Research and Evaluation Services Article Archives
Social Services for People
Identified as Suicidal
Published in The Roundtable, vol. 3, no. 6 (July - August 2000),
p.4-5
In last month’s column I reported new research on the social networks of suicidal people, based on a May 1999 survey of about 2,000 Connecticut residents who had contact with family service agencies in that state. I found their social networks generally distinguished by thinness both in the variety of resources they used and in terms of their very poor view of the helpfulness of those assets they did access. Here I offer a companion analysis of the services provided to this group of 36 people by the same family service agencies. The pattern suggests that services are structured more by the prevailing concept of suicide as an individual mental-health issue than by the specific circumstances of the individual who is treated.
Services to suicidal individuals are highly focused. The top two most frequently provided services for suicidal people and also for all Connecticut residents were individual counseling and unspecified psychological or mental health services. However, three-fourths (75 percent) of the suicidal group received individual counseling, compared to half (49.5 percent) of all family-service clients statewide. A bit more than five out of eight (63.9 percent) of the suicidal group got unspecified psychological or mental health services, but this was provided to less than one third (30.5 percent) of the state pool. The profile of services provided parallels those given to Connecticut consumers generally, but at much higher frequencies.
Each suicidal individual also received more different kinds of services, on average, than their fellow residents did. The agencies offered each of 10 distinct services to 20 percent or more of the suicidal group. In addition to the two mentioned above, these included:
For all state residents, only the two services highlighted previously were given to more than 20 percent of them. Though the greater focus and frequency of services to suicidal people are reassuring, an enormous gulf separates the three most commonly offered (individual counseling, psychiatric, and psychological/mental health services) from the rest of the set.
The profile of services to this group embodies a crisis orientation. In addition to offering crisis intervention to one-fourth of the group, the agencies also provided:
At first blush this seems hardly surprising. But it may also indicate that counselors and other staff are becoming involved somewhat late in the lives of these people. It suggests a need to strengthen prevention initiatives and early intervention outreach efforts (e.g., education).
Services are highly focused on individuals. All of the most common services target the individual, rather than the individual’s family or their broader social environment. For example, individual counseling is offered to suicidal people at three times the frequency of family counseling.
The one intervention occurring with some frequency that might serve to expand a suicidal individual’s sources of support is a support group (19.4 percent). Unfortunately, as we learned from last month’s analysis of their social networks, only a little more than the one-fifth (22.2 percent) of suicidal people who used support groups found them to be "very helpful". This compares poorly with the 54.2 percent of Connecticut residents statewide who gave support groups a top rating. Professional staff may wish to rethink offering support groups to suicidal clients.
Generally, there is considerable tension between the profile of services provided and the landscape of social support in which the suicidal person operates. The suicidal person, we learned, relies very heavily on counselors and doctors. They turn frequently to friends and neighbors, and their church. But they seriously under-utilize family members as assets, and find them far less helpful than do others.
The current pattern of service provision, focused so narrowly on the relationship between professional helper and client, does little to bring friends, neighbors or church into play, nor does it appear to address the pervasive disconnection with family members. We need to balance this with public education and other strategies (e.g., resolution of relationship conflict) that ease access or remove barriers to social supports already in place. Increased self-sufficiency is the potential reward of a more contextual approach to services for suicidal people.