Gatekeeper training to prevent youth suicide – does it work?

This week, Suicide Prevention Week, I am posting each day about a "hot topic" in suicide prevention. Gatekeeper training is perhaps the hottest of the hot, at least in my opinion, as it is quite possibly the most popular intervention undertaken by those involved in suicide prevention.

Gatekeeper training involves educating natural helpers, or adults who interact with youth as part of their regular day, to recognize warning signs for suicide and know how to respond appropriately to suicidal youth. A gatekeeper should ultimately be able to provide a link, or open the gate, between a young person and a mental health professional.

The interesting thing about gatekeeper training as an intervention is that we have little evidence indicating that it works. By works, I mean a few things. Do gatekeeper training programs get adults who work with youth to ask the "suicide question?" Are we training the right adults? Do youth even go to adults to talk about their feelings?

Researchers Peter Wyman and Hendricks Brown, along with a team, have started to answer some these questions, while raising additional ones.

Many in schools and communities are training everyone they can possibly reach as gatekeepers. The results of the research done by Wyman, Brown, et al. indicates that it would be better to focus on training those who already have open, communicative relationships with youth. Those people might be teachers, mental health professionals, or coaches.

When the school district studied provided gatekeeper training to staff who were already asking youth about suicide, such as staff in helping profession roles within the schools, those staff continued to ask students about suicide. When the same training was provided to those who weren't already asking students about suicide, there was little effect on their behavior. In other words, those adults who do not ask students about suicide are not going to start asking because of a training. They may report knowing more about suicide risk and suicide prevention, but that knowledge is not translating into behavior change. For the helping professionals in the study, the barriers to open communication about suicide had already been broken down, facilitating student communication to these staff about suicidality.

Additionally, the study found that suicidal students' own attitudes and behaviors influenced whether school staff learned about students' suicidality. It's very much a chicken-or-egg type of situation. If students don't feel like the adults in their school or community will listen to them, they are not likely to come forward, no matter how many adults are trained to respond appropriately. If students don't come forward, trained gatekeepers don't have the opportunity to ask the question, no matter how well-intentioned they may be about using their training.

One program takes a unique approach to gatekeeper training, integrating it into a comprehensive approach to suicide prevention. "Sources of Strength," recently accepted into SPRC/AFSP's Best Practices Registry, has teens identify the trusted adults in their school or community. Then, those people are approached to be trained as gatekeepers.

One thing those of us working in suicide prevention can do is take into consideration the questions raised by Wyman and Brown's research when thinking about implementing a gatekeeper training program. These research findings reinforce the importance of taking a strategic and comprehensive approach to suicide prevention.

Copyright 2009 Elana Premack Sandler, All Rights Reserved