A couple of days ago I spent several hours talking with an old colleague and friend who is a senior nurse educator discussing how we – anyone – can crack the code to get suicide prevention training into the 2,500 or so nursing schools in the United States.
We reluctantly concluded that it can’t be done.
Currently, the vast majority of nursing schools teach nothing, or next to nothing, about suicide prevention, either as a major preventable public health problem, or as a clinical care skill set in assessment, treatment, and management. One major school shared its curriculum with me – 10 slides total taught as part of a single class, eight of which contained errors of fact, all dated. Some slides had bell bottoms on them.
At the end of our discussion, we concluded that we can’t crack the code to get suicide prevention training into nursing schools or, for that matter, medical schools, or even psychology, social work and counseling graduate training programs.
The walls of resistance are too high, too strong, a walled fortress.
Against a fixed belief system, Galileo was likewise frustrated.
On the topic of suicide it is easier to get a meeting with the Pope than a dean of nursing, or any other dean responsible for pedagogy.
Trying to get a suicide prevention curriculum across the mote and into the fortress requires not only a secret password to lower the draw bridge, but a fierce persistence.
I know. I’ve tried. For more than 25 years. I have a flat spot on my forehead from using my noggin as a battering ram.
For your review, I have collected the classic excuses from schools of nursing, social work, community colleges training counselors of various kinds, chairs of psychology departments and others. These are stones in the status quo wall of resistance.
“Yes it’s important, but, sorry, the curriculum is full.”
“The dean is not interested.”
“Not our job.”
“Students are already slammed.”
“No one here teaches suicide prevention.”
“We cover it in one of our classes, I think.”
“They learn that on their practicum placement.”
“I think we had an adjunct that taught that stuff a few years ago.”
“Not to worry, they will learn what they need on internship.”
“This subject does not fit into our four domains of required knowledge for a degree.”
Result?
This year we will graduate thousands upon thousands of healthcare providers with almost zero information, knowledge, or skills in how to help the suicidal patients they will surely encounter in their offices, emergency departments, or as counselors or home health consultants.
How are we to implement the 2012 National Strategy for Suicide Prevention in this educational blackout?
I don’t know what to call it. Willful blindness? Deliberate indifference? Simple ignorance? Bone stupidity? Benign neglect?
Or is it simply ego? As in, the professor teaches what the professor enjoys teaching – student real-world training needs be damned.
Had I not supported early career graduates from a variety of professions who lost a patient to suicide while still learning the therapy trade (it’s a major trauma, period, and too often career ending), I would not be so ticked off about this failure to teach what has been recommended for more than a decade by such shady operators like the Institute of Medicine.
We are sending baby therapists to the front to fight death by suicide with BB guns.
There are glimmers of light , e.g., University of Washington School of Social Work, and a few others. But all across the academic landscape we see few new shoots of hope that one day soon graduates will have both the knowledge and skill to support an unencumbered, non-stigmatized, compassionate view of what it is like for their patients to so suffer as to wish to be dead.
Today, they are not trained – or even exposed – to a curriculum which has any chance at all of preparing for what lies ahead.
The upshot of this continuing filibuster of excuses by academics is that thousands upon thousands of graduating nurses, social workers, psychologists, physicians, PAs, counselors, chiropractors and a half dozen other healthcare professionals will enter their respective fields this year with a baseline of suicide knowledge so low as to be professionally embarrassing.
There is an old saw in medicine, “You can’t treat what you don’t know.”
Of the expected 40-plus thousand who will die by suicide in America in 2015, somewhere between 20 and 40 percent will die “unexpectedly” while in active or recent care of healthcare professional.
Unexpectedly?
Really?
Did you not ask your sick, depressed, alcohol-dependent, frightened, in-crisis, overdosed, recently-diagnosed-with-cancer or schizophrenia or bi-polar disorder patient, or about-to-flunk-college-due-to-anxiety-attacks student, if they were having any thoughts of self-destruction, and if you could talk about it with them?
No?
And now you are “surprised” they killed themselves?
No one taught you the warning signs?
No one taught you about the etiology of suicidal pain? About its neurochemistry? About being unable to sleep because suicidal thoughts are pounding in your head? About its prevalence in the very patients you see? About evidence-based effective treatments?
And now they are dead.
No one told you should ask?
No one told you had to ask?
No one trained you in how to ask?
With suicide taking more lives than car crashes in America, shame on someone whose address is somewhere on Ivory Tower Lane.
If you are a student in training to become a healthcare professional I invite you to start a revolution. Disturb the comfortable. Pole vault over the moat and scale the walls.
Say, “My! The emperor appears to be naked.”
Then ask the dean of your college, “Why am I not being taught how to prevent suicide, and how to detect, assess, treat, and manage suicide risk in the patients I will be responsible for when I graduate?”
And, “If a patient of mine dies by suicide and I am sued, shall I sue you for negligence in preparing me for my chosen profession?”
Don’t pause, don’t wonder, don’t defer to the grownups training you, just ask a simple question, “When will I learn about suicide and how to prevent it?”
Personal note. Sometimes when I wake up in the morning I am totally disappointed in one half of the human race. But by midday, I can’t remember which half. By evening I am typically on a rant at one bunch or the other, and this post is just one more joust at the windmill.
Dr. Paul
P.S. Please visit our new website at www.qprinstitute.com and see our new QPR for Vets online course. In an earlier post I ranted about veteran suicide; now our team has done something. If you know someone working with vets, we’re happy to comp them into the course to kick the tires for possible adoption.
Your comments are welcome.
onsuicide 
Okay Paul, I am convicted, so I will ask the Dean of our College of Health here at UAA, of which I am a staff member. The timing is good, since I just passed the training to become an Advanced Trainer for QPRT. Thanks for the challenge!
Dear Dr Paul,
I love your rants….
Robin Ball invited me to Dallas later this month (talk about a dream vacation!) to talk about the Gun Shop Project with 30 large gun retailers from across the country. I am excited – and intimidated – by the opportunity.
Would love to speak to you – if you are willing – about zero suicide, my complicated cousin’s suicide death this past April, guns, etc. Let me know if/when you would be willing to chat.
Best regards to you and to Pam.
Hope you are spending most of your time on the St Joe!!
Elaine
________________________________
Thanks, Elaine. The new course for vets includes your CALM module per our earlier work. I’ll back channel you on your request. Yes, spending time on river. Where else?
It is ignorance on the part of the schools, We have several nurses who come to our support group to understand how survivors feel. At least that is a start-a small one but a beginning!
Hi Paul,
You write:
“At the end of our discussion, we concluded that we can’t crack the code to get suicide prevention training into nursing schools or, for that matter, medical schools, or even psychology, social work and counseling graduate training programs.
The walls of resistance are too high, too strong, a walled fortress.”
You are not alone in your conclusion. But I am curious about the “walls of resistance” and what is being “walled” off and what is being “walled” in and by whom?
A “wall” has a couple of interesting definitions – “an enclosure that protects” and “a structure that holds back pressure.”
So, again I am curious when we are talking about suicide education, what is it we need “protection” from and where is the “pressure” coming from, and who is being threatened so that the “wall of resistance” needs to be in place at all.
Why is it we need to “resist” help?
It makes me think about the familiar adage: “It is not that they don’t know the solution, it is that they don’t know the problem.”
More questions than answers.
Maybe a Trojan Horse is needed.
Keep up the good work!
BTW: you and I shared the same stage at Croke Park in Dublin at the World Suicide Prevention Day Conference where we both gave keynote addresses — but were both separated by a calendar year — 2013-2014!
Talk about a parallel universe!
It would be fun to compare notes sometime and to also put our heads together to address the above issue from as many different perspectives as can be possibly imagined.
For if this “wall of resistance” is indeed reality, I believe it was John Lennon who said: “Reality leaves a lot to the imagination.”
Thanks for what you write each time!
I received this thoughtful and welcome email from a nurse educator in Montana and sought permission to publish here.
Greetings Paul,
I received your informative blog regarding the unfortunate deficit of suicide prevention education in nursing schools across the country. Indeed, the literature is replete with the lack of such education and training among the various healthcare professional curricula. Please allow me to update you regarding our efforts at Montana State University College of Nursing.
About four years ago now, Dr. Fredricka Gilje and myself began integrating QPR Gatekeeper Training into a senior baccalaureate nursing course. Our students have consistently reported in the accompanying QPR pre- and post-training surveys an increase in knowledge base about suicide prevention, improved perceived skill in suicide risk assessments, as well as a positive change in attitude toward suicidal persons. The QPR course has been so well received that we decided to approach our dean, Dr. Helen Melland, about expanding such training to our students on other campuses as well as offering training to College of Nursing faculty and staff. Dr. Melland readily agreed and has been very supportive of this effort.
We now have QPR instructors located not only on the Billings campus but also Bozeman and Great Falls. QPR instructors there are integrating this content into their respective courses, including graduate students in our doctorate in nursing practice program. We now have more than 60 College of Nursing faculty and staff trained as gatekeepers.
I feel this is only the beginning. We will continue to promote suicide prevention education and training in our nursing courses. At some point, Dr. Gilje and I would so enjoy visiting with you in Spokane. We would like to discuss our vision for greater integration of suicide prevention education in nursing.
Warm regards, Julie
Julie Pullen DNP, GNP, NP-C
Geriatric Nurse Practitioner
Associate Clinical Professor
Montana State University
College of Nursing
1500 University Drive
Apsaruke Hall
Billings, MT 59101
This post definitely has some scary information, but I’m very pleased that I read it.
I came to this site while trying to find a way to contact you with a story that started in 2005. That year I read an article about “cutting” among Ivy League students. Before then I didn’t know about self-mutilation. Once I did, I needed to understand why young, intelligent and successful kids would cut or burn themselves–and in some cases, go beyond self-harm and take their own lives. I started looking for the answer to my question, and I found your book, Suicide: The Forever Decision. After reading it, I wrote a young adult novel called Sliding on the Edge, basing many scenes on what I learned from my research, but primarily from your book.
After my book was published in 2009, I received letters from readers, expressing their thanks. They could relate to the girl in the story and that, they said, helped them. Then, just last month, a girl contacted me to say she’d read Sliding on the Edge several times. This girl, it turns out, was not only cutting, but considering suicide. She was fortunate enough to have help from her school counselor who stepped in to advocate for psychiatric evaluation. I gave your book to the parents and they in turn bought more copies because it helped them through this very difficult time and they wanted to share that help.
I just wanted to tell you how much your book has meant to me, and now to others through the research I did using your work. Sorry for such a long comment, but I’ve been wanting to tell you this for a while, and this seemed the best way.
Thank you for this comment and post. And keep up the good work writing! The Forever Decision has been widely read and has done a bit good in the world perhaps. It is available in several languages now and is free as iPhone app in English and Spanish, or as a PDF download from our website at http://www.qprinstitute.com.
I wish the training deficit were not the problem it is for those at risk, but even today I learned that in both Kentucky and Colorado the state psychological associations are either attempting to gut existing laws to avoid needed training or are resisting their passage. The California Psychological Association demanded that Governor Brown veto a mandatory suicide prevention training bill in a state that loses roughly 3,000 people a year to suicide, or the equivalent of 9/11 every single year.
I may post what are are surely unwelcome letters I’ve been writing to psychological membership associations who are attempting to avoid mandatory training in the life-saving knowledge and skills they need to help people just like the girl you described. They’ve had more than a decade to get trained. They haven’t. Worse, they don’t know what they don’t know and they are too proud to ask.
Here’s a compelling read on the problem from the Denver Magazine today: http://www.5280.com/suicideprevention?page=2