Proper care starts with the basics:  Structural attention for suicide prevention

Proper care starts with the basics: Structural attention for suicide prevention

How should I ask a client about suicidal thoughts? What do I do if a client tells me they are thinking about suicide? As a clinical psychology teacher, I am regularly faced with these kinds of questions from students in the master's programme.

In those lessons for master's students, we already see a distinction emerging between abstract knowledge and skill. Some of these students are fresh from their bachelor's programme; others have a rich work history. Their shared aim is to work as a mental health professional. Later, in practice, they will have to deal with issues like these. Yet it depends on me, as an individual teacher, what these students learn about this subject. As a result, we have no insight into the knowledge, skills, competencies, and attitudes of the professionals responsible for this care.

Alerting and discussing

Especially when it comes to the role of health professionals in reducing suicide, there is still room for improvement. Research on suicides in Western Europe and North America between 2000 and 2017 showed that 3.7% of those who committed suicide were hospitalized in a psychiatric hospital when they died; 18.3% had sought inpatient help in the previous year; and 26.1% had contacted outpatient services. A lack of specific training leaves mental health professionals feeling ill-equipped to provide professional help in the case of suicidality. A common misconception is that asking about suicidality might fuel suicidal thoughts. In fact, research shows that initiating discussion on suicide can create openness and feelings of relief, and this in turn can lead to quicker treatment and prevent worse.

No fixed place

The reason that mental health professionals are often lacking in suicide prevention skills lies in their professional training. Suicidology, the science of suicidal behaviour, its causes, and suicide prevention, has no fixed place in the curricula in the Netherlands and is therefore not structurally taught in medical and mental health education in this country. This is despite the fact that targeted training helps reduce the number of suicides, according to previous research in the UK.

Sounding the alarm

In 2017, a consortium of Clinical Psychology professors sounded the alarm to draw attention to this gap in our education, particularly in psychology. Targeted training of mental health professionals is therefore part of the Third National Suicide Prevention Agenda 2021-2025, under the management of 113 Zelfmoordpreventie (113 Suicide Prevention). The initiative can count on broad political and social support.

Structural embedding

As part of the Third National Suicide Prevention Agenda, Leiden University, the RINO group, and 113 Zelfmoordpreventie are working together to develop a teaching package to embed suicide prevention as a continuous thread running through the curriculum of all psychology courses in the Netherlands, from bachelor's to specialist training. The focus is on prevention, diagnostics, treatment options, crisis management, and professional responsibility. The package will consist of e-learning modules and blended learning materials. After the psychology courses, other training courses for mental health professionals will follow, such as degree programmes in medicine/psychiatry, and higher professional education.

From pilot balloon to manned flight

To ensure the teaching materials suit the target group, we must first determine what, in the area of suicide prevention, students in the current situation know, believe, and are capable of at the various stages of their education. The #ZEPPELIN study sends up a pilot balloon among students in fields related to mental health to assess their knowledge, skills, and attitudes towards clients with suicidality. The second step will be to investigate whether structural education in suicide prevention skills leads to improved knowledge and skills among these students who hope to become mental health professionals. You can read the first findings of the #ZEPPELIN project here.

The most important finding is that, in general, students at all educational levels are motivated and positive about structurally acquiring specific knowledge and skills in this area. We hope that by developing and implementing the e-learning packages we can ensure that in the future suicide prevention skills will be taught as a matter of course, and that this will no longer depend on individual teachers.

This blog was published (in Dutch) as an article in Impact Magazine in September 2021.