Clinical and counseling psychology programs currently lack adequate evidence-based competency goals and training in suicide risk assessment. To begin to address this problem, this article proposes core competencies and an integrated training framework that can form the basis for training and research in this area. First, we evaluate the extent to which current training is effective in preparing trainees for suicide risk assessment. Within this discussion, sample and methodological issues are reviewed. Second, as an extension of these methodological training issues, we integrate empirically- and expert-derived suicide risk assessment competencies from several sources with the goal of streamlining core competencies for training purposes. Finally, a framework for suicide risk assessment training is outlined. The approach employs Objective Structured Clinical Examination (OSCE) methodology, an approach commonly utilized in medical competency training. The training modality also proposes the Suicide Competency Assessment Form (SCAF), a training tool evaluating self- and observer-ratings of trainee core competencies. The training framework and SCAF are ripe for empirical evaluation and potential training implementation.
Physician assisted suicide (PAS) poses complex legal and ethical dilemmas for practicing psychologists. Since the passage of the Oregon Death with Dignity Act in 1997, Montana and Washington have passed similar legislation. Despite the law requiring competence evaluations by medical and psychological professionals, existing psycholegal literature inadequately addresses the role of psychologists in the PAS process. This article reviews legal statutes and analyzes ethical dilemmas psychologists may face if involved. We consider competence both generally and in the context of PAS. Suggestions are made for psychologists completing competence assessments and future directions to improve competence assessments for PAS are provided.
Criminal defense attorneys (N = 142) responded to a survey asking them to read a vignette describing a Hispanic defendant charged with assault and rate the severity of the defendant's mental illness and likelihood of referring him for an evaluation of competence to stand trial (CST). The vignettes varied in terms of whether the defendant spoke English or Spanish, and whether his mental illness symptoms were obvious or ambiguous. Overall, attorneys rated the Spanish-speaking defendant as less mentally ill than the English-speaking defendant, and were less likely to refer the Spanish-speaking defendant for a CST evaluation. Attorneys who perceived more logistical barriers to seeking a CST evaluation in their local communities were less likely to refer the defendant for a CST evaluation, but only when the defendant spoke Spanish. These findings suggest attorney decisions were influenced by language, although further research is needed to identify the mechanism of this influence.
The practice of physician-assisted suicide (PAS) is currently legal in Oregon (Oregon Death With Dignity Act, 1995), Washington (Washington Death With Dignity Act, 2008), and Montana (Baxter v. Montana, 2009). In an effort to identify important characteristics of patients and clinicians involved in evaluations of competence to request PAS, 216 licensed psychologists from Oregon and Montana were surveyed regarding their attitudes toward PAS and their personal and professional experiences with suicide. They were also asked to make a competence decision for a patient requesting PAS based on a case vignette. Cognitive ability, as indicated by a question regarding the importance of cognitive ability and components of competence that rely on reasoning skills, was the only patient factor that significantly predicted competence decisions. Results also suggested that personal characteristics of clinicians, particularly whether someone in their personal life had ever attempted suicide and their willingness to support a family member’s choice of PAS, influence their decision regarding the competence of the patient. Exploratory analyses also revealed that clinicians consider perceived burdensomeness to be of little importance when conducting a competence evaluation for PAS. In all, the largest effects were observed for the experimental vignette condition, clinician personal experience with attempted suicide, and clinician perceived importance of patient MacArthur Competence Assessment Tool for Treatment–Appreciation scores. The implications of these results are discussed, centering on recommendations for clinicians considering participating in competence evaluations for PAS and future directions for research.
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