This feature by Tony DuBose, PsyD and Yevgeny Botanov, PhD is a reflection on the mental health profession. DuBose and Botanov take stock of the state of the field, both in terms of achievements as well as taking a look at how to raise the bar for the future.
On September 10 we observed World Suicide Prevention Day and on October 10 we will observe World Mental Health Day. Amid these two observances, it is important to reflect on the accomplishments that have increased access to much needed psychological interventions and to examine what more can be done.
The World Health Organization estimates that nearly 1 million people die by suicide annually. To extrapolate from the figures in the United States – where there is 1 death by suicide for every 25 attempts – we can estimate that globally 25 million people attempt suicide annually. Furthermore, over 40% of individuals who attempt suicide do not receive mental healthcare; half of those who do receive mental healthcare report that treatment doesn’t meet their needs.
Behavioral Tech specializes in training mental health professionals in DBT, a treatment that was initially designed to treat suicidal behaviors. The initial studies on DBT focused on individuals with borderline personality disorder (BPD) due to their high risk for suicidal behavior. Some of us still recall the time when BPD was considered untreatable. Unfortunately, there are likely still mental health professionals who continue to hold outdated beliefs about BPD and suicide.
Fortunately, the empirical evidence says otherwise. Significant progress has been made in the last 30 years in treating individuals diagnosed with BPD, and those at high risk for suicide. While DBT has the largest body of evidence, other evidence-based interventions have also been developed. Unfortunately, a recent survey conducted by researchers at Harvard University and the University of Toronto indicates a lot of variability worldwide in the number of providers who are trained in these treatments. Additionally, only a very small percentage of those who are licensed mental health professionals in the United States provide these treatments.
The dearth of mental health providers trained in evidence-based treatments is exacerbated by the global need for effective treatments. DBT was created to treat high levels of emotion dysregulation, and BPD is one of the diagnostic disorders within the spectrum of severe emotion dysregulation. Our conservative estimate, based on review of several international sources on the epidemiology of BPD, is that about 3% of the global population will experience high levels of distress because of severe emotional dysregulation in their lifetime. The current global population estimate of individuals aged 15-65 is about 4.5 billion people. Thus, the conservative estimated global need for treatments to help individuals experiencing high levels of distress from difficulties in emotional regulation is 135 million people.
Our basic message is that there are approximately 135 million people in the world who at some point in their lives will experience functional difficulties due to severe emotional distress, and many will consider suicide. While it is very difficult to determine what percentage of people in the world have received an effective treatment for these problems, our estimate is it is probably no more than 2%.
We also consider the reasons why so few mental health professionals will provide these services. Often there is fear that working with suicidal individuals will lead to an unmanageable workload or interfere with their personal lives. The research data indicates that self-efficacy tends to guide the treatments mental health practitioners provide. Meaning practitioners are less likely to use an intervention they don’t feel they have the capacity to execute well. We also think there may still be a sense of hopelessness about the ability to treat individuals who have severe and complex problems. We hope that the past three decades of data can convince practitioners that evidence-based treatment like DBT can indeed be effective. Attaining specialized training can reduce burnout, increase self-efficacy, and reduce out-of-session coaching. Working with severe and complex individuals could lead to increased reward and satisfaction.
If you are a mental health professional who is moved by the need to help those who suffer greatly, we want to extend hope to you that there is an effective and rewarding way to engage in this work. More importantly, we extend an invitation to you to join the ranks of those of us who work to help people build lives they experience as worth living. For more information about upcoming training events, click here or contact us at firstname.lastname@example.org with your questions.
Anthony P. DuBose, PsyD, is the Chief Training Executive & Director of CE/CME for Behavioral Tech, LLC, and a Founding Member and Advisory Board Member of the Evidence Based Treatment Centers of Seattle, PLLC. Dr. DuBose has trained and consulted internationally in the treatment of borderline personality disorder, substance use disorders, and suicidal and self-injurious behaviors in adults and adolescents. He has collaborated with Marsha Linehan, Ph.D., ABPP, and other researchers on the study of DBT, particularly related to its dissemination and implementation. He is licensed as a psychologist by the state of Washington, and is certified as a DBT Clinician by the DBT- Linehan Board of Certification.
Yevgeny Botanov, PhD is a licensed clinical psychologist and assistant professor at Pennsylvania State University – York. He completed his doctoral training at the University of Kansas and his predoctoral internship at Northwestern University, Feinberg School of Medicine. Dr. Botanov is interested in clinical science, particularly in relation to depression and suicide. This includes the efficacy and effectiveness of health interventions and mechanisms of change. He seeks to understand not only what interventions work but also how they work. Recently, Dr. Botanov has begun examining clinical science literacy in health professionals and health consumers.