Training non-mental health professionals to assess and manage suicide risk: Community level intervention for suicide prevention in Guatemala

Abstract

Background: Domestic violence, childhood physical and sexual abuse, and gang violence are prevalent and growing problems for Guatemalan youth, particularly in low socioeconomic (SES) areas. Resources in the community for psychosocial support are greatly lacking. Schools often serve as the main source of support for these highly vulnerable adolescents. Yet, many teachers lack the training to manage the psychological distress of their at-risk students and to properly engage, assess, and manage the psychological needs of their students. We developed a brief risk assessment and management training for teachers to address this gap. Aims: We present the acceptability and preliminary effectiveness of the training at increasing teacher’s knowledge and understanding of how to engage and work with their at-risk students around their thoughts and feelings of suicide. Method: Twenty-two teachers from a school in a low SES community in Guatemala participated in the training program. Mixed methods were used to explore effectiveness, acceptability, and satisfaction with the training. Primary outcomes assessed were changes in self-reported knowledge and understanding of engaging and working with students at risk of suicide. Results: Participants reported increased knowledge and understanding of all training targets ( p < .05). Acceptability was high as no participants dropped out and all participants rated the training as useful for their professional development, meeting their expectations, and as highly satisfying. Conclusion: Brief, focused training on suicidality can be effective and is acceptable to lay professionals. Further examination of the effectiveness of the training in a larger sample is required to assess the long-term impact of the training and its transportability to other communities.

Effects of brief training on mental health provider’s knowledge of working with youth at risk of suicide in Guatemala

“…El Limon is noted to be a ‘Red Zone’ district, characterized by violent crime, overcrowding, pollution, and gang activity (i.e. extortion, violent street crime, and narcotics trafficking) (Alonzo et al, 2020). Domestic violence, child abuse, and neglect occur at high rates.…”

“…Domestic violence, child abuse, and neglect occur at high rates. Access to electricity and water is limited, and cable and wifi services are often lacking entirely or unreliable when available (Alonzo et al, 2020).…”

“…Thirty-six years of armed conflict had devastating effects on Guatemala. Today, more than twenty years after the conflict ended, Guatemala continues to struggle with a corrupt law enforcement system and government; family and community fragmentation; endemic poverty; discrimination; gender-based violence; drug and gang related violence; rampant organized crime; and, a government characterized by intimidation (Alvarado & Massey, 2010; Branas et al, 2013; Brands, 2011; Carey & Torres, 2010; Garcia, 2004; Gavigan, 2009; Herrera et al, 2005; Musalo & Bookey, 2013; Reimann, 2008; Rodríguez et al, 2002; Sabin et al, 2003; Puac-Polanco et al, 2015; Alonzo et al, 2020). These conditions have had serious psychological consequences for Guatemalans, including high rates of psychiatric illness and suicide.…”

“…There are virtually no training programs on mental health issues for primary health care personnel. Where training does exist, it is often inadequate in length and depth (Alonzo et al, 2020). For example, training in psychiatry during residency and in medical school for non-mental health specialties is less than 1 month.…”

Creating SPACE

“…Initial capacity mapping identified and validated several common issues, including community and family violence, as well as depression and suicidality, particularly among preteens and teens (ages 11-19). The common points of intersection concerning these immediate challenges allowed participants (teachers and school administrators in Peronia, and mental health care providers, community health care providers, youth leaders, and social workers in El Limon -see Alonzo et al, 2020) to discuss the impact of these issues on education and development and related long-term implications. These common issues were used to guide their strategic planning work and establish how to use and expand existing networks to have a deeper impact and improve outcomes for their communities, particularly concerning health and mental health.…”