Background: Suicide rates have increased over the last 25 years in the US. Most prevention efforts are clinically-focused (e.g., Zero Suicide Initiative), which are life-saving and much-needed, but medical professionals are not the only workers who interact with people at risk for suicide. There are other industries that intersect with people at high-risk for suicide, principally around life disruptions (e.g., divorce, financial problems, unemployment) that are positively associated with suicide. Unlike clinical professionals, professionals in “industries of disruption”, such as family law attorneys, have no mental health training. This mixed methods study examined how frequently family law attorneys encountered clients in mental distress, their exposure to client suicide, and their recommendations for suicide prevention.

Methods: Data are from semi-structured interviews with attorneys (n=17) and an online survey with a convenience sample of attorneys (n=381). A sampling universe was compiled from contact information publicly available through state-based registries of family law attorneys. In the beginning of the project, interviews were completed with 17 attorneys to explore experiences and inform development of an online survey. For the online survey, attorneys were invited to participate via direct email with up to three follow-up emails. Qualitative data analysis was conducted used template analysis to accommodate the semi-structured interviews. Descriptive statistics were used to summarize quantitative findings.

Results: In the qualitative study, vexing themes emerged from attorneys recalling often harrowing experiences with suicidal clients and having little to no training about mental health during law school. Many said their “hands were tied” and could not escalate help or notify others about a client’s mental health concerns, which co-occurred with a theme of “ethical quandaries” of attorney-client privilege. Feeling like their “hands were tied” also related to a theme of "across the table," in which attorneys recounted experiences when the opposing side's client appeared at risk for suicide; situations in which they felt they could not intervene. The online survey sample was comprised of 61% women and the average age was 52.2 (SD=12.7). The majority (71%) had worked with a client at risk for suicide at some time in their career, and of them, 36% reported working with such clients in the past 6 months. Over one-third (36%) experienced a client die from suicide, and 26% had experienced the opposing side’s client die from suicide. Only 27% of respondents reported receiving suicide prevention training. The most highly endorsed (46.9%) training strategy was a website for attorneys indicated what they can/should do for at-risk clients.

Conclusions: To our knowledge, this is the largest survey of family law attorneys to examine their exposure to suicide, revealing they are highly exposed to suicide and generally lack training in suicide prevention. Data collection is underway with additional industries of disruption: mortgage and loan default and bankruptcy; employment workforce development and unemployment services; and the self-storage industry. Results from across these industries provide the foundation for next steps to develop, tailor, and test suicide prevention training for in these overlooked industries that frequently encounter individuals experiencing suicide risk.