This paper presents a structured approach to suicide prevention consultation grounded in empirical research and community-specific assessment. It introduces the triangle model, which identifies three necessary causal conditions for suicidal behavior, and situates it within a broader multidisciplinary framework that addresses psychosocial, environmental, and sociocultural risk factors. The paper also examines protective factors outlined by the Suicide Prevention Resource Center, emphasizes the role of positive psychology in reducing stigma, and highlights the importance of cultural sensitivity in designing interventions. Together, these elements form a flexible consultation design applicable across diverse target populations and organizational settings.
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An "immense need" exists for technical assistance and general consultation 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. Individual risk factors can then be identified and incorporated into 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 through 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. This approach can eliminate the tendency to label and stigmatize, instead shifting toward 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 incorporated into 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.
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 being experienced, and the degree of planning that has occurred. The triangle model is helpful for teaching counselors how to identify risk factors in individual patients, but several other risk factors must also be identifiable.
Risk factors include those that are psychosocial in nature, such as a family history of suicide, the presence of substance abuse disorders, and the presence of mental health disorders. Furthermore, environmental risk factors need to be addressed within the target population. Easy access to lethal means of self-harm, recent job loss, and recent trauma may all be considered environmental factors. Sociocultural risk factors that must be addressed in consultation include the level of social support versus isolation within the target community. For example, if the target community is a college campus, 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 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.
A general framework for understanding and practicing consultation can be developed and applied across different scenarios. This framework consists of preliminary assessments such as the evaluation of the target population and its demographic characteristics. Age, gender, sexual orientation, ethnicity, and environmental variables need to be tabulated and evaluated. The procedures by which to recognize at-risk individuals within the target population are then discussed. This might include an assessment of persons who have already been diagnosed with concurrent mental health problems such as depression, as well as 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.
"Systems approach addressing organizational and cultural variables"
"SPRC protective factors and barriers to care"
Suicide prevention consultation is a multidisciplinary and ongoing public health strategy. Consultation methods will vary depending on the target population and the risk factors specific to the community or organization. Similarly, consultation strategies will vary depending on the value systems and worldviews present in the target population. Working with institutions on developing protective measures while minimizing risk factors may raise questions related to organizational culture and administration. When such issues arise during consultation, it is important to remain sensitive to the needs of both the community and the organization.
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