Evidence-Based Care for Suicidality as an Ethical & Professional Imperative: How to Decrease Suicidal Suffering & Save Lives

Jobes, D. A., & Barnett, J. E. (2024).

The American Psychologist

10.1037/amp0001325.

Advance online publication.

https://doi.org/10.1037/amp0001325

Abstract

Suicide is a major public and mental health problem in the United States and around the world. According to recent survey research, there were 16,600,000 American adults and adolescents in 2022 who reported having serious thoughts of suicide (Substance Abuse and Mental Health Services Administration, 2023), which underscores a profound need for effective clinical care for people who are suicidal. Yet there is evidence that clinical providers may avoid patients who are suicidal (out of fear and perceived concerns about malpractice liability) and that too many rely on interventions (i.e., inpatient hospitalization and medications) that have little to no evidence for decreasing suicidal ideation and behavior (and may even increase risk). Fortunately, there is an emerging and robust evidence-based clinical literature on suicide-related assessment, acute clinical stabilization, and the actual treatment of suicide risk through psychological interventions supported by replicated randomized controlled trials. Considering the pervasiveness of suicidality, the life versus death implications, and the availability of proven approaches, it is argued that providers should embrace evidence-based practices for suicidal risk as their best possible risk management strategy. Such an embrace is entirely consistent with expert recommendations as well as professional and ethical standards. Finally, a call to action is made with a series of specific recommendations to help psychologists (and other disciplines) use evidence-based, suicide-specific, approaches to help decrease suicide-related suffering and deaths. It is argued that doing so has now become both an ethical and professional imperative. Given the challenge of this issue, it is also simply the right thing to do. 

Note: I really wish the APA would make these article available for every mental health provider.

Here is my best summary:

1. Use evidence-based suicide risk assessments like the Ask Suicide Questionnaire, Columbia Suicide Severity Rating Scale, and Patient Health Questionnaire-9 to identify suicide risk, but do not rely solely on them.
2. Implement acute stabilization interventions for highly suicidal patients, such as the Safety Plan Intervention, Crisis Response Plan, reducing access to lethal means, crisis hotlines/text lines, and caring contact follow-ups.
3. Utilize evidence-based psychological treatments focused specifically on suicidal thoughts and behaviors, rather than solely treating underlying mental disorders. Examples are Cognitive Therapy for Suicide Prevention, Dialectical Behavior Therapy, and the Collaborative Assessment and Management of Suicidality.
4. Receive comprehensive training in evidence-based suicide assessment and treatment during education and through continuing education to increase competence and reduce fear of working with suicidal patients.
5. Integrate significant others into treatment with patient consent for support, monitoring, and reducing hospitalization need, while addressing confidentiality.
6. Follow risk management strategies like thorough informed consent, documentation, and consulting colleagues, which align with ethical principles and reduce liability concerns.