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.”
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.
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?
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.
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.