Imagine you’re having chronic migraines. You see your doctor, who prescribes a colonoscopy. Makes no sense, does it? But the rough equivalent happens to tens of thousands of people who seek mental health help for suicidality every year.
Suicidality is often approached as a symptom of mental health diagnoses, such as bipolar disorder or depression, explains Nicole Siegfried, Lightfully’s Chief Clinical Officer. It’s not treated independently—it’s folded into other interventions, with the hope that it eases alongside the symptoms of the disorder.
“Research shows that in addition to appropriate assessment, the most effective interventions are specific to suicidality,” says Siegfried. “They improve emotional acceptance, reduce attachment to suicidal thoughts, increase hope, and boost belonging and connection.”
In 2020, almost 12.2 million people ages 18 or older reported that they had serious thoughts about suicide, according to the Centers for Disease Control and Prevention. Of those, 1.2 million people attempted suicide, and roughly 46,000 died by suicide.
Suicide is now the ninth-leading cause of death in the United States, and the second-leading for those ages 10-14 and 25-34.
What’s more, nearly half of individuals who die by suicide visited a healthcare provider in the month before their death. Clinicians are not always well-equipped to accurately assess for suicidality or provide effective, long-term interventions for chronic suicidality, says Siegfried.
Revamping mental health care to successfully assess and treat suicidality requires an agile model in which suicidality can be addressed as a specific focus of treatment. That’s why Lightfully’s interventions include regular assessments from both clinicians and patients, a process-based therapy (PBT) treatment model, and continuous tracking of progress.
Together, these represent a groundbreaking approach unique to Lightfully. Let’s take a closer look at each.
The Advantages of Regular Assessments
Understanding suicidality requires that clinicians have a holistic view of the patient’s mental health and the core maladaptive processes that need to be addressed during treatment. That’s where assessments come in. Most clinicians receive less than two hours of training in assessing suicide risk, says Siegfried. At Lightfully, all staff receive formalized training in suicide risk assessment, addressing risk factors, safety considerations, and protective factors.
Patients are evaluated multiple times (at least weekly) during their stay at Lightfully through evidence-based assessments for a range of symptoms, including suicidality, Siegfried says. The Interpersonal Needs Questionnaire (INQ), for example, assesses various processes related to suicidality, while other, more formal assessments target patients’ thoughts and behaviors.
These are especially helpful for clinicians who want to determine patients’ suicide risk levels and gauge the impact of treatment on reducing suicidality.
“Suicide risk assessments aren’t necessarily on a timetable. For instance, you don’t have to wait for a full week before you reassess,” says Amber Parris Claudon, LICSW and Lightfully’s Vice President of Clinical Training. “You can reassess at any moment based on how the client is presenting at that time.?”
Regularly measuring mental health outcomes has two benefits for clinicians and patients: Clinicians can easily track the effectiveness of Lightfully’s interventions, and they can adjust care in real time to fit individual patient needs.
The Unique Benefits of Process-Based Therapy
When people are struggling with negative emotions, they often ask for clinicians to “take it away,” Siegfried says. But trying to avoid emotional pain is often what leads to suffering.
“What happens often is the emotion feels so intolerable, patients do everything they can to avoid it. Unfortunately, avoiding negative emotion creates a cycle in which emotional suffering actually increases,” Siegfried says. “We tell people, ‘Hey, we’re not going to take away your negative emotion. Negative emotion is part of the human condition. We are going to help you learn to approach your emotional pain with compassion and acceptance, which will ultimately reduce your suffering.’”
Lightfully’s distinctive treatment model is centered on PBT, which provides patients with an exploration of how they approach and interact with their difficult emotions and negative thoughts with the goal of moving into compassion and acceptance rather than avoidance.
Through this unique approach, Lightfully’s interventions promote adaptive practices that lead them from suffering into well-being.
Why Continuously Tracking Progress Is Vital
Assessing suicidality involves patients too, Claudon says—they complete weekly assessments that provide practitioners with an inside look at how patients are responding to interventions and how they perceive the therapeutic relationship.
By continually receiving feedback from patients, clinicians can gain a clearer picture of how their patients are progressing and target specific issues during treatment.
This is especially important, because sometimes patients can’t or won’t express how they feel during sessions with clinicians. Written assessments give them the chance to be more open about their mental health and treatments, Claudon says.
“Our patients might not be able to sit down in session and say, ‘Amber, I feel so sad and disappointed and hopeless,’” Claudon says. “But they might have an easier time sitting down with an assessment and reading different questions and cues and expressing their pain or their struggles. So it gives us this extra layer of safety to compare what the client is presenting as versus how they show up in an assessment.”
Keeping a close watch on how patients respond to treatment and progress during their time at Lightfully is vital, Siegfried says. Clinicians want to constantly evaluate which interventions within PBT are effective for that patient.
After all, the goal for clinicians is to leave patients with the tools they need to for emotional flexibility beyond their time at Lightfully.
“We’re not just alleviating symptoms. We’re changing those underlying core processes so that when other things come up, they will have a new way of interacting with those life stressors,” Siegfried says.
“Treating the core processes that perpetuate suicidality is a long-term endeavor,” she continues. “Even when suicidal symptoms improve, clients will need to continue to address those maladaptive processes that keep them stuck. We get the client to a place where they’re able to continue the work with their outpatient team more long term.”