Confronting the threat of suicide - Counseling Today Archive

At age 16, Kim Johancen-Walt became a suicide survivor after her brother, Kevin, took his own life through carbon monoxide poisoning in 1988.

Johancen-Walt, who grew up in a suburb of Denver, recalls being both deeply saddened and incredibly angry with her brother for ending his life. “I remember [a friend’s father] telling me the night Kevin was found that there would never be a day in my life that I wouldn’t think about my brother and the circumstances surrounding his death,” says Johancen-Walt, an American Counseling Association member who works in private practice in Durango, Colo., and serves as a senior counselor and assistant training director at Fort Lewis College. “Although I am happy to say that I actually have had days — many, in fact — that I have not thought about Kevin or his suicide, those words were my first lesson in coming to terms with how much my life was going to be changed. Accepting the full impact of my brother’s decision to commit suicide has been an essential part of my own healing process.”

After her brother’s death, her own life took an altered path, Johancen-Walt says, which included developing a passion for suicide prevention. Growing up, Johancen-Walt was sexually abused by her brother. Although it was never confirmed, her family believes Kevin was also sexually abused at a babysitter’s house when he was a child. “Kevin had untreated anxiety, had developed a substance abuse problem with alcohol and was having problems at work and in meaningful relationships at the time of his death,” Johancen-Walt says. “I believe that Kevin’s death may have been prevented if he had received early treatment that not only addressed his symptoms but also the psychological pain that fueled them. Furthermore, treatment may have provided him with additional information and skills that may have ultimately made a difference in his decision to end his life.”

In 1999, 11 years after Kevin’s death, the surgeon general declared suicide a public health crisis in the United States. But in more than a decade since that pronouncement, not enough has changed, says Darcy Haag Granello, a professor of counselor education at Ohio State University and a member of ACA. “There are some pockets of excellent programming, but as a nation, we have not taken this on,” she says.

Nationwide, Granello says, more than 34,000 people die each year from suicide — about 90 people per day. In a report based on a 16-state survey and published by the Centers for Disease Control and Prevention in May, suicide was found to be the leading cause of violent death in 2007, putting it ahead of homicides.

Adding to the problem, Granello says, is that although people in crisis often turn to counseling, not enough counselor training has been focused on suicide prevention. “The average amount of training in counselor education is less than one hour on suicide prevention and intervention. The absurdity of that is that as counselors, these are the people we see — these are our clients — yet we are not preparing our graduate student population sufficiently to handle these clients,” says Granello, adding she is pleased that the new CACREP Standards include suicide prevention and intervention.

Granello and her husband, Paul, conduct training for a variety of groups, including counselors, psychologists, teachers and emergency room personnel, and in those sessions, the Granellos offer a distinct, bottom-line message. “The No. 1 thing we tell counselors is to ask the question — ask it often and ask it in different ways. Ask if they’re feeling suicidal. Ask if they’re thinking of killing themselves. The take-home message everywhere we go is ‘Just ask,'” says Granello, coauthor of Suicide, Self-Injury and Violence in the Schools: Assessment, Prevention and Intervention Strategies, being published by ACA this summer.

Counselors can inadvertently make assumptions about whether clients are suicidal, and those assumptions are often wrong, Granello warns. She tells the counselors she trains to ask the question every time they meet with a client, even if it’s during a career counseling session. “Many times, people say no the first time. They don’t know you, they don’t feel comfortable. And by the time they get to know you and trust you, you don’t ask it anymore.” Counselors need to ask the question even after they become familiar with a client, Granello says, not just the first time they meet that client.

Research shows that talking about suicide decreases the actual risk, Granello says. In fact, she says, 80 percent of people who die by suicide tell someone about their plans in the week prior to their death. Unfortunately, Granello says, individuals confronted with these revelations most often respond with silence, ridicule or minimizing. People have very few places they can talk about their thoughts and feelings openly, so counselors have a real opportunity to serve as that outlet, Granello says. “Engage people in the conversation. … There’s no magic to it. Ask the question [and] open the conversation.”

“From my experience, there is great opportunity for the counselor who has a suicidal client who is talking about [his or her] suicidal thoughts or behaviors,” concurs Johancen-Walt. “This is not only an opportunity for a counselor to gather more information about actual risk, such as determining whether the client has an actual plan and the means to carry out the plan, but it is also an opportunity to challenge irrational beliefs that the client’s life will be better if [he or she is] dead. I am much more concerned about the client who is not talking about suicide if I have determined that clusters of risk factors are present.”

In these types of crisis situations, it’s important for counselors to understand that dying isn’t the client’s true desire, Granello emphasizes. “People who are suicidal don’t want to die. That’s not the goal,” she says. “People who are suicidal want the pain to end.” The feeling has been called “psycheache,” Granello says, and clients battling it might be unable to envision themselves going another day with the deep, intense pain that it involves. “The fact that people who are suicidal are telling people, reaching out in a way they know how, means that they are looking for some relief. From a counseling perspective, that’s a really positive thing. What it means is we can help people work through that intense psychological pain and find a way through it. That’s fantastic.”

On alert for risk factors

The potential threat of suicide cuts across all lines, regardless of the counselor’s setting, says ACA member Jason McGlothlin, associate professor at Kent State University and coordinator of the university’s counseling and human development services master’s programs. “Research says if you haven’t had a suicidal client yet, you will at some point.”

With that in mind, it’s important for all counselors to gain an understanding of the risk factors and to stay alert for potential tip-offs with clients. McGlothlin, author of Developing Clinical Skills in Suicide Assessment, Prevention and Treatment, published by ACA, offers five key emotional risk factors typically found among individuals who are suicidal. He adds that these risk factors are common across all age ranges. One is hopelessness, which might involve a client being unable to see a future. Another is helplessness — a feeling that no one can help and there is no way out. A third is worthlessness, which might encompass a client feeling that he or she isn’t worth saving or that life isn’t worth living. Fourth is loneliness, which isn’t necessarily indicative of a lack of friends or support. Instead, McGlothlin says, a client might feel empty inside, as though something is missing. The fifth emotional risk factor is depression.

To date, research has identified more than 100 risk factors leading to the possibility of suicide, Granello says. Although acknowledging that it is difficult to assign a degree of significance to every factor, she believes certain factors are worth spotlighting. For instance, 90 percent of people who die by suicide have some kind of psychiatric disorder, most commonly depression or bipolar disorder, she says. Additional major risk factors include substance use and abuse, a sense of hopelessness, a rigid cognitive structure leading to poor coping skills or the inability to problem solve, and perfectionism and impulsivity, especially in young people, Granello says. A previous suicide attempt is another major risk factor. However, Granello adds, only about one-third of people who complete suicide have made a previous attempt. “So it’s a good statistic,” she says, “but it doesn’t account for two-thirds of the people.”

That said, Johancen-Walt believes a client’s previous suicide attempt is a risk factor strongly deserving of counselors’ attention. “Edwin Schneidman, a great pioneer in the field of suicide research, wrote about how the ‘unresolved core-wounding’ associated with the previous suicide attempt puts someone at great risk of further attempts or completion. Counselors working with clients who have previously attempted suicide must address the unresolved feelings and thoughts that may have contributed to the original attempt.”

Other risk factors Johancen-Walt cites include history of trauma, untreated depression and anxiety, history of suicide in the family or peer group, substance abuse, other self-harming behaviors and problems with primary support systems. “Risk factors that counselors may not always be aware of include the loss of meaningful relationships and issues related to sexual identity or sexual orientation,” she adds. “Furthermore, a client who is impulsive or has issues with out-of-control rage may also be at risk.”

The most important first step as a counselor in determining suicide risk is to conduct a thorough assessment, according to McGlothlin. Some counselor education programs promote a triage approach to assessment, he says. PIMP (which inquires whether the client has a Plan, the Intent and the Means to complete suicide, and has made Prior attempts) is one example of a suicide-risk screening that can be completed in a matter of minutes. That might be appropriate in a triage situation when a quick assessment is needed, such as in a hospital or an inpatient clinic, but if a counselor is going to see the client more than once, McGlothlin says, a much more thorough assessment should be used.

The “simple steps” model, which McGlothlin created, takes a more global approach and considers life factors, diagnosis and common emotional factors of suicide. McGlothlin’s assessment model is not a one-time approach, he says, but rather a tool counselors can weave into treatment planning. He says his model brings in all the factors of the client’s life and addresses whether those factors equate to a higher potential for suicide.

“Suicide is so complex that if you don’t grab all parts of it, you might be missing something,” McGlothlin says. “And if you’re missing something in the assessment, you might miss it in the treatment. The more thorough your assessment, the more thorough your treatment.” The three foundations of good treatment, he adds, are having a good therapeutic relationship with the client, assessing thoroughly and then following up on any issues that arise.

As for specific treatment modalities that have proved effective, McGlothlin points to person-centered approaches, solution-focused approaches and other models that focus on the counselor/client relationship and keeping clients in the here and now. “Lately, dialectical behavioral therapy has shown promising outcomes in the treatment of suicidal ideation,” McGlothlin adds.

Granello says interventions with a suicidal client are always two-tiered. The first tier involves helping the client through the immediate suicide crisis; the second tier involves addressing whatever issues are underneath. Granello developed a seven-step model for the first tier of intervention, which is aimed at preventing death or injury and restoring the client to a state of equilibrium. The seven steps (each of which involves specific strategies) are assessing lethality, establishing rapport, listening to the story, managing the feelings, exploring alternatives, using behavioral strategies and following up.

Johancen-Walt offers several treatment suggestions to counselors. First, she says, give unconditional acceptance. “Early in treatment, I offer clients my belief that they are doing the best they can to survive painful thoughts and feelings. Suicidal and other self-destructive behaviors serve as coping strategies for many clients desperate for emotional relief. By framing behaviors this way, we can create a therapeutic container absent of judgment while also targeting feelings of shame that may contribute to the isolation many suicidal clients feel.”

Next, ask the client direct questions and create a safe space for talking about feelings, Johancen-Walt says. Also helpful is exploring client supports and resources. “To foster an environment in which change is possible, it is important to help the client identify supportive others in their life while also capitalizing on the client’s inherent strengths,” she says. “For example, through the exploration of how a client may have survived a previous crisis, the counselor can assist the client in creating a list of specific skills and strategies that can help the client survive current challenges.”

Strive to understand the client’s unique experience, she adds, because the client might be more willing to try out new skills and strategies with a counselor who “gets it.” Finally, teach clients effective coping skills. “Many clients engaged in either suicidal or other forms of self-destructive behavior have a limited toolbox of coping strategies,” Johancen-Walt says. “Counselors must offer clients additional tools such as stress management or emotion regulation skills and encourage clients to practice using the skills in between sessions. Time should regularly be spent in session going over coping strategies.”

Simply being open to talk goes a long way toward preventing clients from attempting suicide, Granello says. “The most important thing that we can do with our clients is to let them know that they can talk about suicide and suicidal thoughts,” she says. “Suicidal thoughts are remarkably common. We have to open up the door to let people have the conversation in a safe and healthy way.”

Hope is another key ingredient, Johancen-Walt adds. “We have to hold hope for even the most hopeless of clients. To fully understand our clients, we have to be able to go into the depths of the pit with them. The trick, however, is to be able to climb back out. If you find yourself losing hope for a high-risk client, then consult or seek out supervision. On more than one occasion, I have asked other counselors to come into session with me and my client when I was caught in the pit.”

From the big picture perspective, Granello says making efforts to reduce the stigma attached to mental health issues and suicide is highly important. Granello, whose brother-in-law died by suicide in 1999, wears a suicide survivor pin to encourage conversation about mental health and available help. At the societal level, she says, counselors should take action and advocate for mental health care by working with school boards to implement suicide prevention education, pushing for insurance companies to pay for mental health coverage and making sure colleges with budget strains don’t cut counseling center staff. “As states were cutting budgets for mental health over the last year, ask yourself what you did,” Granello says. “Did you contact your legislators? Write letters to the editor? Get involved with local grassroots efforts? What sort of education and outreach can you provide?”

Suicide in the schools

Schools are in a prime position to address suicide prevention and aftermath because they have ongoing, close contact with students, says David Capuzzi, a past president of ACA and senior faculty associate at Johns Hopkins University’s Department of Counseling and Human Services. “The key to facilitating both prevention and post-vention is to thoroughly prepare all the adults in a school building — teachers, counselors, administrators, janitors, cafeteria workers, secretaries, bus drivers, etc. — to recognize the signs and symptoms, as well as the risk factors, and to know when an immediate referral to the building counselor should be made. All adults in contact with young people in a school can be taught what to look for, what to say and not say to a student they are concerned about and how to facilitate a referral. This can be a powerful way to keep students safe.”

Capuzzi recommends that school counselors trained in suicide prevention go on to provide in-service training for the other adults in their schools. “You can’t start anything until all the adults know what to do,” he says. “You never, never, never go into an auditorium or classroom and start talking about suicide until all the adults are prepared way ahead of time.”

When a counselor identifies a student who may be at risk, an important first step is to conduct a risk assessment interview with specific questions and indicators, Capuzzi says. Without one, he says, a counselor cannot be certain who is truly suicidal. “Counselors have to use their own professional judgment after conducting a risk assessment interview focused on potential suicidality,” says Capuzzi, who is also a professor and core faculty with the Walden University School of Social and Behavioral Sciences. “If there is uncertainty on the part of the counselor, a second assessment should be done by another counselor who has the skills to conduct such an assessment. After that, immediate next steps should be arranged for the purpose of preventing the client from inflicting self-harm.”

The job of the school counselor is to discern whether a student is potentially suicidal and, if so, to make a referral and get help for the student right away. “Children and teenagers often don’t delay their attempts very long,” Capuzzi warns.

Major risk factors for adolescents include psychiatric disorders, poor self-efficacy and problem-solving skills, sexual or physical abuse, concerns over sexual identity or orientation, the easy availability of firearms, substance abuse, exposure to violent rock music and parental divorce, according to Capuzzi. However, an important theory has emerged in the past decade that it may be more effective to increase protective factors in an adolescent’s life rather than trying to reduce the risk factors, says Capuzzi, whose second edition of Suicide Prevention in the Schools: Guidelines for Middle and High School Settings was published by ACA last year.

Among the protective factors that have emerged out of recent research are social network and external support, reasons for living, self-efficacy and self-esteem, emotional well-being and problem-solving skills, Capuzzi says. Knowing about the protective factors may open up opportunities for school counselors to help students. For instance, Capuzzi says, if social networks and external support are helpful, a counselor could help teach a student how to make friends and reach out to people for support. Likewise, a counselor could support a student in improving self-esteem, enhancing problem-solving skills or overcoming depression.

Rather than offering potential techniques for working with adolescents, Capuzzi believes it is more important to challenge school counselors to seek education and supervision regarding suicide prevention and post-vention. Although taking a course is helpful, he says the only way for counselors to develop the necessary skills is to work with an experienced mentor under supervision.

One of the unique aspects of effective suicide prevention in school settings, McGlothlin says, is addressing the developmental issues that invariably arise with students, such as dealing with hormones and adolescents’ desire for admiration from their peers. “As adults, we want to fit in, but it’s not as high on our priority list,” he says. School counselors should make themselves aware of how students interact and which students might feel like outsiders, McGlothlin says. He is careful to note that “outsiders” aren’t the only students at risk for suicide, but being aware of those who don’t appear to have true peer support is important.

In addition to implementing and tailoring a suicide prevention program for their schools, McGlothlin suggests that school counselors take advantage of the opportunities they have to be hands-on with the students. “One of the big issues about school-age suicide is that they become more isolated and, depending on their age, they might not know about the resources out there,” he says. “Having the school counselors out there being visible, talking to kids, showing that they are a resource, that’s a huge factor in school suicide prevention.”

To some degree, suicide prevention in schools begins with the administration, McGlothlin says. Principals and superintendents must realize that suicide is a prevalent issue that needs attention. One of the big myths, he says, is that if no one talks about it, suicides won’t take place. “It’s going to happen whether you talk about it or not,” he insists. “So talk about it.” Having a plan of action for the worst-case scenario is essential, he says, adding that the school counselor needs to understand exactly how the plan would unfold should a suicide occur, including when and how to inform the administration, teachers, students, community and media.

Antistigmatization is a key element in the trainings Granello conducts at schools. Only 25 percent of adolescents report that they would tell an adult if they knew a peer was considering suicide, she says, so teaching students to speak up is important. Granello recalls one student who had a light bulb moment during one of the suicide prevention seminars. “He said, ‘I get it. It’s better to lose a friendship than to lose a friend.'”

Meanwhile, Granello is making suicide prevention a campuswide responsibility at Ohio State, where she is project director of the university’s Campus Suicide Prevention Program, which launched in 2006. The unique program utilizes more than 60 campus “partners,” ranging from administrative and academic departments to student groups and community partners, each of which agrees to incorporate suicide prevention into their work. “It takes the whole idea of suicide prevention away from the sole venue of the counseling center and makes it a shared responsibility of the campus community,” Granello explains.

Training others to act as gatekeepers on college campuses is pivotal, Granello says. “They’re not counselors, but they’re people who have their finger on the pulse of what’s going on.” Gatekeepers can be trained to recognize warning signs and then reach out and ask the student to come with them to get help. “We have to be more proactive about being out in the university, not waiting for people to come to us,” Granello says. She points out that in the past decade, none of the students who died by suicide at Ohio State had been to the counseling center. “They fall under the radar. Counselors can’t wait for them. [That’s why] gatekeepers are important.”

The period after a suicide takes place is a “very dangerous” time in schools, Granello says, because of the possibility of suicide contagion. Granello and her husband were called recently to a small college campus after a student completed suicide. As might be expected, the college community had organized memorial services and candlelight vigils, flown the flag at half-staff and participated in other tributes in the aftermath of the suicide.

“It comes from the heart and comes from the right place, but it’s exactly the wrong thing to do,” Granello says. “They had a copycat suicide a month later. The point is that all of us have to be very careful that we are following empirically validated post-vention procedures, not what we feel we should naturally do. Schools aren’t trying to encourage contagion; they just don’t know.” She emphasizes the importance of following the specific protocols for post-vention procedures put out by the American Association of Suicidology (see “Resources on the Web” below).

Heading off the threat

Assessing for the threat of suicide can be a complex and anxiety-inducing task for any counselor. These experts pooled their knowledge to come up with a list of do’s and don’ts for counselors working with suicidal clients.

DO ask about suicide with all your clients, McGlothlin says. “Sometimes that’s a scary thing to talk about for new counselors … [but] take time to do it.”
DO read all you can on the topic, Capuzzi says.
DO get advanced training in suicide prevention programming, risk assessment and intervention strategies, Granello says.
DO ask why. “It is important to ask clients why they are feeling suicidal instead of only focusing on their behaviors,” Johancen-Walt says. “Many clients may have unresolved feelings surrounding earlier traumas and need to have these issues addressed in treatment. We need to treat the client, not just the symptom.”
DO document. “The more you document, the better,” McGlothlin says. “Document how you assess, how you treat and how you follow up.”
DO ongoing assessment. “Through ongoing assessment, we are able to also highlight our clients’ success while identifying potential roadblocks to recovery,” Johancen-Walt says.
DO get other people involved. “Frame this not as ‘breaking confidentiality’ but as bringing in all possible resources to help keep the client or student alive,” Granello says. “This can actually help facilitate the development of rapport if clients or students believe that you care so much about their well-being that you will do everything in your power to help keep them safe.”
DO work under supervision if you are treating a suicidal client and don’t have the necessary experience, Capuzzi says.
DO realize that the help has to be immediate, Capuzzi says.
DO follow up, McGlothlin says. Asking about suicidal thoughts should not be a one-time thing.
DO know the services available in your school or community to help clients or students who may be suicidal, Granello says. “Have an action plan developed ahead of time for what you will do if someone you are working with is suicidal.”
DO create realistic treatment goals. “It is important that we are helping our clients set themselves up for success in regard to their therapeutic treatment goals,” Johancen-Walt says. “Counselors need to also educate clients about the treatment process in a way that incorporates information about relapse and ongoing commitment to recovery.”
DON’T ever promise someone who is suicidal that you won’t tell anyone else, Capuzzi says.
DON’T lecture, critique or criticize. “It’s futile to get into conversations about blaming clients,” McGlothlin says. “They feel bad enough. They don’t need to hear lectures.”
DON’T be afraid to bring up the topic of suicide. “It will not put the idea in anyone’s head,” Granello says. “There is solid research that talking about suicide, in appropriate ways, actually lowers risk. Don’t wait. Ask the question.”
DON’T work in isolation, Johancen-Walt says. “Whether you are in private practice or part of a team, it is important for counselors to seek ongoing consultation with other practitioners and to create treatment teams that include psychiatrists, medical and mental health professionals, family members, teachers, coaches, etc.”
DON’T assume that suicide is about death, Granello says. “In fact, most people who are suicidal are ambivalent. They don’t want to die; they just want the unbearable pain to end. As counselors, we can use that ambivalence to help keep them alive.”
DON’T leave a potentially suicidal person alone, even for a moment, Granello says.
DON’T assume that someone else in your community, organization, agency or school will take responsibility for suicide prevention programming and awareness. Step up and get involved.
DON’T give up, Johancen-Walt says. “It is important always to communicate to our clients that their lives are worth saving, even if they do not believe it in a painful moment. We can hold hope for our clients until they are ready to hold it for themselves.”

All recommendations aside, Johancen-Walt says it is important to remember that both the counselor and the client share responsibility in preventing suicide. “As a counselor and also as a survivor of suicide, I believe that if a client has committed suicide, it is important to look at our responsibility as mental health providers and as a larger community that strives to prevent suicide. Through this process, I believe we may find opportunity to strengthen our prevention efforts.”

But no less important, she adds, is the subsequent ability to let it go. “In fact,” Johancen-Walt says, “I routinely tell counselors that they will not last in this field if they are not able to ultimately give responsibility for the client’s life back to the client.”

Granello echoes these thoughts, saying people are responsible for their own choices, and counselors shouldn’t try to carry that burden for others. But at the same time, she adds, if counselors know how to help, they should try. “Suicide is the most preventable type of death,” she says. “We can do a heck of a lot better than 34,000 a year.”

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Letters to the editor: ct@counseling.org.

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Myths surrounding suicide

The following list is adapted from Jason McGlothlin’s book, Developing Clinical Skills in Suicide Assessment, Prevention and Treatment.

Myth: The suicidal person wants to die and feels there is no turning back.
Fact: Suicidal people are usually ambivalent about dying and frequently will seek help immediately after attempting to harm themselves.

Myth: All suicidal people are deeply depressed.
Fact: Although depression is often closely associated with suicidal feelings, not all people who kill themselves are obviously depressed. Ironically, some suicidal people appear to be happier than they’ve been in years because they have decided to “resolve” all of their problems by killing themselves.

Myth: Most elderly people who die by suicide are terminally ill.
Fact: Most elderly people who die by suicide are not diagnosed with a terminal illness. More often, they are suffering from depression and sometimes experience somatic symptoms related to depression.

Myth: Suicide is very common among individuals in lower economic classes.
Fact: Suicide crosses all socioeconomic distinctions; no one class is more susceptible to it than another.

Myth: Suicide is a problem that is limited to the young.
Fact: Suicide rates rise with age and reach their highest levels among White males in their 70s and 80s.

Myth: Suicidal people rarely seek medical attention.
Fact: Research has consistently shown that about 75 percent of suicidal people will visit a physician within one month before they kill themselves.

Darcy Haag Granello also provided some common misconceptions about suicide during an interview with Counseling Today.

Myth: Suicidal people keep their plans to themselves.
Fact: More than 90 percent of people who die by suicide show clear warning signs; more than 70 percent (more than 80 percent of adolescents) tell someone they are planning to kill themselves.

Myth: Asking someone if they are suicidal will put the idea in their head.
Fact: A direct and caring approach to asking the question lowers suicide risk.

Myth: People who talk about suicide don’t actually plan to do it; they are just seeking attention.
Fact: Talking about or threatening suicide is a significant risk factor. Most people who die by suicide tell someone else they are planning to kill themselves. Counselors must take all suicide threats and behaviors seriously.

Myth: Suicidal thoughts are relatively rare.
Fact: Each year in the United States, approximately 8.3 million adults (nearly 4 percent of the population) seriously consider suicide; about 1 percent make a suicide plan, and about half of those individuals attempt suicide.

— Lynne Shallcross

Resources on the Web

School-based Prevention Guide: theguide.fmhi.usf.edu (A resource with free checklists, programs and resources for schools)
American Association of Suicidology: suicidology.org (Up-to-date information, professional conferences and suicide research)
Suicide Prevention Resource Center: sprc.org (Resources, magnets, posters, fact sheets and other information)
American Foundation for Suicide Prevention: afsp.org (Research, education about suicide and mood disorders, policy promotion)
NotMyKid.org (sponsored by the American Association of Suicidology) (Information for parents and resources for families)
National Institute of Mental Health: nimh.nih.org (Research and professional information)
Suicide Prevention Advocacy Network: spanusa.org (National hotline, public policy)
Substance Abuse and Mental Health Services Administration: samhsa.org (Grant opportunities, best practice guidelines, research dissemination)

ACA resources

Suicide Across the Life Span: Implications for Counselors (order #72807), edited by David Capuzzi, offers detailed information on topics such as identifying the risk factors for suicide, suicide assessment, ethical and legal considerations, and counseling techniques for work with children, adolescents, adults, and survivors and their families ($35.95 for ACA members; $56.95 for nonmembers).
The second edition of Suicide Prevention in the Schools: Guidelines for Middle and High School Settings (order #72884) by David Capuzzi includes a step-by-step framework of essential information for school counselors, administrators and faculty ($24.95 for ACA members; $29.95 for nonmembers).
Developing Clinical Skills in Suicide Assessment, Prevention and Treatment (order #72861) by Jason M. McGlothlin covers assessment interviews, legal and ethical issues, case examples, discussion questions and much more ($33.95 for ACA members; $49.95 for nonmembers).
Suicide Assessment and Prevention (order #78217) is an hourlong DVD presentation by John S. Westefeld that includes the latest data on suicide and suicide prevention and covers how to assess for suicide risk and how to conduct a suicide intervention ($149 for ACA members and nonmembers; produced by Microtraining Associates Inc.).

All three books and the DVD can be ordered directly through the ACA online bookstore at counseling.org/publications or by calling 800.422.2648 ext. 222.

“Suicide Assessment: Sharpen Your Clinical Skills” is a 47-minute podcast featuring Jason McGlothlin. He addresses questions about how to conduct a suicide assessment face-to-face; differences between assessing children, adults, older adults and families; and some of the issues of treatment planning with suicidal clients. To access this podcast, visit the ACA website at counseling.org

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