Author: erics

Obstacles to Suicide Prevention and Treatment Training

Posted on by erics

Suicide claims one person in the U.S. every 12 minutes, according to the CDC. That’s 123 lives lost each day in America alone.

Many of these people reach out to or are referred to counseling or other treatment and interventions intended to prevent an eventual death by suicide, but unfortunately – and despite the best of intentions – most of these therapists and professionals are undertrained (or not trained at all) and ill-equipped to effectively help these troubled individuals.

Two major obstacles stand in the way of developing and delivering effective training for those in the suicide prevention and treatment field:  insufficient funds availability and a lack of national standards.

Lack of Funding for Suicide Prevention and Treatment in General

As pointed out in a 2018 article by USAToday, although the CDC reports that suicide is the 10th leading cause of death in the United States, and the second leading cause of death in youth, funding for suicide prevention and treatment lags behind other top killers.

In fact, according to NIH, Centers for Disease Control and Prevention, more funds are available for vision disorders, intellectual and developmental disabilities, sleep research, and dietary supplements than for suicide prevention – all associated with conditions having much lower mortality rates than death by suicide.

Additionally, with the exception of accidents, the same study shows that the leading causes of death have declined since 1999, while the suicide rate has increased by 33.3%.

Suicide Rate Chart

Conducting research projects and completing randomized controlled trials (RCTs) needed to determine effective prevention and treatment methods can be expensive, and the costs of developing evidence-based and outcome-based programs and running treatment centers are prohibitive for many organizations.

With this lack of funds for suicide assessment and treatment in general, it follows that training in effective assessment and treatment is also lacking – and that is certainly distressing for those in this field.

No National Standards Requiring Training for Suicide Prevention and Treatment

As reported in the American Journal of Public Health, a study completed in 2017 found that only ten states currently mandate training for behavioral healthcare professionals in how to spot risk for suicide and take preventative action. Furthermore, there are no national standards requiring training. The study identified the following:

  • # of states with policies mandating and encouraging suicide prevention training for healthcare professionals:  2
  • # of states with a policy mandating suicide prevention education for healthcare professionals:  8
  • # of states with a policy encouraging suicide prevention education for healthcare professionals:  5
  • # of states with a policy mandating or encouraging training for the treatment for suicidal patients for healthcare professionals:  0

The same report, which emphasizes deficiencies in mental health training, asserts that accrediting organizations must include suicide-specific training and education in their graduate programs, and furthermore, the government should require such training for healthcare systems receiving state or federal funds.

The Dangers of These Obstacles

We all want to help, but the fear of doing or saying the wrong thing and failing to effectively treat a person in need can have devastating effects.

In fact, with no other option in sight, poorly trained therapists often resort to referring suicidal clients to the emergency room. However, studies show that emergency department presentation and admission into psychiatric hospitalization can actually increase the risk of a lethal outcome in people with suicidal ideation.

In addition to a fear of failing to successfully treat a suicidal client, there’s also the concern of exposure to malpractice liability and the risk of losing one’s license to practice. In their confusion and grief, families of suicide victims often look for external causes for the loss of their loved ones, sometimes landing on the actions or inactions of those who were meant to help.

Too often, these fears leave suicidal patients without the care, treatment, or interventions that they so desperately need.

Overcoming Obstacles to Training

If suicide were more commonly and widely viewed as a leading public health issue, as other leading risks are, perhaps more funds would be allocated to suicide prevention and treatment, and more focus would be put on developing standards for effective training.

In the meantime, CAMS-care offers training in the evidence-based and outcome-based Collaborative Assessment and Management of Suicidality (CAMS) framework, developed by Dr. David A. Jobes over the course of the last 30 years.

With a robust base of clinical trial research, the CAMS framework presents a collaborative approach to suicide assessment, intervention, and treatment. Flexible and affordable training, available both online and onsite, helps healthcare providers and other individuals become more confident in their ability to help their clients and patients with suicidal ideation and risk and avoid lethal outcomes.

Self-Determination Theory (SDT) and the CAMS Framework® of Evidence-Based Suicide Prevention

Posted on by erics

I was recently reviewing some literature for a current study and happened to come across a newly published conceptual article by a scholar named Édua Holmström, who is at the University of Helsinki in Finland. The article was a marvel to me as Holmström’s paper uses the “Self Determination Theory” (SDT) to conceptually explain how the CAMS Framework® of suicide prevention motivates suicidal individuals to choose life.

The Power of CAMS

Those who use the CAMS framework with suicidal patients already know that it first and foremost is based on empathy & honesty, and encourages your clients to work collaboratively with you to develop their unique suicide-focused treatment plans. This paper shines a light on this important element of the CAMS approach to treatment, and theorizes that this autonomy and acknowledgment of the client’s ability to make decisions about their own treatment plan is the key to the effectiveness of CAMS to clinically help save lives.

Applying Self-Determination Theory to CAMS

It turns out that SDT elegantly describes certain key aspects of this spirit and embodies the essence of doing CAMS as a collaborative and empathic therapeutic patient-centered framework. Within CAMS there is a clear and overt emphasis on respecting and validating the suicidal patient’s autonomy, a central construct within SDT. Writing about CAMS, Holmström notes “…many suicidal individuals make informed decisions about treatment with the support of an empathetic clinician.”

I could not agree more. And it is exhilarating to read the reflections of an unmet scholar in a faraway land applying a novel theory (at least to me) as explanatory for this evidence-based approach to suicide intervention that has consumed me over my entire professional career. Even after 35+ years in the field I cannot begin to describe the unabashed excitement I felt discovering this beautifully written paper about something that is so near and dear to my life’s work, and it got me thinking…

I often say to my students, “There are no new ideas, just repackaged old ones that capture enduring truths.” Over the years I have heard variations on this notion as it relates to CAMS. A seasoned and savvy inpatient nurse during a training session once told me that CAMS was nothing new, it was simply good nursing! She was delighted when I agreed and shared that I began my professional career on inpatient nursing staff as a psych tech. Her response? Of course, you did, I knew it! Some years later I had a similar conversation with a sophisticated clinical social worker who insisted that the essence of CAMS was merely doing good clinical social work!

Over decades I have come to relish many such conversations with clinicians across disciplines who have said in some way or another that they have been “doing CAMS” for years without realizing it. I think of my friend Kevin Briggs, who was a CHiPS highway patrolman for many years. His beat was the Golden Gate Bridge, and in his book, Guardian of the Golden Gate Bridge, Kevin recounts incredible experiences of talking suicidal of people out of jumping to their deaths from the iconic bridge. He could not save them all, but he literally did help save hundreds of lives. Over coffee, Kevin once told me that he used to lie down on the pavement to be at the same level with certain prospective jumpers sitting on a pipe on the other side of the railing so he could talk to them at their level. He asked me: So, was I doing CAMS? My response: Kevin, you are a natural!

Benefits of Evidence-Based Treatment

Many of my days are consumed with randomized controlled trials (RCTs), interpreting data, and writing scientific papers in my determined effort to prove that CAMS works through replicated RCTs with the highest rigor of science possible. It is my passion and my goal to well establish a solid place for CAMS within systems of care as a means of clinically saving lives for people on the brink of life.

But when I read this article from a faraway land explaining to me how my intervention works, it gave me pause to think. I reflected on many conversations over decades with clinicians about how to help save lives. And I reflected on some simple and enduring truths about life. Most people want to live a life with purpose and meaning; most do not desire death by suicide. But for those who do, simple ideas about autonomy, empathy, collaboration, and truth go a long way toward creating the possibility of saving a life, even in the face of suicidal despair. “Good nursing” or “good social work” can help transform lives and help people self-determine whether they live or die.

It is gratifying and humbling to see an outside source confirming the importance of self-determination concepts as potential cornerstones of CAMS.