title: Individuals at Risk for Suicide.
abstract: BACKGROUND
  Individuals experiencing suicidal ideation and/or behaviors are often difficult to engage in treatment. Up to 50% of individuals presenting to an ER for treatment of a suicidal crisis refuse outpatient treatment referrals. This study examined outpatient mental health clinicians' perceptions of the barriers to and facilitators of mental health treatment engagement of individuals at risk for suicide.
  
  
  METHODS
  Thirty-six mental health clinicians working with clients with past and/or current suicidality (ideation, behaviors) in outpatient mental health centers participated in four focus groups. Data were collected using semistructured interview. A process of content analysis was utilized in which data were analyzed thematically.
  
  
  RESULTS
  Five main domains of barriers and facilitators emerged including (a) client-level, (b) clinician-level, (c) service-level, (d) agency-level, and (e) intervention-level variables. In all, 38 barriers and 31 facilitators were identified. The most frequently identified facilitator was the clinician's own sense of engagement with the client, identified by 31% of the clinicians. The most frequently identified barrier was housing instability, identified by 34% of the clinicians.
  
  
  CONCLUSIONS
  Knowledge of clinicians' perspective on treatment engagement of clients at risk for suicide may inform the development and implementation of interventions and guide training/supervision programs for those working with this vulnerable population.
authors.affiliation: 1 Fordham University Graduate School of Social Service, New York, NY, USA.|2 Suicide Prevention Research Program, New York, NY, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Alonzo
authors.affiliation: 1 Fordham University Graduate School of Social Service, New York, NY, USA.|2 Suicide Prevention Research Program, New York, NY, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Moravec
authors.affiliation: 2 Suicide Prevention Research Program, New York, NY, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011613:Psychotherapy; D012306:Risk; D000068217:Social Workers; D013405:Suicide
keywords: high risk; mental health professional; outpatient treatment; suicide; treatment engagement