Board-certified psychologists represent a model of excellence in clinical assessment and care for our profession across various specialty domains. Suicide risk assessment and management is necessary across all clinical assessment and care domains and is the area of focus for this brief article. We describe current societal trends in suicide behavior, highlight the current status of suicide risk education in doctoral-level psychology education programs, offer suggestions for how psychologists can specifically and positively impact suicide risk assessment and management for their patient populations, and conclude with recommended changes in policy and training for ABPP specialty boards to integrate suicide risk assessment and management procedures with applications and examinations.
Societal Trends and Vulnerable Populations
It is sobering that a person dies by suicide every 11 minutes in the United States (CDC, 2024). The CDC reported that over 49,000 individuals died intentionally by suicide in 2022. This equates to about 14.2 deaths per 100,000 persons, which was a return to a peak level of deaths by suicide since the year 2000. While there had been an initial decline in the rates of suicide deaths in 2019 and 2020, in subsequent years, the rate again resumed a continuous increase (CDC, 2024). Those at greatest risk include individuals who are Non-Hispanic American Indian and Alaskan Native (27.1/100,000 people), males (23.0/100,000 people), and older adults over 84 years (23/1000,000 people) or between 75-84 years (20.3/100,000 people). Firearms continue to be the most frequent method of suicide, accounting for nearly 55% of deaths by suicides (CDC, 2024). Understanding that suicide prevalence is on the rise in society, it is imperative that our doctoral psychology education programs provide sufficient training and education in suicide risk assessment and management and that psychologists are prepared to competently respond to such risk as it arises in their clinical practice.
Current Doctoral Education of Psychology Students
Importantly, doctoral psychology graduate programs now provide expanded education in suicide risk assessment and management than in previous national surveys. At the same time, the vast majority of recent and historical studies/surveys on the topic suggest that doctoral psychology students would benefit from more substantial efforts to provide education in suicide risk assessment and management. A recent study by Kleespies and colleagues (2023) of US-based APA-accredited doctoral programs revealed that only 15.3% provided a course on suicide risk, even though the graduate program directors believed training in suicide risk assessment to be very important. While most programs indicated that they provided some type of education in suicide risk (88%), only about 60% provided education in suicide risk assessment and safety planning. This suggests that students may not be fully prepared for internship training to care for individuals at elevated acute and chronic suicide risk. Notably, most internship training directors (96.5%) report training interns in suicide risk assessment and management. While varied components of training were emphasized, not all programs reported training in suicide risk screening, safety planning, or means restriction, all of which are known to be important in preventing and managing future suicidal behavior. Previous studies noted that only 40-55% of psychologists received suicide risk assessment and management training during graduate school or internship training about 30 years ago (Bongar & Harmatz, 1989, 1991; Kleespies et al., 1993). Therefore, there have been substantial improvements in educational efforts. Nonetheless, many concur that the education on risk identification and management from that time to the present remains insufficient to address the public health crisis of suicide in our society (Kleespies et al., 2023).
There are many opportunities to expand doctoral-level education on suicide risk assessment and management. At the board certification level (ABPP), there are several ways this may be addressed and we provide some practical recommendations below.
Board-Certified Psychologists Provide Suicide Prevention and Management
Board-certified psychologists prevent and manage suicidal thinking and behavior among individuals who are at increased risk. It is essential that individuals who are in the care of a psychologist are provided with high-quality, evidence-based assessment and treatment of suicidality as well as factors that are associated with increasing risk for suicidal behavior, such as major mood disorders and serious mental illnesses. Board-certified psychologists, who are preeminent in their sophistication of clinical skills, may serve to advocate for expanded education associated with suicide risk management.
Board-certified psychologists across specialties provide assessment and treatment for numerous communities of individuals who are at increased risk of suicidal thinking and behavior (Note: Specific examples of related specialties are noted below for each finding). Persons who may be at increased risk include sexual and gender-diverse youth (Duffy et al., 2024; Clinical Child and Adolescent Psychology), individuals with serious mental illness (Bai et al., 2021; Trott et al., 2024; Serious Mental Illness), individuals with major mood disorders (Arnone et al., 2024; Clinical Psychology), and those with substance use disorders (Isaacs et al., 2022; Lange et al., 2024; Addiction Psychology). Neurological issues, including traumatic brain injuries and degenerative neurocognitive disorders, have also been linked to an increased risk of suicidal thinking and behavior (Chen et al., 2022; Talaslahti et al., 2024; Clinical Neuropsychology). Suicidality, encompassing ideations and behaviors, is also a notable issue for children, especially young Black boys (Mintz et al., 2024; Counseling Psychology). Additionally, there are occupational risk factors for suicidality among first responders, including police and firefighter personnel who experience greater exposure to trauma (Syed et al., 2020; Vigil et al., 2021; Police and Public Safety Psychology). Suicide impacts couples and families, whereby survivors of suicide may experience substantial negative impacts on their mental health. These include family members such as children, siblings, parents, and spouses (Jang et al., 2020; Wilson et al., 2022; Couple and Family Psychology).
Opportunities for ABPP Specialty Boards
Board-certified psychologists provide high-quality psychological services through numerous specialty distinctions and qualifications. There are many ways in which specialty boards may consider opportunities to address to the importance of suicide risk assessment and management within their membership. A common thread across specialty boards includes the possible options of addressing this domain within eligibility qualifications, practice samples, and oral examination. For example, specialty boards may elect to provide examples of how clinical expertise and practice sample videos or written materials could attend to competence in suicide. Oral examinations provide examiners with the option of inquiring about experiences with attending to the suicide risk of individuals in the clinician’s care. Oral examination ethical vignettes may also include suicide risk assessment and management components as written or alterations to a written vignette for a candidate to consider. These can provide a unique opportunity for the candidate to discuss the nuances of managing suicidality, which can demonstrate their sophistication with various APA ethical code standards associated with competence, privacy and confidentiality, assessment, and therapy (APA, 2017). Applicant understanding of relevant laws associated with acute suicide emergencies is another option for specialty boards to consider. For example, candidates could be expected to be clear about their legal duties and responsibilities concerning suicide emergencies and their state’s licensing board requirements. While it is understood that suicide risk assessment and management may not be a domain that all candidates identify with as experts, establishing that the Board-certified candidate meets expectations to protect the public and demonstrate the highest level of clinical expertise is of utmost value.
Summary
Suicide continues to be a leading cause of death in our society. Over the past 30 years, there have been incremental improvements in the education and training of psychologists in suicide risk assessment and management according to recent surveys. Currently, the American Psychological Association (APA) does not provide concrete guidelines or educational competency expectations related to suicide and violence risk assessment and management. To improve professional competence regarding suicide risk assessment and management, the development of professional standards for education and training are highly recommended. Board-certified psychologists provide psychological services to many subpopulations that are at an increased risk of suicide and are, therefore, in a vital position to pursue continuing education to provide high-quality services within their specialties. Many opportunities exist within the specialty boards in evaluating candidates to determine expertise in suicide risk assessment and management to protect the public and maintain a high standard of excellence as a psychologist.
Education and Professional Practice Recommendations
Psychologists are encouraged to consider the following recommendations to promote lifelong competence in suicide risk assessment and management for doctoral graduate programs, doctoral clinical training sites, licensed psychologists and ABPP specialty boards:
- Doctoral Graduate Programs: Consider adding a graduate level course on behavioral emergencies that include a focus on suicide risk assessment and management. Expansion of existing course offerings that dedicate a course to this topic would highlight the value of not only understanding the current literature but also evidence-based interventions that target suicidality.
- Doctoral Clinical Training Sites: Integrate opportunities for doctoral students to provide assessment and treatment of individuals who experience suicidal thinking and behavior. Providing high-quality supervision associated with access to individuals who experience such behavioral emergencies will promote clinical practice competency development.
- Licensed Psychologists: Maintain competence in suicide risk assessment and management through continuing education activities and programs. For example, there are many online programs available through APA (Clay, 2022; APA, 2024) and recent work published in On Board with Professional Psychology (Jobes, 2024).
- ABPP Specialty Boards: Determine ways to integrate attention to suicide-related content as applicable to the individual specialty board and through various steps of the application and oral examination process.
References
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Christopher G. AhnAllen, PhD, ABSMIP
Board Certified in Serious Mental Illness Psychology
Correspondence: cahnallen@bwh.harvard.edu
Lisa M. Brown, PhD, ABPP
Board Certified in Geropsychology
Correspondence: lbrown@paloaltou.edu
Phillip M. Kleespies, PhD, ABPP
Board Certified in Clinical Psychology
Correspondence: kleespies@aol.com
Colin Simsarian, MA, MS
Correspondence: csimsarian@paloaltou.edu
Brenda Hammond, MS
Correspondence: bhammond@paloaltou.edu
Bruce Bongar, PhD, ABPP
Board Certified in Couple and Family Psychology
Correspondence: bbongar@paloaltou.edu