How skilled are our Mental Health Professionals in Detecting and Treating Suicide Ideation ?

Updated: Feb 24


On December 7, 2021 U.S. Surgeon General Dr. Vivek Murthy issued a new Surgeon General’s Advisory to highlight the urgent need to address the nation’s youth mental health crisis.


While he said that the pre-existing numbers were increasing before the pandemic, Covid-19 had a devastating effect on our youth.


“The COVID-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating."

This Fall, a coalition of the nation’s leading experts in pediatric health declared a national emergency in child and adolescent mental health.


The Surgeon General’s Advisory on Protecting Youth Mental Health outlines a series of recommendations to improve youth mental health across eleven sectors, including young people and their families, educators and schools, and media and technology companies. Topline recommendations include:

  • Recognize that mental health is an essential part of overall health.

  • Empower youth and their families to recognize, manage, and learn from difficult emotions.

  • Ensure that every child has access to high-quality, affordable, and culturally competent mental health care.

  • Support the mental health of children and youth in educational, community, and childcare settings. And expand and support the early childhood and education workforce.

  • Address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers.

  • Increase timely data collection and research to identify and respond to youth mental health needs more rapidly. This includes more research on the relationship between technology and youth mental health, and technology companies should be more transparent with data and algorithmic processes to enable this research.

See link: https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html


We are in dangerous times in #mentalhealth. Unfortunately, we still live in a world of #stigma and #isolation if you have been diagnosed with a mental illness. Because of this many people shrug off symptoms and do not get the help that they need to get better. This is particularly true in men. A lot of this stems from traditional long term beliefs that "boys don't cry," "toughen up," etc. We are just starting to penetrate the #degradation and feeling of #weakness within our #military when our #veterans of #war come home with all of their limb's but significant #trauma, #survivorsguilt, #depression, #anxiety, #addiction and #ptsd. We have to keep messaging that seeking help for #mentalillness is not only brave but should be looked at no differently than seeing a general practitioner for any other illness, disease or area of concern.


See the newsletter I published in September 2021 during #suicideawarenessmonth https://www.melissamullamphy.com/_files/ugd/3c3522_d48155c5066045e3bd39025c1f3d8899.pdf WE MUST DO BETTER FOR OUR VETERANS.


In addition finding care is another obstacle. Particularly in a #covid world and #covid hangover.


Many patients that were receiving help when the pandemic began got lost when practices and clinics were shut down. While the hospitals overflowed with #covid patients, those seeking mental health were given a back seat to care and put on never ending waiting lists.


The form of care also has changed and still remains a dangerous and somewhat controversial practice today. Due to the fear of infection during #covid and still today many mental health providers moved to an "e" platform to provide care using technology. Examples are counseling via #evisits, #zoom and #facetime also called #telehealth. While I understand they have their place, and there are some real benefits, I have sat in the counselors chair and there are many things that will get lost in translation over a phone call or a #zoom meeting. For example, non verbal communication, patient hygiene, social queues, anxiety, posture, and getting the true full picture of the patient.


While it was critical during the #pandemic, in my opinion there is a place for it, but the preference should always be in person treatment; unless there are special circumstances that make the patient "at risk" have difficulty with travel, disabilities, are stigmatized going and feel "safer" in the privacy of their own home, infection risk, etc. Recently I glanced at #psychologytoday and there are many therapist not taking any new patients and if they are they are strictly only offering #telehealth (not in person). Some also require the patient to be vaccinated for #covid which further complicates getting help. Those that do offer in person services have a wait list that is three to six months out. What the hell do you do in an emergency? Go to the ER? Sounds good but is the person that is assessing you qualified? According to the article below the answer is no.


In Suicide Prevention, 'Put Your Own Oxygen Mask on First !'

— Suicide assessment without adequate training contributes to failed outcomes



Word of Warning: Help Yourself Before Helping Others

"The American Association of Suicidology (AAS) is determined to prevent inadequately trained social workers and mental health professionals from working with potentially suicidal patients..."


The Outcome of Failed Prevention

Prior to and since this 2012 AAS warning, suicide rates have risen in nearly every state, with increases greater than 30% in 25 states. 2015 data from 27 states indicate 54% of suicide decedents were not known to have a mental health condition.

The U.S. is at 50-year historical highs. There has been a 50% increase in suicide among women since 1999. The youth suicide rate also skyrocketed more than 50% in the last decade.

A significant proportion of completed suicides occur within hours, days, or a few weeks of the last hospital, emergency department (ED), or other clinical encounter.

Moreover, ED care has continued to increase during the pandemic, with approximately 10% of patients evaluated for behavioral health complaints. For example, ED visits for suspected suicide ideation and attempts have risen year-over-year among adolescents ages 12-17, especially among girls. This underscores the need for additional competent screening during this disruptive public health crisis.


Recommendations

How can existing practices ensure a better harmony, communication, and equality of assessment outcomes for those who need help? It is well past time to make changes to improve the competence of mental health professionals. Below are 10 suggestions based on literature review and my administrative, teaching, clinical, and forensic experience.


Guidance

Suicide assessment training with reasonable reductions in lives lost will only improve through the disciplined use of an organized and open system to exchange innovative work and become familiar with it.

  1. Detailed assessment guidelines and course of study, including those proposed by the AAS and AAEP must be used to facilitate the adequate education of multidisciplinary mental health trainees.

  2. These standards must also offer specifically tailored information for supervisors and instructors to ensure that trainees master the content and acquire the skills necessary in core competencies.

  3. Improvements in psychiatric and mental health instructor guidance of emerging professionals will require greater than standard mentor expertise.

  4. Supervisors must devote time and energy to mentees from various disciplines above and beyond normal faculty responsibilities.

  5. Emergency medicine should be some of emergency psychiatry's biggest advocates.


Training

The U.S. Preventive Services Task Force continues to conclude that current evidence on the effectiveness of suicide risk assessment and documentation is lacking, of poor quality, or conflicting.

  1. Rather than thoughtlessly following the limitations of suicide meta-analysis with often reckless and wasteful biases, utilize real patient-centered accelerated and probabilistic (likelihood ratio) protocols.

  2. Valid and reliable standardized assessment, in addition to clinical judgment, provide a tiered and rational "time out" checklist in busy clinical settings.

  3. The suicide assessment cascade should further evaluate the impact of ideation and non-ideation states on attempt rates with confirmatory, research-based neurological tests.

  4. Dig beyond traditional ideation in slimly selected patient samples, the usual query standard of care. Clinical impression alone and ideation-centric suicide screens continue to show poor predictive value for near-term events.

  5. The balance of screening benefits and harms must be innovatively studied and determined.


Source:

https://www.medpagetoday.com/opinion/suicide-watch/97153?xid=nl_mpt_SRPsychiatry_2022-02-18&eun=g1976049d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=PsychUpdate_021822&utm_term=NL_Spec_Psychiatry_Update_Active


As a specialty practice we must do better. The above article cites areas of improvement, training and guidance that working clinicians particularly in the Emergency Room. It is too important to get the need/risk assessment and diagnosis correct. If you have limited experience in #suicidal behavior, terminology, and #selfharm you owe it to your patients to make sure that you are educated on the very latest journals, research, DSMV-R. If you are not, make sure that you get a seasoned clinician at the bed side before discharging a potentially suicidal patient with a script for an #ssri or #benzodiazipine and orders to follow up with a therapist because I can tell you it IS NOT EASY TO FIND TODAY. There is also a huge back up log and many no longer take insurance.


"Even a stopped clock is right twice a day," very occasionally performing correctly, but more generally performing unreliably.
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