Psychologists’ Practices, Training, and Experiences Conducting Suicide Risk Assessment in Canada: An Explanatory Sequential Mixed Methods Study
Creators: Dubue, Jonathan
Publisher: name: University of Alberta Library
Year: 2023

<p>Over the last 10 years, suicide prevention best practices have changed. We have learned that suicide cannot be reliably predicted, that hospitalizations for acute suicidality are harmful, and treating suicidal behaviours only has a small effect size. As a result, collaborative and humanistic models of suicide risk assessment (SRA) are indicated, with a priority on understanding and treating the idiographic drivers of the client’s suicidality. Understanding if these changes have been incorporated into psychologists’ practice is essential, given SRA training has historically taught information-focused and risk-based assessments, where prediction was prioritized over prevention. </p>

<p>The purpose of this study was to understand how, or if, psychologists in Canada have been incorporating this information into their practice, as well as more broadly understanding how they learn and experience the process of suicide risk assessment (SRA). To do this, I used a sequential explanatory mixed methods approach, which integrates both quantitative and qualitative methods to explore and explain research findings. One-hundred and sixty psychologists completed a survey on their SRA practices, training, and experiences, and I conducted nine follow-up interviews asking them to elaborate and explain their survey answers. The survey results were analyzed using descriptive statistics whereas the interview results were analyzed with a co-investigator using both Thematic Analysis (bottom-up) and Rapid Assessment Process (top-down). Together, we integrated both the quantitative and qualitative strands into conclusions that answered our main research questions: How do psychologists in Canada (a) practice, (b) learn, and (c) experience SRA, as well as (d) how do the interviews explain the survey results?</p>

<p>Regarding (a) SRA practice, psychologists in Canada conduct idiosyncratically structured and risk focused SRAs, where their priority is ensuring their client’s safety. These SRAs are a medley of practices they’ve acquired throughout their training and experiences, with the heaviest influence coming from their practicum or internship supervisors. Those who use standardized SRAs usually do so because of work or institutional requirements, whereas those who use personalized SRAs believe standardized SRAs disrupt the therapeutic relationship. Psychologists are confident in their SRA practices, identifying that this process took years of post-graduate experience. They also understand hospitalization as a harmful last resort but will not hesitate to make a confidentiality- or alliance-breaking referral if it means keeping their client safe. Regarding learning SRA, (b) psychologists resoundingly report their graduate SRA training was insufficient and inefficient, as the lack of practicable and experiential training limited their confidence and competence when working with suicidal clients. As such, psychologists support SRA and crisis management as a core competency in graduate training. Concerning (c) SRA experiences, psychologists understand suicidality is a psychosocial issue, typically resulting in the hopeless belief that the pain will never end, yet, more than half of psychologists do not ask about what drives their client’s suicidal ideation. Psychologists reported that working with a suicidal client is more stressful than working with others because of the conflict between feeling responsible for their safety and maintaining their clients’ autonomy and dignity. Accordingly, most psychologists fear the legal or professional consequences of an improper SRA and use SRAs to mitigate their legal vulnerability. The (d) interviews explained several of the survey results, resulting in these integrated findings.</p>

<p>This broad and deep understanding of psychologists’ SRA practices, training, and experiences offers critical insights into how we can implement findings from the last 10 years into routine care. This includes promoting collaborative and therapeutic SRAs in practice, incorporating experiential graduate training, focusing on training supervisors to teach SRA, and integrating suicide prevention as a core competency for CPA-accredited programs. Other implications for practice, training, and policy are discussed, including future directions and limitations.</p>