Behavioral Health Counselors

Behavioral Health Counselors

As service providers, behavioral health counselors often come into contact with persons at-risk of suicide. There are training tools available to help the behavioral health provider to feel more confident in their ability to assist a person at-risk. There are online versions for some of these training tools.

Question, Persuade, Refer, Treat (QPRT)

The QPRT Suicide Risk Management Inventory was developed to help professionals who assist, evaluate, manage, counsel or treat persons at-risk of suicide, better assess and monitor those at elevated risk for suicidal behaviors.

The QPRT is a risk detection, risk assessment and risk management tool uniquely designed to gather critical, standardized information about a person’s status in an intake, screening or interview setting, while simultaneously establishing a safety plan for those determined to be at risk.

The Helpline Center has a certified QPRT instructor that can provide training on implementing the Suicide Risk Management Inventory.

Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals (AMSR)

Outpatient behavioral health providers play a crucial role in preventing suicides. Studies have shown that a substantial proportion of people who died by suicide had either been in treatment or had some recent contact with a mental health professional. Yet many providers report that they feel inadequately trained to assess, treat, and manage suicidal patients or clients.
Assessing & Managing Suicide Risk: Core Competencies for Mental Health Professionals meets providers’ need for research-informed, skills-based training.

AMSR is a one-day training for mental health professionals, including:

  • Social workers
  • Licensed counselor
  • Psychologist
  • Psychiatrists

6.5 continuing education credits are available from NASW, NBCC, APA and Continuing Medical Education Credits (CME).

Recognizing and Responding to Suicide Risk (RRSR) Online Training through American Association of Suicidology

Recognizing and Responding to Suicide Risk: Essential Skills for Clinicians (RRSR) is an advanced, interactive training based on established core competencies that mental health professionals need in order to effectively assess and manage suicide risk.

The program includes:

The 13 Ws for Rapid Suicide Risk Assessment

The following approach to suicide risk assessment focuses on the idea that a good, emphatic interview which elicits the client’s story—from the idea of suicide as a solution to suffering to the present moment in time—lowers anxiety, reduces isolation, facilitates contentedness between the listener and the person at risk, and therefore lowers immediate and future risk of suicide.

The 13 Ws approach focuses on getting the person’s story, and telling one’s story is therapeutic.

Keep your questions short and ask:

  1. What’s Wrong? This question will elicit the client’s version of the problem (the only version that really matters).
  2. Who’s Involved? Since most suicidal crises involve conflict with another person, this question will often be answered in the first question above. Sometimes a good question to find out who is in the conflict is to ask, “Who will find you if you kill yourself?”
  3. Who Else Knows? This question is asked to find out if others are involved, including a possible suicide pact, or if someone else knows the client is suicidal. This person may be an ally or an enemy to reducing risk, and the interviewer must know the lay of the interpersonal ground to be effective.
  4. Why Now? Things may have been bad for a long time; the answer to this question should elicit the precipitating crisis, loss, event, or rejection.
  5. With What? The answer here can vary from “I haven’t decided yet” (low lethality) to, “My father’s 44 magnum.” The more lethal the means under consideration, the higher the risk. Access to the means selected must be determined at this time.
  6. Where? Specificity of location to carry out the act means higher risk (the planning has been done and a place has been chosen).
  7. When? Again, a specific time means increased risk. Often, the answer to “When?” may involve the action of a third party (under “Who?” above). A contingency-based suicide plan is very dangerous because neither the client nor the interviewer is entirely in charge of third party action.
  8. When in the Past? It is important to find out if the client has been suicidal in the past, or even made a suicide attempt in the past. This is often forgotten in routine interviews and, yet, the best predictor of future behavior is past behavior.
  9. Why in the Past? This question may yield a pattern of precipitants/conflicts which lead to suicidal thoughts, feelings and actions; critical information for the interviewer to access regarding the current crisis.
  10. Why Not in the Past? If the person has been suicidal in the past, the answer to this question should help direct the interviewer toward helping to establish which protective factors need to be set into place as quickly as possible.
  11. Why Not Now? This question should yield a list of protective factors (reasons for living). The interviewer may need to push and prod a bit here. The longer the list elicited, the greater the protection and the lower the risk.
  12. Who Else in the Past? This question is designed to find out who has served as a possible role model for suicide. A parent? A sibling? A lover? An admired celebrity? It is important for the interviewer to help the client differentiate his or her problems from those of the role model. Such differentiation lowers current risk.
  13. Will You Be Safe and Accept Help? A “no” to this question tells you that despite your best efforts, the client is still actively considering suicide and cannot commit to safety. Most people will agree to be safe after a lengthy session of active listening and a telling of their story; if not, then a more powerful intervention will be necessary. A “yes” to this question amounts to a “No-Suicide Contract,” the elements of which include a good faith agreement to be safe and an agreement to plan for safety. For such a contract to be valid, the client must be sober, non-psychotic, and able to understand the safety plan. The interviewer should explain his or her obligations under the contract as well.

By the end of this interview, you should know what problem suicide would solve. Help the person solve this problem and you remove the need for suicide.

Last, to help build a safety net around the person at risk ask, “Who else needs to know you are in this much pain?” The answer to this question will tell you who might help the person survive the crisis. Get the person’s permission to contact these people, get them to rally around and, again, the risk for suicide goes down. It is, some theorists believe, impossible to kill yourself without opportunity. Reduce opportunity by bringing in caring others and the risk for suicide is lowered.

(from Paul Quinett, QPR Institute, 1996)