Clergy as Suicide Prevention Gatekeepers

Abstract

801 U.S. Catholic, Jewish and Protestant clergy reported on their suicide gatekeeping activities. Using vignettes, they identified suicide risk and selected interventions for three risk levels. Two-thirds of the sample who provide counseling reported at least one contact from a suicidal person per year. Clergy were significantly more concurrent with experts in identifying risk and selecting interventions with high risk but deviated more from the experts with low and medium risk. Most reported needing more training.

Keywords

Clergy suicide gatekeeper risk identification

Preventing suicide is a global imperative (World Health Organization [WHO], 2014). Suicide is the 10th leading cause of death in the U.S. (U.S. Department of Health and Human Services [HHS] et al., 2012) and the 2nd leading cause of death worldwide in 15–29 year olds (WHO, 2014). In order to address this worldwide problem, the WHO and the U.S. National Strategy for Suicide Prevention (HHS et al., 2012) outline several approaches to preventing suicide including reducing risk factors and increasing protective factors. Risk factors can include limited treatment resources (WHO, 2014). Religiosity and spirituality (R/S) can be protective (Alexander et al., 2009; Amit et al., 2014; Hovey, 1999; Larson & Larson, 2003; Stack, 1983; VanderWeele et al., 2016; Weaver et al., 2003). However, some (WHO, 2014) caution that some attitudes toward suicide can make R/S a risk factor.

Training gatekeepers to identify a person at risk of suicide and intervene is a “best practice” (WHO, 2014, p. 38) with encouraging results (Gould et al., 2003; Isaac et al., 2009; King & Smith, 2000; Mann et al., 2005; Van der Feltz-Cornelis et al., 2011). Faith leaders are viewed as gatekeepers (HHS et al., 2012; WHO, 2014) because they may be accessible when resources are limited and because R/S can be protective (WHO, 2014). Suicidal people assign faith leaders a gatekeeper role when seeking their help. Approximately 25% of the U.S. National Comorbidity Survey sample of people with all types of mental health disorders contacted clergy for help (Wang et al., 2003). Significant predictors of contact included suicidal ideation, plans or attempts. Suicidal people seeking treatment were as likely to contact clergy as other providers. One third of another sample viewed clergy as “first-line helpers” (p. 197) for most mental health problems including risk of self-harm (Ellison et al., 2006). Clergy report being contacted by suicidal people (Leane & Shute,1998; Moran et al., 2005), but it is not clear how often clergy engage in a gatekeeper role or how effective they are in this role. Clergy have reported low confidence and limited training in risk identification (Leane & Shute, 1998). They also have scored lowest in knowledge about suicide lethality compared to others (Domino & Swain, 1985–1986; Holmes & Howard, 1980). Their referral pattern of suicidal people to mental health professionals is also unclear (Mason et al., 2011; Meylink & Gorsuch, 1988). Given the global imperative to prevent suicide and the key role of faith leaders as accessible suicide prevention gatekeepers, it is vital to understand their ability to fulfill this preventative role. This exploratory study sought to clarify the frequency and effectiveness of clergy’s gatekeeping activities by reporting on their suicide risk identification and interventions; their suicide knowledge; their confidence and preparation for this gatekeeper role and their attitudes toward suicide.

Method

Participants

Over a year, clergy organizations distributed a survey link to their full or part time U.S. Catholic, Jewish and Protestant clergy, whether they had engaged suicide or not. Organizations included 13 district-level clergy with church membership in the National Council of Churches of Christ in the USA (NCC; out of 186 district-level clergy contacted), four clergy alliance groups, four Catholic archdioceses (out of 18 contacted), and eight theological seminaries (out of 12 contacted). Eighty-five clergy were contacted via personal networks and yielded additional contacts.

Measures

The survey did not define suicide to avoid biasing clergy responses. Demographic items included questions about frequency of gatekeeping activities (“In your clergy role, how many suicidal persons request your help annually?” “In your role as clergy, how many suicide deaths have you been involved with?” “Annually, how many suicide-related funerals do you conduct?”), questions about level of confidence in working with suicidal people with or without alcohol and drugs (“How confident do you feel in your work with suicidal people?” “How confident do you feel in your work with suicidal people who use drugs and/or alcohol?”), questions about training and position on suicide, and several measures.

Measures included respondents’ assessment of suicide risk and selection of interventions appropriate to level of risk using three vignettes (Debski et al., 2007), developed by a psychologist and psychiatrist based on clergy interviews (Mason et al., 2011). One depicted low suicide risk, one medium and one high (Appendix 1). Pilot testing guided revisions. The average suicide risk rating assigned by two recognized suicidology experts served as a criterion against which individual respondents were compared (Neimeyer & Bonnelle, 1997). More accurate risk identification was operationalized as less deviation of the respondents’ rating from the criterion. Interventions deemed appropriate for that vignette by both recognized suicidology experts were scored two points, and interventions deemed appropriate by one expert were awarded one point. Higher scores indicated more concurrency and better performance.

The Suicide Lethality Scale (SLS; Holmes & Howard, 1980) measures suicide knowledge with 13 multiple-choice items. Higher scores represent more accurate knowledge. Range and Knott (1997) present evidence of construct-related validity. Dr. Holmes recommended updating the measure (C. Holmes, personal communication, June 23, 2011), resulting in new wording for two items, new content for four items, and five new items.

The Suicide Opinion Questionnaire (SOQ) is an “extensively used” (Range & Knott, 1997, p. 44) 100-item measure with eight subscales assessing attitudes towards suicide (Domino et al., 1982), with evidence of construct-related validity (Domino, 2005). Individual subscales have been used (Domino, 1990). To avoid over burdening study participants, we included 19 SOQ items comprising the three scales that relate to religion, each with acceptable psychometrics (Domino, 1996; Domino et al., 2000). Higher scores on the “Right to die” subscale indicate greater agreement with items like “Suicide is an acceptable means to end an incurable illness.” Higher scores on “The importance of religion” subscale indicate greater agreement with items like “The higher incidence of suicide is due to the lesser influence of religion.” Higher scores on the “Suicide is morally bad” subscale indicate greater agreement with items like “In general, suicide is an evil act not to be condoned.”

Procedures

Before beginning the survey, participants were given all relevant information. Afterwards, they registered for a $10 gift card and resources. The institution’s review board approved the study.

Results

Response Metrics and Sample Characteristics

Because online web-based survey results can be invalidated by a single user completing the survey multiple times (Eysenbach, 2004) and because more respondents registered for the gift card (N = 2,775) than completed the survey (N = 2,378), a stringent multistage vetting process using IP geolocation databases and IP addresses from both surveys was implemented. For example, if a respondent completed the survey on a device with an IP address with a geolocation outside of the United States, and in the gift card registration claimed to be located in Texas, both responses were removed. Once identified as invalid, responses from that particular IP address or subnet were no longer considered, resulting in a final sample size of 801 verified respondents.

Respondents were similar demographically to the sample of clergy reported in the 2010 National Survey of Congregations (NSC, Hartford Institute for Religion Research, 2012). A majority was male (n = 582, 73%), married (n = 638, 80%) and working full time (n = 625, 78%) with 68% (n = 546) reporting working more than 40 hours per week. The mean age of the sample was 49.83 years (range: 23-85 years) with Catholic clergy being significantly older (M = 53.74, SD = 12.65) than other respondents (F = 3.59, p = 0.01**). Compared to the 2010 U.S. Census Bureau (2010), the sample underrepresented black and Hispanic clergy and therefore over represented white clergy. A small number (n = 48, 6%) was not ordained. About half (n = 394, 49%) reported having a Master’s of Divinity degree. The most reported size of current place of worship was 51–100 attendees on an average worship day (n = 162, 20%). The second most reported size was 1–50 attendees (n = 131, 16%). All four regions of the U.S were represented with 39% (n = 311) of respondents currently living in the Northeast. Most respondents were Protestant (n = 655, 82%) with many denominations represented, the most numerous being the United Church of Christ (n = 123, 15%). Sixty-four percent (n = 510) reported being born again or evangelical Christian. Based on the 2011 Yearbook of American & Canadian Churches (NCC, 2011), 92% of U.S. clergy are Protestant and seven percent are Catholic. One percent are Jewish (A. Hickman, personal communication, October 11, 2012). This sample comprised 82% Protestant, ten percent Catholic and six percent Jewish clergy.

Clergy Gatekeeper Activities

Most of the respondents (n = 735, 92%) reported providing one or more hours of counseling weekly. Sixty-six percent of these (n = 484) reported being approached by at least one suicidal person per year, with an average of 2.15 contacts (SD = 4.65) from suicidal people annually, and having been involved with a total average of 3.09 suicide deaths (SD = 7.91) across their professional experience, with 62% (n = 498) experiencing at least one suicide death. Respondents reported conducting on average less than one suicide funeral per year (M = 0.46, SD = 1.15). Catholic clergy reported significantly more contacts with suicidal people annually (M = 5.15, SD = 8.38; F = 12.28, p < 0.0000**), being involved in significantly more total suicide deaths (M = 8.2, SD = 16.67; F = 13.29, p < 0.0000**), and conducting significantly more annual suicide funerals (M = 1.68, SD = 2.69; F = 40.19, p < 0.0000**) than other respondents. Clergy in their 50’s and 70’s reported being involved in significantly more total number of suicide deaths than clergy in their 30’s (Table 1). Clergy in their 70’s reported conducting significantly more suicide funerals annually than clergy in their 30’s, 40’s, and 50’s. Hispanic clergy reported conducting significantly more funerals annually (M = 1.66, SD = 3.5; F = 37.64, p < 0.0000**).

Table 1.

Significant clergy age group differences.

Variable	Sample	F	p	20s	30s	40s	50s	60s	70s
Variable	M (SD)	F	p	M (SD)	M (SD)	M (SD)	M (SD)	M (SD)	M (SD)
Counseling training hours	56.50 (34.97)	4.24	0.0003**	37.13 (33.38)	53.43 (35.1)	50.6 (34.42)	60.18 (33.21)	63.04 (36.6)	62.16 (35.66)
Suicide deaths	3.09 (7.91)	4.80	0.0001**	0.48 (1.53)	1.12 (2.76)	2.03 (3.37)	4.19 (10.71)	4.51 (9.81)	5.3 (5.9)
Suicide funerals	0.46 (1.15)	2.28	0.04*	0.45 (2.16)	0.42 (1.52)	0.39 (1.04)	0.42 (0.79)	0.53 (0.98)	1.16 (1.5)
SOQ morally bad	11.97 (4.01)	8.23	0.0000**	14.03 (4.28)	13.34 (3.66)	12.37 (3.93)	11.44 (3.88)	10.81 (4.14)	11.03 (3.46)

*Significant at the 0.05 level.

**Significant at the 0.01.

Respondents provided an average of 5.32 hours per week of counseling in general (SD = 5.94) with an average number of 4.57 sessions (SD = 5.77) for each counseling case. They made 7.23 (SD = 8.97) referrals on average every year to mental health professionals. On average clergy who provide counseling and who have been contacted by suicidal people (n = 484) referred 76.6% of suicidal people (SD = 35%) to mental health professionals, with 3.31% (n = 16) making no referrals and over half (n = 272, 56%) referring 100% of suicidal people to mental health professionals. The barriers to referral of suicidal people cited most frequently by clergy were finances (49%) and stigma (41%). Only 8% of the sample (n = 35) reported that all suicidal people signed a release of information to permit care coordination, with 45% (n = 196) reporting that no suicidal person has ever signed a release of information for care coordination.

Forty percent of respondents (n = 266) do not mention the word “suicide” in the funeral. In an open-ended item, respondents indicated that mentioning the word “suicide” in a funeral depends on family wishes, faith community needs, whether the suicide is common knowledge in the community and how much information the clergy person has about the suicide. Eighty-six percent of respondents (n = 644) reported they have not experienced a copycat suicide.

Clergy Gatekeeper Effectiveness

On the original 13 item SLS (some items updated; α = 0.47), respondents scored significantly higher (M = 7.08, SD = 1.97) than the Domino and Swain (1985–1986) convenience subsample of 35 clergy (M = 5.77, t = 18.8, p < 0.0001**). On average, clergy got 58% (SD = 0.14) of the items correct ranging from 17% to 94%.

Mean deviation scores for risk identification differed significantly for each of the three vignettes (F = 683.66, p < 0.0001**) with more concordance with the experts for the high-risk vignette (M = 0.2, SD = 0.64), less concordance for the lower risk vignette (M = 2.06, SD = 1.58), and the least concordance for the medium risk one (M = 2.44, SD = 1.46). For the high-risk vignette, 695 (87%) did not deviate from the experts. The experts also were more concordant in the high range of risk. White (M = 4.57, SD = 2.5; F = 13.25, p < 0.0003**) and non-Hispanic respondents (M = 4.64, SD = 2.56; F = 8.31, p = 0.004**) were significantly more concordant with experts.

Again, clergy were significantly more concordant with experts for interventions with the high-risk vignette (F = 28.34, p < 0.0001**) where clergy selected an average of 2.44 appropriate interventions (SD = 1.19), an average of 2.1 appropriate interventions (SD = 1.06) with the lower risk vignette, and an average of 2.05 appropriate interventions (SD = 1.16) with the medium risk vignette. Of note is that a small number (n = 15) of respondents stated that they or another person should go to the person’s house to talk or remove the gun.

Clergy Gatekeeper Confidence and Preparation

About a third of respondents (32.53%, n = 257) reported they were either very uncertain or uncertain in their work with suicidal people. Fifty-six percent of the sample (n = 439) reported they were either very uncertain or uncertain in their work with suicidal people who use alcohol or drugs. Respondents reported significantly more confidence working with suicidal people (M = 3.01, SD = 1.08) than with suicidal people who use alcohol or drugs (M = 2.42, SD = 1.19; t = 18.21, p < 0.0001**) with Catholic clergy reporting significantly more confidence working with suicidal people who use alcohol and drugs (M = 2.84, SD = 1.29) than Protestant clergy (M = 2.36, SD = 1.15; F = 4.03, p = 0.007**).

Sixty-eight percent of respondents (n = 543) reported receiving at least one hour of formal training working with suicidal people. The average number of formal counseling training hours respondents reported was 56.5 hours (SD = 34.97) and the average number of formal training hours working with suicidal people was 12.58 hours (SD = 19.85), significantly different from each other (t = 39.57, p < 0.0001**). Clergy in their 50’s and 60’s reported more counseling training hours than clergy in their 20’s and clergy in their 60’s reported more than clergy in their 40’s but not more suicide training hours (Table 1). Eighty-six percent of respondents (n = 617) endorsed the need for more suicide-related training. Themes from an open-ended item on training needs included risk identification (“simple guidelines for recognizing high risk situations”), counseling skills (“better listening skills”), knowledge about suicide (“learning updated facts”), religious issues (“theological grounding to discuss/explain suicide”), resources (“available resources”), and delivery modes of training (“I prefer case studies”). An open-ended response captured these themes:

The counseling courses I took for my MDiv were entirely, without doubt, lacking any substance, actual training, or real merit. We were told to refer. That's all. And while I agree that I am not trained to serve as someone's therapist or psychiatrist, I am, all too often, the first person they come to when fighting depression or suicide. I needed and still need basic counseling techniques to have been taught. I learned much of that working at a domestic violence shelter where I dealt with suicidal individuals often. But that came from experience, not training. In addition, formal theological training addressing these issues that did more than battle over whether or not suicide is a sin (how helpful is that going to be in that moment??) would have been of great value the first time someone walked into my office and asked if their mom was in hell because of her suicide.

Clergy Attitudes Toward Suicide

Forty-six percent of the sample (n = 372; 95% of Catholic clergy, 76% of Jewish clergy, and 39% of Protestant clergy) reported that their religion/denomination has a position on suicide, with significantly more Protestant clergy reporting their denomination does not have a position on suicide (χ² (3) = 31.36, p < 0.000**). Themes from an open-ended item on their religion/denomination’s suicide position include (1) their religion/denomination is against suicide for moral reasons, “Human life is sacred,” (2) mental illness diminishes moral responsibility, “Psychological problems diminish the culpability of the action,” (3) the need for compassionate pastoral care, “It is a sin. However, I would hope that fellow Christians would place more emphasis on the need to have compassion on those suffering and less focus on judging the act of suicide, which I think is counterproductive,” and (4) suicide is different from euthanasia, “Suicide is distinguished from voluntary euthanasia.”

Themes from an open-ended item on their own suicide position indicated agreement with their religion/denomination’s position: (1) suicide is morally unacceptable, “No one has a right to take a life,” (2) a focus on mental illness, resulting in diminished moral responsibility, “Suicide is an objectively serious moral act, but whose subjective imputation of wrong is often mitigated by psychological issues/fear/trauma,” (3) a focus on prevention, “My responsibility is to do whatever I can to prevent one's suicide,” and (4) suicide is different from euthanasia, “End-of-life measures are not suicide.”

Cronbach’s alpha for the combined SOQ subscales was 0.86. An iterated principal axes factor analysis of the SOQ, followed by varimax orthogonal rotations, yielded three factors with loadings of .34 or higher corresponding to the three SOQ subscales, with one item omitted from each subscale and one item moved from “The Importance of Religion” subscale to the “Suicide is morally bad” subscale. Factor 1 (α = .87), explaining 44% of the variance, appeared to measure a “Right to die” attitude, the belief that people with incurable diseases should be allowed to die by suicide in a dignified manner. Factor 2 (α = .79), explaining 31% of the variance, appeared to measure an “Importance of religion” attitude, the belief that people who die by suicide lack solid religious convictions. Factor 3 (α = .76), explaining 25% of the variance, appeared to measure a “Suicide is morally bad” attitude, the belief that suicide is a serious moral transgression.

Clergy groups differed significantly in their attitudes. Jewish clergy reported significantly less belief in the importance of religion (M = 9.02, SD = 3.02) compared to Catholic clergy (M = 11.11, SD = 3.94) who reported more belief in the importance of religion than other respondents (F = 4.65, p = 0.003**). Jewish clergy reported significantly less belief that suicide is morally bad (M = 8.89, SD = 3.09) compared to other respondents (F = 9.80, p < 0.0000**). And Jewish clergy reported significantly more belief in the right to die (M = 16.93, SD = 4.63) compared to other respondents (F = 17.36, p < 0.0000**). Clergy in their 50’s, 60’s and 70’s reported significantly less belief that suicide is morally bad than clergy in their 20’s and 30’s, and clergy in their 60’s reported significantly less of this attitude than clergy in their 40’s (Table 1). Non-white clergy (M = 11.17, SD = 3.84) reported significantly more importance of religion attitude (F = 8.81, p = 0.003**) than white respondents.

Discussion

This study sought to report on the frequency of clergy’s suicide prevention gatekeeper activities and clergy’s ability to fulfill a gatekeeper role effectively. Key findings include: a majority of respondents reported being contacted by at least one suicidal person per year and being involved with at least one suicide death across their professional career with significant differences between clergy groups, and respondents identified risk and intervened significantly more concurrently with experts with high suicide risk and less concurrently with experts in the medium and lower risk categories. They reported being underprepared for their gatekeeper role and reported a spectrum of attitudes about suicide.

Frequency of Gatekeeper Activities

Two-thirds of respondents who provide counseling to congregants reported at least one request for help from a suicidal person per year, though different from 84% of Leane and Shute (1998) 79 clergy, perhaps due to this study’s wider sampling strategy. Almost two-thirds reported being involved in at least one suicide death in their professional experience and conducting less than one suicide funeral per year.

Respondents reported providing low intensity counseling services to all help seekers, similar to previous findings (Mollica et al., 1986; Moran et al., 2005; Wang et al., 2003; Weaver et al., 2003). Respondents contacted by suicidal people referred on average 76.59% of suicidal people to mental health professionals, with over half referring all suicidal people to a mental health professional, though almost half of the sample also reported that no suicidal person had signed a release of information permitting clergy collaboration with mental health professionals (McMinn et al., 2005). This is surprising because some clients would prefer for their mental health treatment to integrate a religious/spiritual component (Pargament et al., 2005; Rose et al., 2008) and both clergy and mental health professional could benefit from greater collaboration to reduce “the caregiving burdens of clergy and clinicians through consultation and collaboration” (Milstein et al., 2008, p. 220). Mental health professionals may need to develop such collaboration competencies (Vieten et al., 2013). They may also be called upon to provide training to clergy on confidentiality laws and on suicide risk identification and intervention.

Effectiveness of Gatekeeping

Although this sample of clergy scored significantly higher than Domino and Swain’s (1985–1986) sample on suicide knowledge, most respondents seemed to be missing important knowledge about suicide, for example, that suicide rates are higher among middle-aged men and widowed/divorced/separated individuals. Respondents were significantly more able to identify suicide risk in the highest risk category but deviated more from the experts in lower and deviated most from experts in medium risk situations. It is important to recognize that clergy may be able to fulfill a gatekeeper role at the high-risk level but may be less effective in the gatekeeper role at medium and lower levels of risk. In terms of selecting interventions, similarly, medium and lower levels of risk pose greater challenges to clergy.

Gatekeeper Preparation

Only a third of respondents reported feeling confident or very confident in their work with suicidal people. Respondents reported significantly less confidence working with suicidal people who use alcohol or drugs. The majority of respondents wanted more training, similar to a clergy workgroup (Marshall, 2005). An important question is why respondents did not report more suicide training. It may be that respondents who provide counseling but report not being contacted by a suicidal person (34%, n = 251) do not perceive the need for suicide training or that clergy are unaware of available trainings or it may be that training is unavailable. Another question is why older clergy reported significantly more counseling training hours, but they did not report more suicide training hours or demonstrate more suicide knowledge.

Clergy Attitudes Toward Suicide

Respondents reported a spectrum of views on suicide, which incorporated themes of moral objections to suicide but were more nuanced. The majority of this study’s Protestant respondents reported that their religion/denomination does not have a position on suicide. This sample’s Jewish clergy reported significantly less belief that suicide is morally objectionable compared to Catholic and Protestant clergy, different from Domino’s (1985) sample of 112 clergy where Jewish and Catholic clergy perceived suicide as less acceptable than Eastern and non-traditional ministers. Jewish clergy reported more belief in the right to die perhaps corresponding to changing attitudes toward physician-assisted suicide over the past 20 years (Witte et al., 2010).

Limitations, Strengths, Future Directions and Conclusion

This study’s web-based approach provided recruitment ease but such surveys can be subject to the bias of a non-representative self-selected sample (Eysenbach, 2004). While the vetting funnel was stringent, it is not known in what way bias may have affected results. It is also not known how a global sample of faith leaders might yield different results. In addition, the study was cross-sectional and based on self-report. However, a strength of this study is in its demonstration of the feasibility of surveying Catholic, Jewish and Protestant clergy about their gatekeeper activities and of using expert ratings on vignettes as criteria for evaluating respondents’ gatekeeper effectiveness. Future research might replicate results across more religions/denominations globally and might determine if clergy are similar or different from other gatekeepers in their effectiveness. Also, more studies are needed to clarify clergy differences and their effect on the gatekeeper role. It would also be of interest to clarify under what conditions clergy attitudes to suicide affect their gatekeeping activities.

In conclusion, a majority of clergy engaged a suicide prevention gatekeeper role. However, clergy may be underprepared for this role, missing key knowledge about suicide. They may be more effective gatekeepers in high suicide risk situations but less effective in lower and medium suicide risk situations. Their attitudes and positions on suicide may include moral objections but are likely to be more nuanced. These findings are relevant to mental health professionals who may be called upon to provide gatekeeper training for clergy. Training should build on clergy’s risk identification and intervention skills at high risk levels and target their ability to fulfill a gatekeeper role at the lower and medium risk ranges.

Footnotes

Author's Note

The authors gratefully acknowledge Lilly for the theological research grant administered by the Association of Theological Schools, which funded this study. The authors also recognize with appreciation the invaluable contributions of Dr. Morton Silverman and Dr. Yeates Conwell in providing expert ratings for three vignettes.

ORCID iD

Karen Mason

Karen Mason is Professor of Üounseling and Psychology at Gordon-Conwell Theological Seminary in South Hamilton, MA.

Monica Geist is on the Math Faculty at Front Range Community College in Westminster, CO.

Richard Kuo is Senior-Systems Administrator at AT&T in Atlanta, GA.

Day Marshall, LMHC, delivers mental health services at Harbor Christian Counseling, Boston, MA.

James D. Wines, Jr., MD, MPH, is a staff psychiatrist at Fernside, one of McLean Hospital's Signature Addiction Recovery Programs, and is an Instructor in Psychiatry at Harvard Medical School.

Appendix 1. Three Vignettes

Low suicide risk range

You have just gone to bed and you receive a call from Linda who says that her husband just walked out on her. She is crying hysterically. After you talk with her, she calms down and tells you that she was so angry she thought about killing herself just to show her husband. She says that she won't act on that thought and says she wouldn't even know how to harm herself but she wonders what to do with the hurt and anger.

Medium suicide risk range

You are meeting with Bernice, a 27-year-old woman who has been depressed since a date rape about 6 months ago. She still feels too ashamed to tell any of her friends or family what happened and she wonders if God will ever forgive her. She looks depressed and when you ask, she says that her primary care doctor started her on an antidepressant last week. She tells you that, when she was 12, when her parents were going through a divorce, she tried cutting her legs a few times, but she stopped because it didn't help. She goes on to say that she has some upsetting suicidal thoughts some days but she does not have a suicide plan.

High suicide risk range

David calls you and says he is struggling with his wife's death from breast cancer a year ago today. He wonders why God didn't heal her. As he continues to talk, you realize that he seems depressed and doesn't seem to look forward to the future. He keeps saying, “I can't imagine life without Jane.” As you continue to question him, you find out that he has a gun next to him and he plans to kill himself after hanging up the phone unless you can give him a reason to live.

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