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Effect of gender, suicidal severity and therapist characteristic on likelihood to treat

How mental health professionals responded to a hypothetical patient

Article under review: Almaliah- Rauscher, S., Ettinger, N., Levi-Belz, Y. and Gvion, Y. (2020). “Will you treat me? I’m suicidal!” The effect of patient gender, suicidal severity, and therapist’s characteristics on the therapist’s likelihood to treat a hypothetical suicidal patient. Clinical Psychology and Psychotherapy, DOI: 10.1002/cpp.2426

Summary: Unfortunately, when a person is seeking treatment and they are in crisis, there is an expectation that clinicians’ responses would be consistent and supportive. In this article, we review research completed by Almaliah-Rauscher and colleagues (2020) that finds people experiencing suicidality are more likely to be referred on, particularly if they are female. This research is helpful in understanding barriers to treatment and particularly suicide prevention.


Most mental health professionals will encounter suicidal patients during their working lives. There could be any number of factors that influence a mental health professionals’ decision to treat a suicidal patient, or their decision to refer them elsewhere for support. A recent study has sought to improve understandings about how professionals make these decisions to treat or refer, and what personal and professional attributes might also be involved.

Previous studies in this area have identified that there are different treatment pathways for people who present with suicidality when compared to those without an elevated risk for suicide. Patients who are suicidal are more likely to be referred to and less likely to be treated. The reasons for this tendency to refer suicidal patients are multiple, complex, and often relate to the individual experience, training, and beliefs of the practitioner. Many professionals working with suicidal patients have had very little specific training in this area and may doubt their competence to treat. The risk of losing a patient to suicide, and the associated guilt and stress might also influence some to refer.

This study sought to extend previous research by assessing the clinician’s likelihood to treat, as well as their empathy and emotional reactions to a hypothetical case study. The degree to which the therapists were susceptible to taking on the emotions of their patient (emotional contagion), combined with an assessment of their own mental health and wellbeing (depression levels) were assessed.

In the study, a total of 331 mental health professionals (psychiatrists, social workers, art therapists, and psychologists) were exposed to one of four hypothetical case studies which shared some common features, but which varied when it came to the patient’s gender, and their risk of suicide, detailed as high or low risk. The voluntary participants completed an online questionnaire. The case study prompted the professionals to assess their willingness to treat and likeliness to refer, helping to assess if gender or suicidality could be deemed to influence this decision. Data related to other personal and professional variables; seniority, training stage, age, education, number of suicidal patients in the last year, and total hours of suicidal training, were also gathered.

The study proved the researcher’s hypothesis that there is a greater chance that potentially suicidal patients will be referred to while depressive non-suicidal patients are more likely to be treated. With regard to the influence of patient gender, the likelihood to refer female patients was higher than the likelihood to refer male patients however willingness to treat female patients also tended to be higher when compared with males. The gender effect was significant only in the high suicidality scenario.

Study Limitations
The study used a hypothetical case study which may have generated different results when compared to outcomes with actual patients. A higher preference to treat women might have been related to the disproportionate number of women undertaking the survey (81.9% of respondents).
Opportunities for professionals and their employers

The study recognises there is a growing need to understand what factors influence treatment pathway decisions, and to support professionals to better understand their practice when working with suicidal patients.

The findings of the research present areas of opportunity for practitioners, and those that support practitioners either through their education or employment. The study asks mental health professionals to reflect upon and consider their owner tendencies to either treat or refer. Referring to the ‘gender paradox’, the study encourages mental health professionals to be more cognizant of the gender-related factors that may influence their decision to treat or refer a patient.

Personal and professional reflective practice regarding the influence of emotional contagion and countertransference can have in work with patients who are suicidal is encouraged.

The study found that professional characteristics rather than personal traits are more important when it comes to treating suicidal patients. This means that training, support, and the continued opportunity afforded by the up-skilling of mental health professionals will lead to more confidence to treat patients who are suicidal. The article indicates further research is required around the development and usefulness of training programs for mental health professionals.

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