59
J. F. Roush et al., Mental Health Professionals’ Suicide Risk Assessment and Management Practices
Table 4. Frequencies: “On all first visits with new patients, I:” Response option
Yes
Routinely ask every patient about current, recent, or remote suicidal thoughts or behaviors (evidence-based practice)
No
199 (68.9)
90 (31.1)
Ask about current, recent, or remote suicidal thoughts and behaviors only with my most distressed patients, e.g., estimated GAF of 50 or lower and suicide warning signs are present
38 (13.1)
251 (86.9)
Only ask about current, recent, or remote suicidal thoughts and behaviors when the patient broaches the subject
12 (4.2)
277 (95.8)
Routinely do not ask any patients about suicidal thoughts and behaviors
11 (3.8)
278 (96.2)
Note. Percentage of sample appears in parentheses. The sum of percentages for endorsement of a response does not equal 100% because of missing data.
Table 5. Frequencies: “In actual practice, when I learn that a new patient is actively thinking about suicide, but has not yet made an attempt, I:” Response option
Yes
No
This has never happened to me
11 (3.8)
278 (96.2)
Immediately contact mental health authorities for further evaluationa
19 (6.6)
270 (93.4)
Depending on the quality of the therapeutic relationship established, continue to see the patient
128 (44.3)
161 (55.7)
Provide the patient with a crisis line number in case the crisis worsens
184 (63.7)
105 (36.3)
Ask for signed permission to speak with significant others
116 (40.1)
173 (59.9)
Conduct a suicide risk assessment and adjust my treatment plan accordingly (e.g., increase visits, speak to family)
223 (77.2)
66 (22.8)
Depending on the quality of the therapeutic relationship, develop a collaborative patient-safety/ crisis response plan and negotiate a treatment plan that matches the level of assessed risk
196 (67.8)
93 (32.2)
Conduct a means restriction counseling session, with family included if available
98 (33.9)
191 (66.1)
Refer the patient to a psychiatrist for evaluation and continue treatment as indicated
79 (27.3)
210 (72.7)
Immediately refer the patient to a hospital emergency room for an evaluation
22 (7.6)
267 (92.4)
Immediately refer the patient to an inpatient psychiatric unit
11 (3.8)
278 (96.2)
Arrange for the patient to see a trusted nonpsychiatrist colleague for a second opinion
10 (3.5)
279 (96.5)
Refer the patient to nonpsychiatrist physician for a medication evaluation
23 (8.0)
266 (92.0)
Make sure I get a signed no-suicide contract in the medical record
64 (22.1)
225 (77.9)
Immediately refer the patient to a state-licensed mental health agency
10 (3.5)
279 (96.5)
Evidence-based practices
Non-evidence-based practices
Note. Percentage of sample appears in parentheses. a This practice was not coded because there are cases in which it would be considered evidence-based and appropriate practice (e.g., in the case of a supervised mental health professional), whereas in other cases it would be inappropriate (e.g., in the case of a licensed independent mental health professional).
conducted again. This produced standardized effect sizes (i.e., standardized odds ratios), which can be more directly compared because they are based on a z-score scale.
Results Descriptive statistics and correlations are presented in Table 1. Average fear of various clinical situations is presented in Table 2, and comfort working with different clinical diagnoses and issues is presented in Table 3. Of note, patient death by suicide was the most highly rated fear, fol© 2017 Hogrefe Publishing
lowed by patient suicide attempt. However, respondents reported feeling more comfortable working with suicide risk as a clinical issue than many other diagnoses and issues. Frequencies for various suicide risk assessment and management practices are presented in Tables 4–6; Table 4 reflects practices conducted at the first appointment with new patients, Table 5 provides information about practices with patients endorsing suicide ideation (EBAM difference score M = 3.15, SD = 2.15), and Table 6 presents frequencies for practices with patients reporting a recent suicide attempt (EBAM difference score M = 2.84, SD = 1.98). Only 68.9% of the sample reported routinely asking every patient about suicide ideation at a first appointment. AddiCrisis (2018), 39(1), 55–64