The Impact of Suicide

By Laura More, MSW, LCSW

The health and economic consequences of suicide are substantial. Suicide and suicide attempts have far reaching consequences for individuals, families, and communities. In an early study, Crosby and Sacks (2002) estimated that 7% of the U.S. adult population, or 13.2 million adults, knew someone in the prior 12 months who had died by suicide. They also estimated that for each suicide, 425 adults were exposed, or knew about the death. In a more recent study in one state, researchers found that 48% of the population knew at least one person who died by suicide in their lifetime. Research also indicates that the impact of knowing someone who died by suicide and/or having lived experience (by personally having attempted suicide, having had suicidal thoughts, or having been impacted by suicidal loss) is much more extensive than injury and death. People with lived experience may suffer long-term health and mental health consequences ranging from anger, guilt, and physical impairment, depending on the means and severity of the attempt (Stone, Holland, Bartholow, et al., 2017).

The economic toll of suicide on society is immense as well. According to conservative estimates, in 2013, suicide cost $50.8 billion in estimated lifetime medical and work-loss costs alone (Florence, Simon, Haegerich, Luo & Zhou, 2015). Adjusting for potential under-reporting of suicide and drawing upon health expenditures per capita, gross domestic product per capita, and variability among states in per capita health care expenditures and income, another study estimated the total lifetime costs associated with nonfatal injuries and deaths caused by self-directed violence to be approximately $93.5 billion in 2013 (Shepard, Gurewich, Lwin, Reed & Silverman, 2016). The overwhelming burden of these costs were from lost productivity over the life course, with the average cost per suicide being over $1.3 million. The true economic costs are likely higher, as neither study included monetary figures related to other societal costs such as those associated with the pain and suffering of family or other impacts (Stone, Holland, Bartholow, et al., 2017).

Suicide Prevention: Evidence-Based Strategies is a 3-hour online continuing education (CE) course that reviews evidence-based research and offers strategies for screening, assessment, treatment, and prevention of suicide in both adolescents and adults. Suicide is one of the leading causes of death in the United States. In 2015, 44,193 people killed themselves. The Centers for Disease Control and Prevention (CDC) notes, “Suicide is a serious but preventable public health problem that can have lasting harmful effects on individuals, families, and communities.” People who attempt suicide but do not die face potentially serious injury or disability, depending on the method used in the attempt. Depression and other mental health issues follow the suicide attempt. Family, friends, and coworkers are negatively affected by suicide. Shock, anger, guilt, and depression arise in the wake of this violent event. Even the community as a whole is affected by the loss of a productive member of society, lost wages not spent at local businesses, and medical costs. The CDC estimates that suicides result in over 44 billion dollars in work loss and medical costs. Prevention is key: reducing risk factors and promoting resilience. This course will provide a review of evidence-based studies on this complex subject for psychologists, marriage & family therapists, professional counselors, and social workers. Information from the suicide prevention technical package from the Centers for Disease Control and Prevention will be provided. Included also are strategies for screening and assessment, prevention considerations, methods of treatment, and resources for choosing evidence-based suicide prevention programs. Course #30-97 | 2017 | 60 pages | 20 posttest questions

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.

About the Author:

Laura More, MSW, LCSW, is a healthcare author and licensed clinical social worker. Laura was one of the founding partners of Care2Learn, a provider of online continuing education courses for the post-acute healthcare industry. She now provides healthcare authoring services. She has authored over 120 online continuing education titles, co-authored evidence-based care assessment area resources and a book, The Licensed Practical Nurse in Long-term Care Field Guide. She is the recipient of the 2010 Education Award from the American College of Health Care Administrators.

CE Information:

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

 

Patient Access to Records: The Invisible Confidentiality Right

By Bruce G. Borkosky, PsyD from Ethics & Risk Management: Expert Tips VII

Confidentiality has been around since Hippocrates. In contrast, the patient’s right to obtain a copy of records (patient access) is a relatively recent concept. This may be a surprise, but patients have had a legal right to their records for only about 30 years. Prior to the 1970s, patients had no right to access their records. No state or federal statutes required it, and the AMA ethics code advised refusal of access. Some patients had to obtain a court order to gain access.

The APA has been a laggard here. The first mention of access rights occurred in 1992, but only in regard to test data and only as an exception to confidentiality. Psychologists could withhold records, except to patients; but psychologists were permitted to withhold access to patients if they determined the access was “inappropriate.” It wasn’t until the enactment of HIPAA that the ethics code began to address access rights.

Access Not Required by APA

Although HIPAA mandates access, official APA policy sees things differently. Here is a sampling:

• The Forensic Guidelines state that a forensic patient has no right of access.
• The Record Keeping Guidelines, the Association of State and Provincial Psychology Boards (ASPPB) Code of Conduct, ASPPB Model Act, Rights and Responsibilities of Test Takers and Guidelines for Test User Qualifications all refer to confidentiality but do not mention access rights.
• Although the ethics code requires release of test data with a written release, records can be withheld by institutional policy or legal proceedings, courts and organizational clients. Finally, psychologists are not required to but “may” release records.

Practitioners Often Refuse Access

This position by the APA may be part of the reason that access to records has been – and continues to be – controversial and a topic of heated listserv discussions. Psychologists refuse to release records to patients, third parties, the courts, non-psychologists and attorneys, sometimes enlisting the courts in their efforts (although courts are rarely supportive). Denial of access is a top HIPAA complaint against health care providers. Psychologists are urged to refuse release of test data to non-psychologists.

Access is Required by Law

This denial of access is surprising, because state and federal laws require access. All states except three (North Carolina, Iowa and Wyoming) have laws requiring access. Further, for the vast majority of psychologists who are regulated by HIPAA, HIPAA preempts any state laws that might limit access.

Finally, patient access is consistent with ethical principles:

Autonomy

The ethics code uses unusual wording for Principle E (normally referred to as autonomy), perhaps to emphasize that respect for autonomy requires more than acquiescence to the patient’s choices – it’s a positive obligation. One should actively enable the patient’s capacity for free choice, including disclosing information to the patient that increases understanding, fosters decision making and nurtures their capacity as a free agent.

Privacy, confidentiality, privilege, informed consent and access comprise these information-based facets of the autonomy right. Patients decide to consent to services, choose to share private information with the psychologist and then they determine whether (and with whom) to release that information to third parties.

Psychologists demonstrate respect for these rights by obtaining written informed consent to treatment and written authorization to release information. Exactly as we demonstrate respect for the patient in handling their information in these ways, we should also respect the patient enough to let them know what information is contained in those records. Further, access is consistent with informed consent – a patient must know what information is going to be released to determine whether to release the records.

Non-Malfeasance

A number of scholarly arguments have been offered as reasons to withhold access. Some scholars believe that the patient might be harmed by the information in the records. However, there is little empirical evidence of such harm, and there is evidence of no harm. On the other hand, patients may be harmed when access is refused. Records may contain errors, other professionals may need the records to perform their jobs and the patient may need access in order to make important decisions. When access is delayed or denied, the patient’s health, legal rights and/or freedom may be derogated.

Honesty (Integrity)

Honesty refers to comprehensive, accurate and objective transmission of information, including patient understanding. When we withhold information, we convert our relationship with the patient from one of respect to paternalism; we make the patient dependent and vulnerable to a range of future harms. Others may wonder what we have to hide. Conversely, access to records increases openness and transparency and is itself clarifying.

Justice

Justice is a broad topic, far too wide-ranging for discussion here. In part, justice refers to fairness, protection of civil liberties, equal treatment, equitable distribution of services and guarding against bias and prejudice. Under various theories of justice, it can be argued that patients’ control over and access to their records, is just.

According to formal justice, equals should be treated equally. When some patients are permitted access to their records but others are not (e.g., clinical vs. forensic), equals are treated disparately and unjustly. Under Libertarian views of justice, patient-control over the distribution of records affirms the patient’s liberty and property rights. Courts have established the patient’s common law property right to the information in their records, so the transfer of this “property” is only just if it is freely chosen by the patient.

In summary, although required by law, psychologists often refuse to release records. Permitting access is the more ethical path, but it’s surprisingly absent from APA ethics and guidelines. Psychologists who believe that refusing to release records is ethical may face (in additional to legal sanctions) a serious ethical dilemma if working for an organization such as the Veterans Administration (using an internet-based patient access system). The APA should clarify this issue in future guidelines.

Related Article: Government backs down on some requirements for digital medical records

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Ethics and Risk Management: Expert Tips VII is a 3-hour online continuing education (CE/CEU) course that addresses a variety of ethics and risk management topics in psychotherapy practice in the form of 22 archived articles from The National Psychologist and is intended for psychotherapists of all specialties.

Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the California Board of Behavioral Sciences; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board; the South CarolinaBoard of Professional Counselors & MFTs; and by theTexas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.

 

Missouri Occupational Therapist (OT) License Renewal & CE Info

Online CEUs for Missouri OTs

Missouri-licensed Occupational Therapists (OTs) and Occupational Therapy Assistants (OTAs) have an upcoming license renewal of June 30, 2015.

Continuing Education (CE) Required:

24 Continuing Competency Credits (CCC) [1 CCC = 1 hour] are required biennially to renew. At least 50% of the 24 credits must be directly related to the delivery of occupational therapy services, and the remaining credits must be related to one’s practice area or setting.

Missouri OTs/OTAs may earn all 24 credits through AOTA-approved online courses.

Professional Development Resources is an American Occupational Therapy Association (AOTA) approved provider of online continuing education (#3159) for occupational therapists and assistants.

Click here to view the Missouri Board of Occupational Therapy Continuing Competency Requirements.

 

Continuing Education and License Renewal for Ohio Psychologists

Ohio-licensed psychologists have a biennial license renewal deadline of August 31^st, even years.  23 hours of board-approved continuing education are required to renew.   The board recognizes The American Psychological Association as a provider of continuing education courses for Ohio psychologists.

The main objective of continuing education is to assure high standards for the psychology practice by requiring licensees to participate in ongoing educational activities.  With these experiences, licensees can increase their competence and knowledge obtained through prior education and training.

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists.  Professional Development Resources maintains responsibility for all content and programs.  Ohio psychologists may earn 20 hours of their required hours through online coursework offered at http://www.pdresources.org/Courses/Psychology/AllCourses/CourseID/1/

Requirements for Continuing Education

All licensees are required, as a condition of license renewal, to complete a minimum of 23 hours of continuing educational activities per licensure/renewal period every two years.  Three (3) hours of professional conduct and ethics are required for renewal.

Definitions of “professional conduct and ethics” will be offered by OPA, OSPA and the Association of Black Psychologists.  Continuing education offerings applicable to this requirement should be identified as such by the sponsoring association to assist licensees in choosing courses.

The board will credit licensees with courses in “professional conduct and ethics” if approved by OPA, OSPA, or the Association of Black Psychologists.

All continuing education courses must be sent to OPA or OSPA for certification before the associations send the hours to the board.  This includes APA-approved courses.  Unless you send continuing education certificates to OPA or OSPA, they will have no way of knowing that the course was completed.  The State Board of Psychology does not accept continuing education certificates directly.

The Board of Registration of Psychologists for Ohio: http://psychology.ohio.gov/

 

Talking with Your Older Patient: A Clinician’s Handbook

New 2-Hour Online CE Course

Click on image to view course details

Advising an older man about starting an exercise program . . . counseling a woman about the proper way to take her osteoporosis medication . . . discussing end-of-life care options with the family of a long-time older patient who is dying. These are just some examples of the complex and sensitive issues facing clinicians who treat older people. Health care providers who communicate successfully with older patients may gain their trust and cooperation, enabling everyone to work as a team to handle physical and mental health problems that might arise. Effective communication techniques, like those discussed in this handbook, can save time, increase satisfaction for both patient and practitioner, and improve the provider’s skill in managing the care of his or her patients. Ongoing communication is key to working effectively with your older patient. If a patient does not follow recommendations or starts missing appointments, explore whether or not a difficulty in communication has developed. Paying attention to communication increases the odds of greater health for your patient and satisfaction for you both.

This course provides general advice for health and mental health professionals for working with older patients, their families, and their caregivers, based on a publication from the National Institute on Aging. Topics include being aware of perceptions about health care, understanding older patients, obtaining medical histories, encouraging wellness, talking about sensitive subjects, supporting patients with chronic conditions, breaking the bad news, working with diverse older patients, working with families and caregivers, talking with patients about cognitive problems, and keeping the door open to effective communications. The booklet also includes references to other useful publications and services for the elderly that can be used for referral purposes, including hotlines for obtaining information about assistance with caregiving, daily living, finances, health, household matters, nutrition, social support, transportation, and utilities. This course is intended for clinicians who would like an introduction to the skills of communicating with the elderly, or who would like to improve the skills they already have. Course #20-60 | 2008 | 66 pages | 15 posttest questions

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Learning Objectives:

1. Identify common stereotypes about aging and ways to combat ageism
2. Identify techniques for discussing difficult issues such as cognitive problems and delivering bad news
3. List tips for promoting wellness among elderly patients, including exercise and nutrition
4. Describe strategies for supporting patients with chronic conditions
5. Identify the role of multicultural issues on patient’s attitudes towards medicine
6. Describe important issues concerning the involvement of family and caregivers in medical discussions

About the Author(s):

The National Institute on Aging is part of the National Institutes of Health, which is part of the Federal Government. Scientists at the NIA help to improve the health of older Americans through research. The NIA provides the Alzheimer’s Disease Education and Referral (ADEAR) Center. The Center offers many free booklets, including this guide.

Accreditation Statement:

Professional Development Resources is recognized as a provider of continuing education by the following:

AOTA: American Occupational Therapy Association (#3159)
APA: American Psychological Association
ASWB: Association of Social Work Boards (#1046)
CDR: Commission on Dietetic Registration (#PR001)
NBCC: National Board for Certified Counselors (#5590)
NAADAC: National Association of Alcohol & Drug Abuse Counselors (#00279)
California: Board of Behavioral Sciences (#PCE1625)
Florida: Boards of SW, MFT & MHC (#BAP346); Psychology & School Psychology (#50-1635); Dietetics & Nutrition (#50-1635); Occupational Therapy Practice (#34). PDResources is CE Broker compliant.
Illinois: DPR for Social Work (#159-00531)
Ohio: Counselor, Social Worker & MFT Board (#RCST100501)
South Carolina: Board of Professional Counselors & MFTs (#193)
Texas: Board of Examiners of Marriage & Family Therapists (#114) & State Board of Social Worker Examiners (#5678)