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Originally published Saturday, February 25, 2012 at 8:05 PM

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Bill would require suicide-risk training for mental-health providers

A bill that recently passed out of the state House seeks to require mental-health providers to undergo training in suicide risk assessment and treatment as part of their continuing-education requirements.

Seattle Times staff reporter

Where to get help

If you are in crisis or worry that someone else is, call the Crisis Line at 206-461-3222 or 866-4CRISIS

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One year ago this month, Matt Adler, a corporate attorney, took his own life.

Adler, 40, was bright, funny and driven. He loved his work and adored his wife and two young children. He was suffering from serious anxiety and depression. But he was taking medication to treat it and receiving counseling. How could this have happened?

As his wife struggled to understand, she came to a conclusion that may be startling: Suicidal ideation is alarmingly prevalent, yet many health-care providers don't really know how to treat a suicidal patient. Even mental-health providers.

"What I've learned is that this is not that uncommon," said Adler's wife, Jennifer Stuber, who teaches health policy at the University of Washington. Experts say the problem is systemic.

A bill that recently passed out of the state House seeks to close that gap. It would require mental-health providers to undergo training in suicide-risk assessment and treatment as part of their continuing-education requirements. National experts, including the Institute of Medicine, have been calling for such training for at least a decade. If the bill passes, Washington would become the first state in the nation to require it.

"This isn't about demonizing health professionals," Stuber said. "This is about opportunities to intervene."

One in 20 adults

Every 15 minutes, someone dies by suicide in this country, states the Centers for Disease Control and Prevention. In Washington, suicide is the eighth leading cause of death, claiming more lives than motor-vehicle crashes, homicide and HIV/AIDS combined.

According to a CDC report, some 230,000 adults in Washington had considered suicide in the past 12 months. That's nearly one in 20 adults, higher than the national average.

About 36,000 Washingtonians make a suicide attempt each year. Many of them were being treated by mental-health counselors; about half were seen by their primary-care doctors in the month before their death, advocates say. Yet many of these providers are not properly prepared to handle the issue.

Paul Quinnett, a Spokane psychologist who has studied the issue extensively, gave an example of a talk he gave recently to a medical group. How many patients had considered suicide, he asked them? None, they answered. How many were being treated for major depression? 1,500. The numbers didn't jibe.

Other times, he's found the same kind of mismatch between intake forms filled out by patients, and clinicians' notes.

"Why don't (clinicians) know they're suicidal?" he said. "Because they don't ask."

Some still think — wrongly — that asking the question will "put ideas" into the patient's head.

"That is not the truth," Quinnett said.

Others may be reluctant to talk about the subject because it's uncomfortable.

"It's a very frightening subject," he acknowledged. "But ... suicidal patients will often stop talking to you when they realize you're terrified of the subject."

Some feel that if they document a discussion of suicide in their notes and the worst happens, they may be sued, Quinnett said.

There's another problem, one Stuber says affected her husband. At the Legislature, she testified that his therapists were concerned he would kill himself.

In an interview, Stuber said she obtained his medical records and learned the following: About two weeks before his death, he told them he had holed up in a motel with a gun but didn't pull the trigger. His psychologist and psychiatrist told him he should be hospitalized. And yet, Stuber said, they did not follow through.

"They just seemed completely disconnected about what to do, given the risks," Stuber told lawmakers.

The psychologist told Adler he couldn't treat him in an outpatient setting, she said the records show. It was their last meeting. About 10 days later, Adler was found dead in a motel room.

Clinicians often recognize they don't have enough training, said Marsha Linehan, a University of Washington professor considered a national expert in treating highly suicidal people. It's not unusual for a counselor to tell such a patient he or she needs to seek help elsewhere, she said.

Stuber believes it convinced her husband there was no hope.

She is considering filing a wrongful-death lawsuit.

Nurses, doctors exempt

The bill, named for Adler, would required mental-health providers to attend six hours of training on the subject every six years. The version passed by the House had included nurses and doctors, too, because many people with depression and anxiety are treated not by a counselor but by their primary-care provider.

But at a Senate committee hearing Wednesday, these groups sounded a common theme: This type of training is vitally important, they said. But we don't need it. The committee stripped them from the bill, ESHB 2366.

Stuber is hopeful the discussion will at the very least raise awareness and bring attention to yet another myth: that people who consider suicide simply can't be helped. That idea, say experts, can have devastating consequences.

As Stuber has learned, it's one thing to be a widow at 39; being a widow due to suicide adds so many more layers to the grief.

News researcher Gene Balk contributed to this report.

Maureen O'Hagan: 206-464-2562 or mohagan@seattletimes.com

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