONCLUSION: Given that serious injury and even death can occur from patient suicidal behavior and/or a patient violent behavior, the implications of these findings are discussed.

Is Suicidal Behavior in Mood Disorders Altered by Comorbid PTSD?

BACKGROUND: Suicide is a leading cause of death among US veterans. Associations between depression, posttraumatic stress disorder (PTSD), and suicidal behaviors have been found in this population, yet minimal research has explored how manifestations of self-injurious behavior (SIB) may vary among different diagnostic presentations. AIMS: This study aimed to identify clinically useful differences in SIB among veterans who experience comorbid mood disorder and PTSD (CMP) compared with those who experience a mood disorder alone (MDA). METHOD: Participants were 57 US military veterans who reported an incident of intentional SIB. The semistructured Post Self-Injury/Attempted Self-Injury Debriefing Interview was used to examine characteristics of the SIB. RESULTS: Veterans diagnosed with CMP were more likely than those with MDA to (a) report that the SIB was impulsive and (b) to be under the influence of substances at the time of self-injury. LIMITATIONS: Generalizability may be limited by small sample size and predominantly European American, male demographics. While highly relevant to routine clinical practice, caution is recommended, as study diagnoses were attained from medical records rather than structured interviews. CONCLUSION: Safety planning that emphasizes protection against impulsive suicide attempts (e.g., means restriction) may be especially important among veterans with comorbid mood disorder and PTSD.

Preventing suicide through improved training in suicide risk assessment and care: an American Association of Suicidology Task Force report addressing serious gaps in U.S. mental health training.

There are twice as many suicides as homicides in the United States, and the suicide rate is rising. Suicides increased 12% between 1999 and 2009. Mental health professionals often treat suicidal patients, and suicide occurs even among patients who are seeking treatment or are currently in treatment. Despite these facts, training of most mental health professionals in the assessment and management of suicidal patients is surprisingly limited. The extant literature regarding the frequency with which mental health professionals encounter suicidal patients is reviewed, as is the prevalence of training in suicide risk assessment and management. Most importantly, six recommendations are made to address the longstanding insufficient training within the mental health professions regarding the assessment and management of suicidal patients.

Psychologist suicide: Incidence, impact, and suggestions for prevention, intervention, and postvention.

Psychologist practitioners are not immune to some mental health problems, including suicidality, for which they provide services. In the aftermath of two recent psychologist suicides, the American Psychological Association's Advisory Committee on Colleague Assistance (ACCA) initiated the formation of a conjoint ad hoc committee consisting of members from ACCA, the American Psychological Association (APA) Practice Directorate, and the Section on Clinical Emergencies and Crises (Section VII of APA's Division 12) to investigate the incidence of psychologist suicide and its impact on colleagues, students or interns, patients or clients, and the profession. The committee reviewed the extant empirical literature on suicide rates for psychologists, evaluated unpublished data on psychologist suicide provided by the National Institute of Occupational Safety and Health (NIOSH), interviewed colleague survivors, reviewed published case reports of the impact of therapist suicides, and linked their findings to the literature on professional distress, impairment, and self-care. The committee concluded that there is evidence suggestive of an elevated risk of suicide for psychologists in past decades. It further concluded that there is a need for further research to confirm if there is a heightened risk of suicide for psychologists in the present day, and to determine factors that might contribute to such risk. Accounts from colleague-survivors suggest that the impact of a psychologist's suicide can affect many people including family, colleagues, students, and patients or clients. This article offers suggestions for possible preventive approaches, for intervention with potentially at-risk colleagues, and for postvention efforts in the wake of a colleague suicide.

Psychological and ethical considerations concerning the debreather and assisted suicide: a commentary on Ogden.

This article offers a commentary on the report by Russel Ogden (2010/this issue) on the use of the "debreather" for suicide assistance by the NuTech (or New Technologies for Self-Deliverance) program. The emergence of NuTech is set within its historical and political context. Nu Tech is criticized for its anarchic and extreme advocacy of self-determination to the neglect of other psychological and ethical considerations (e.g., the individual's emotional state, the mutability of his or her quality of life, and his or her decision-making capacity). Some of the risks of covert, unregulated, assisted death are noted as is a potential shift in healthcare that might diminish interest in the undignified NuTech methods of dying.

Treating aggression in the psychiatric emergency service.

Reports indicate that the severely mentally ill, those patients with schizophrenia or bipolar disorder, are at increased risk of being violent to others. They are also at increased risk of being victims of violence or homicide. This article discusses the state of knowledge concerning the 3 most common classes of drugs used to decrease agitation in the psychiatric emergency service setting: benzodiazepines, conventional antipsychotics, and atypical antipsychotics. The decision whether to use benzodiazepines alone versus benzodiazepines combined with an antipsychotic, and whether that antipsychotic should be a conventional or atypical antipsychotic, hinges on considerations of mental health history, need for synergistic sedating effects, and the side effect profiles of the various medications.