Suicide prevention consultation strategies and implementation

Suicide Prevention

An "immense need" exists for technical assistance and general consultation that is specific to community healthcare needs (Walker, Louton, Walker & Frizzel, 2006, p. 40). A suicide prevention consultation strategy should first identify risk factors specific to the community and target population. For example, job or financial loss might be identified as a core risk factor in the community. Then, individual risk factors can be identified and used in a comprehensive consultation and intervention strategy. Relying on empirical research, the suicide prevention consultation is also designed in accordance with state laws and/or organizational policies. Appropriate prevention strategies are outlined, and intervention strategies are designed to meet the specific needs of the individual within the target population. Finally, the suicide prevention consultation strategies are implemented according to best practices.

Consultation services should be as multidisciplinary as possible, allowing for the treatment of individuals in a diverse community (Gutierrez, Brenner, Olson-Madden, Breshears, Homaifar, Betthauser, Staves & Adler, 2009). Suicide prevention consultation can entail screening methods, risk reduction strategies, and "postvention" planning (Columbia Care Service, 2010). One model that has been especially effective is the triangle model and theory, which suggests that there are specific causal conditions that must exist before a suicide occurs (Cutter, n.d.).

Suicide can be prevented when relevant causal conditions are identified and transformed in consultation services. However, it is also crucial to incorporate methodologies that draw from positive psychology. Positive psychology implies a focus away from pathology and toward ideals, visions, dreams, and goals. Positive psychology can eliminate the tendency to label and stigmatize, instead shifting towards a more nuanced approach to suicide prevention. Meyers, Meyers & Grogg (2004) also note the importance of "fostering productive home-school connections" in a school counseling setting. These types of social strategies are critical to the consultation process. There are also "optimal and ethical" uses of "rapidly changing technologies" that can be used in an overall suicide prevention strategy (Meyers, Meyers & Grogg, 2004). For example, consultants should remain sensitive to anonymity issues when electronic medical records or any other databases are accessed.

Suicide Prevention Consultation Design

This suicide prevention consultation design is based on the triangle model outlined by Cutter (n.d.). The triangle model illuminates three necessary and sufficient causes of self-injurious behaviors, which can also be called "suicidal aspects," (Cutter, n.d.). These three aspects form the lines of the triangle in the model and include the intensity of the wish to die, the kind and amount of distress that is being experienced, and the degree of planning that has occurred. The triangle model is helpful for teaching counselors about identifying risk factors in individual patients, but there are several other risk factors that must be identifiable. Risk factors include those that are psychosocial in nature, such as a family history of suicide, presence of substance abuse disorders, and presence of mental health disorders. Furthermore, environmental risk factors need to be addressed within the target population. Easy access to lethal means by which to cause self-harm; recent job loss; and recent trauma may all be considered environmental factors. Sociocultural risk factors that must be addressed in consultation include level of social support vs. isolation within the target community. For example, if the target community is a college campus, the programs for promoting social integration on campus should be evaluated. Are there support groups for persons struggling with mental health issues? Is the campus community one that is supportive of diversity in terms of gender identity, sexual orientation, and ethnicity? Other sociocultural variables pertinent to suicide prevention consultation include access to healthcare services.

Because of the importance of environmental and institutional variables, there is a strong need to incorporate a multidisciplinary approach. In addition to the triangle model applying to individual counseling, the consultation also incorporates a systems approach applying to organizational variables. Suicide prevention is viewed as dependent on variables such as individual access to suicide methods, level of social integration vs. isolation, and perceived stigmas against seeking mental health services. These issues are addressed in the consultation process. Barriers to accessing healthcare services are especially important. The presence of prevailing religious beliefs might also impact the type of suicide interventions that are recommended for the organization. For suicide intervention strategies to be meaningful, they must be rooted in the belief and value system of the target population. Walker, et al. (2006) stress the importance of recognizing and being sensitive to cultural nuances during the consultation procedure. There may, for example, be specific social stigmas against seeking mental health support or specific beliefs about suicide itself within a particular ethnic group. Individual differences in beliefs about death might also come into play.

A general framework for understanding and practicing consultation can easily be developed and applied in different scenarios. This framework consists of preliminary assessments such as the evaluation of the target population and its demographic issues. Age, gender, sexual orientation, ethnicity, and environmental variables need to be tabulated and evaluated. Then, the procedures by which to recognize at-risk individuals within the target population are discussed. This might include an assessment of persons who have already been diagnosed with concurrent mental health problems like depression. It might also include an identification of those at risk due to recent job loss or returning from military service. Research-driven models such as the triangle model can then be applied in individual counseling recommendations.