The few studies conducted on clergy knowledge and attitudes regarding suicide suggest that many clergy members need and desire training in assessing suicide risk (Domino, 1985; Leane and Shute, 1998). Although many congregations forge formal collaborations with professional mental health services (e.g., Thomas et al., 1994), Mannon and Crawford (1996) found that clergy from small congregations or from more conservative backgrounds are less likely to refer individuals to professional mental health services. They also reported that many clergy feel less confident about providing support and advice about severe mental disorders than about other matters. However, the African American ministers in their sample reported high levels of confidence even about handling serious mental disorders among their parishioners. Given the positive effects on mental health and suicidality of religious involvement and complementary faith-based treatment (e.g., Donahue, 1995; including seeking help from clergy, Koenig et al., 1998; Propst et al., 1992, see Chapter 6) and the widespread use of clergy, many comprehensive suicide prevention programs incorporate faith-based interventions into their strategies (see Chapter 8). Some researchers have also authored articles and handbooks delineating appropriate responses to suicidal and distressed elderly and youths for clergy (e.g., Koenig and Weaver, 1997; Weaver, 1993; Weaver et al., 1999).

To maximize treatment effectiveness and to reach under-served groups, collaborations of mental health professionals with culturally relevant providers, including spiritual ministers could be effective (Marsella and Yamada, 2000; Weaver, 1993). In recognition of the importance of cultural context, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994) provides guidelines for a culturological assessment of individuals presenting with mental disorders and includes mention of cultural variations in the expression of psychopathology. Nursing diagnoses have included spiritual distress and spiritual well-being for years (Johnson et al., 2001). The framework for culturally and spiritually sensitive approaches to treating and reducing mental disorders and suicidality is emerging.

• Assessment tools are inadequate to determine acute suicide risk or to predict when a person will attempt or complete suicide. Assessment tools must be validated for various populations since they may not be generally applicable. Despite the limitations, tools for detection or risk assessment can be an important component of treatment when used appropriately.