Suicide Risk Following Hospital Discharge

Posted on March 9, 2026March 19, 2026 by erics

When a person is facing a serious mental health crisis, they often go to or are taken to the hospital. While at the hospital, the focus is on stabilization and keeping them safe. But what happens once they leave?

Multiple studies show that a patient’s risk of suicide significantly increases once they are discharged from the hospital. [1] In the first week after discharge, the risk of suicide increases by 300 times higher compared to the general population. [2] Also, as many as 30% of patients admitted to the hospital for a suicide-related concern are re-admitted within a year. [3]

Something clearly needs to change. We must better support patients who experience a serious mental health crisis. We also need to help prevent a crisis from happening again. During this vulnerable time, patients deserve the best care possible so they can get on a path to healing. While there are many factors at play when it comes to post-discharge suicide risk, there are some steps that hospitals and clinicians can begin implementing to help start actionable change.

What Happens During Hospital Discharge?

Before a patient is discharged from the hospital, there are steps put in place to help reduce the patient’s risk of suicide. These steps often include creating a safety plan and counseling on reducing access to lethal means. While these are meant to help reduce risk, they are often not enough. The patient is then discharged from the hospital with either a plan for follow-up outpatient care or a care referral. This transition is where the risk period begins.

Why Post-Discharge Care is Often Unsuccessful

There are many factors at play when it comes to suicide after hospitalization. Here are some of the key areas where the systems in place may be failing.

Inconsistent use of screening and assessment tools
Hospitals often vary in how they identify high-risk patients. Many of the tools focus on risk factors rather than digging deeper and identifying the root of the patient’s suicidal thoughts. These standard risk assessments can feel like a checklist rather than a unique, patient-centered approach to treating what lies beneath. They may miss specifics that could be helpful in treating the patient moving forward.

Fragmented care transitions
Currently, there is no standard protocol to follow when it comes to handing off patients in emergency departments to outpatient providers. This handoff is where a lot of the risk comes in because the next steps often rely heavily on the patient. Patients may leave the hospital feeling confused, unsupported, or ill-equipped to take the next steps toward getting long-term, sustainable care. It’s important to also remember that the patient just went through an extremely traumatic event and may still be feeling overwhelmed. It’s important that they have the correct steps laid out in front of them and a plan in place for care with a clinician who can provide further support.

Barriers to accessing outpatient mental health services
Ideally, the first follow-up session after discharge should happen as soon as possible. Unfortunately, follow-up care is not always straightforward or easy to access. Often, the patient does not follow their discharge plans. In fact, around only 50% of patients follow up on their referrals for outpatient care. [4] Depending on the patient’s situation, they may face several barriers when it comes to accessing outpatient care, whether it’s financial, logistical, or a combination.

Challenges Hospitals are Facing

In addition to each of the factors above, hospitals themselves are also facing their own challenges. Many hospitals are overwhelmed. From overcrowded emergency departments to short (and often overworked) staff, hospitals struggle to keep up with the demand. Clinicians may not have the capacity to do a thorough suicide risk assessment of the patient as well as intervention work. There may simply even not be enough space for patients at risk to stay in the hospital for as long as they need to.

Hospitals and emergency departments can also be extremely stressful environments for those already dealing with a mental health crisis. People in emergency rooms for mental health reasons may often be deprioritized due to other more urgent needs coming through the doors. This means that those in a mental health crisis may be waiting for hours if not days before they are truly seen and helped in the ways they may need.

Emergency medical settings are a critical point of care. By providing access to suicide-focused treatment beyond just stabilization, there are opportunities to bridge a consistent gap in mental health care and take the necessary steps towards saving lives.

Tia Tyndal, Ph.D.

How CAMS Can Help Address These Gaps

CAMS, the Collaborative Assessment and Management of Suicidality, is an evidence-based clinical framework that is focused on identifying and treating suicidal drivers. CAMS has been used in various mental health care and hospital settings. Here are a few of the ways that CAMS can work to help bridge the gap between inpatient and outpatient care for those in crisis.

Structured yet flexible: CAMS works well within fast-paced settings. It can easily be integrated into existing workflows without disrupting other methods and protocols.
Improved risk assessment: CAMS tools focus on the patient’s voice and their meaning, not just symptoms or risk assessment scores. It supports clinicians in documenting clear, shared clinical plans.
Safety planning that works: Safety planning is a key element of CAMS. It is collaborative, meaning the patient and provider work together to come up with a plan. This helps patients feel more equipped and in control.
Bridging the transition: CAMS helps bridge the transition between inpatient and outpatient follow-up care. By providing protocols for follow-up, CAMS helps cement continuity so that no patient falls through the cracks after discharge.
Training & skill-building for staff: CAMS provides specific training that helps those working with people in crisis. CAMS Brief Intervention (CAMS-BI™) is a training that is designed to be used for those working in emergency departments.

Complementary Solutions: EmPATH Units

One fairly recent advancement in emergency care for those struggling with a mental health crisis is the development of EmPATH units. As an extension of emergency departments, EmPATH units are designated spaces specifically for those in a mental health crisis. They are designed to offer a more calm and comforting atmosphere. While still fairly new, more EmPATH units continue to be added onto hospitals and clinics across the United States.

Practical Steps Hospitals Can Take Now

While not every hospital has the current ability or resources to add an EmPATH unit into their system, there are other steps that many of them can take in the meantime.

Training & implementation
Training and implementing CAMS is a great place to start. All individuals start with the foundational clinician training. From there, staff can be trained in specific areas, such as CAMS-BI™. Hospitals might consider a phased rollout with champions in key departments to help them as they get started.

Workflow integration
Next, embedding the CAMS Suicide Status Form (SSF) into electronic health records is a way to help make sure nothing slips through the cracks. Hospitals might start aligning their discharge protocols with CAMS documentation. They might also align follow-up procedures. This could happen as they continue to implement CAMS into their system.

Cross-department collaboration
It’s important to be sure that everyone is on the same page. By connecting emergency departments, inpatient psychology and psychiatry, outpatient providers, and care managers, everyone can know the standard protocols of CAMS. If possible, it may be helpful to have times of regular case reviews to refine practice and improve outcomes as well as referrals that continue using CAMS.

A Better Path Forward

Suicide risk after hospital discharge is a serious issue. It seems backwards that the time period after a patient receives care for a crisis is also the time they are at the highest risk of suicide. However, taking steps to lower this risk is doable.

CAMS provides an evidence-based treatment that improves patient care. It is structured, giving clinicians real, concrete steps to follow. It is also extremely adaptable and can be catered to individual patients and their lived experiences. From assessment to discharge to after care, CAMS can be used along every point of a patient’s road to recovery. Hospitals can start pursuing training in CAMS. They can also take steps to better align their departments and clinicians. This will help everyone be on the same page when treating at-risk patients. Nobody should have to slip through the cracks when treatment and hope is available for all.

Sources:
[1] https://www.jointcommissionjournal.com/article/S1553-7250(24)00067-9/fulltext

[2] https://theactionalliance.org/sites/default/files/report_-_best_practices_in_care_transitions_final.pdf

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC4504270/

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC4504270/

Frequently Asked Questions

Why is suicide risk higher after hospital discharge?

Suicide risk is significantly elevated after hospital discharge because patients are transitioning from a highly structured environment to one where support and monitoring may be less consistent. During this period, individuals may still be coping with the factors that contributed to their crisis while also facing barriers to accessing follow-up care. Research shows that suicide risk can be dramatically higher in the first week after discharge compared to the general population.

How long does suicide risk remain elevated after hospitalization?

The period immediately following discharge—especially the first week—is considered one of the highest-risk times for suicide. However, elevated risk can persist for months as patients attempt to reconnect with outpatient care and stabilize their mental health. Ensuring continuity of care and timely follow-up appointments is critical during this extended vulnerability window.

What are common gaps in post-discharge mental health care?

Common gaps include inconsistent suicide risk assessments, fragmented transitions between hospital and outpatient providers, and limited access to timely follow-up care. Many discharge plans rely heavily on patients to arrange services themselves, which can be difficult during a period of emotional distress. These system challenges can leave individuals feeling unsupported and increase the likelihood of disengagement from treatment.

What is the CAMS Framework® and how does it support suicide prevention?

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical framework designed to assess and treat suicidal risk by identifying the psychological drivers behind a person’s suicidal thoughts. Rather than focusing solely on risk factors, CAMS emphasizes a collaborative process between clinician and patient to develop targeted treatment and safety planning. Learn more about the CAMS Framework® at https://cams-care.com/about-cams/.

How can hospitals improve suicide prevention after patient discharge?

Hospitals can improve post-discharge suicide prevention by strengthening care transitions, implementing consistent suicide-focused assessments, and ensuring rapid follow-up with outpatient providers. Training clinicians in structured, suicide-specific approaches can also help improve continuity of care and documentation. Many healthcare systems integrate the CAMS approach into their workflows to support assessment, collaborative safety planning, and follow-up care. Learn more about CAMS training at https://cams-care.com/training-certification/.

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After Your Child’s Suicide Attempt

Posted on January 26, 2026April 3, 2026 by Heidi Hamamoto

What to Do After Your Child’s Suicide Attempt — and How CAMS-Care Can Help

When a child has attempted suicide, the days and weeks that follow are often filled with fear, confusion, guilt, and uncertainty. Many parents describe feeling overwhelmed — unsure of what to say, what to do next, or how to help their child begin to heal. The video Parents to Parents: After Your Child’s Suicide Attempt was created to speak directly to these very real experiences, offering guidance from both clinicians and other parents who have walked this difficult path.

This guidance aligns with principles from the Zero Suicide Initiative, an organization that offers evidence-based, suicide prevention consultation and guidance. Research on the Zero Suicide Framework shows that care is improved (individually and at a system level) when it is proactive, collaborative, and specifically focused on suicide risk rather than general mental health alone.

The video linked at the bottom of this page can help parents understand what recovery actually looks like after an attempt: how to talk with their child, how to create safety, and how to partner with clinicians in a structured and hopeful way during a frightening time.

1. Acknowledge the Emotional Impact

First and foremost, it’s important for caregivers to recognize and validate their own emotions. Guilt, fear, anger, panic, numbness, and even relief can all coexist in the aftermath of a suicide attempt. These feelings are understandable — and common.

The video underscores that, while it can feel isolating, parents are not alone, and their reactions are shared by many families who have survived this crisis.

2. Understand What Comes Next

After the immediate medical response (emergency care, hospitalization if needed), the focus shifts to support and safety. This includes:

Co-creating a safe home environment by removing/securing or reducing access to potential means of harm.

Engaging with clinicians and mental health providers to initiate follow-up care, including therapy and psychiatric support.

Listening openly to your child’s feelings and thoughts without judgment, and letting them know they are loved, valued, and safe. The film encourages parents to learn what signs to watch for, how to talk about the attempt with their child, and how to make mental health care accessible.

3. Seek Evidence-Based Suicide-Focused Care

One essential piece in a child’s recovery journey is accessing evidence-based therapeutic approaches that focus specifically on suicidality rather than general mental health management alone. One such model is the Collaborative Assessment and Management of Suicidality (CAMS) — often referenced in suicide care communities and clinical settings.

CAMS is a suicide-specific treatment framework that actively involves the young person in identifying what is “driving” their suicidal thinking and collaboratively building a plan to address those drivers. It’s not a rote checklist; it’s a flexible, empathic approach where the clinician and child (or family) work together to:

Assess suicidal risk in depth

Create personalized safety and stabilization plans
Build treatment beyond safety and stability that moves teens towards lives they find worth living

Track progress and adapt care as needed

This model has been supported by research showing reductions in suicidal ideation, hopelessness, and distress, and improved engagement with care — all critical in the period after an attempt.

CAMS-4Teens® is a framework in which a clinician works with the parents to keep the home safe and provide guidance on how best to support your child through a course of CAMS treatment( typically six to 8 one-hour sessions) using the Stabilization Support Plan (CAMS-4Teens: Working with Parents).

Parents can locate a CAMS Trained™ clinician in their area using the CAMS‑care Clinician Locator.

4. Build a Support Team Around Your Child

Recovery is rarely a solo journey. The video highlights the value of connecting with both professional and community support — including family therapists, school counselors, peer support groups, and other caregivers who understand the experience. Parents who have been there often say that having someone to talk to — whether a trained provider or another parent who has survived similar circumstances — can make all the difference.

5. Maintain Hope and Patience

Perhaps the most crucial message is one of hope. While a suicide attempt is a serious and frightening event, it does not mean a child is beyond help or that recovery isn’t possible. With appropriate care, safety planning, ongoing support, and open, compassionate treatment and communication, many families find their way back to stability and connection. Over time, parents and children can work toward healing together — learning new ways to cope, to stay connected, and to build a future worth living.

Please visit Supporting Parents | Zero Suicide where the film can be viewed in chapters and there are additional resources for healthcare providers, faith leaders, and schools.

Autism Spectrum Disorder (ASD) and Suicidality

Posted on September 26, 2025February 27, 2026 by erics

Please note the following post uses identity-first language, though acknowledges that preferences may differ between self-advocates.

Background

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by ongoing differences and challenges in social communication and restricted and repetitive behaviors (American Psychiatric Association, 2013). Research has highlighted increased early death in autistic individuals, and suicide is a primary cause (Cassidy et al., 2014). Autistic adults are at increased risk for suicide compared to non-autistic adults (Hedley et al., 2017). In a study of a large, diverse population of adults in the United States, the risk of suicide attempts was five times higher for autistic adults than for non-autistic adults (Croen et al., 2015). While suicide research has largely focused on autistic adults so far (McDonnell et al., 2020), autistic youth are also more likely to attempt and die by suicide (Navaneelan, 2012). A study of autistic individuals aged 4-20 years evaluated during a psychiatric hospital stay found that 22% of autistic youth commonly talked about death or suicide (Horowitz et al., 2018). While studies differ about exact prevalence rates, experts agree that there is reason for concern.

Despite the increase in research and autistic self-advocacy groups’ attention on this topic, there continues to be a major lack of tools to manage suicidal behaviors in the autistic population. Therapists feel less confident providing care to autistic individuals experiencing suicidal thoughts (Jager-Hyman et al., 2020). The good news is that there are efforts to validate screening tools for use with autistic adults, including screeners (e.g., SBQ-ASC, SIDAS-M, STUQ), and more in-depth assessment tools such as the Suicide Assessment Kit-Modified Interview (Hedley et al., 2025). However, these tools are designed for adults, and there are not yet appropriate for autistic youth. This is important when considering existing screening tools, given that autistic individuals may not always exhibit traditional suicide symptoms and warning signs. For example, autistic individuals may present with facial expressions which may not directly match their emotional experience (e.g., laughter when anxious or depressed) or have difficulty verbalizing their thoughts, feelings, and experiences when overwhelmed (Oliphant et al., 2020).

While quality access to mental health services is a problem for all children and adolescents, this challenge is worse for autistic individuals and their families (Cervantes et al., 2023). In fact, many providers do not accept autistic patients. In a study of over 6,000 outpatient mental health facilities in the United States, only half offered services to autistic children (Cantor et al., 2022), which is particularly concerning given this group’s increased mental health care needs. When these needs go unmet, autistic youth are more likely to present to Emergency Departments (EDs) (Badgett et al., 2023). Unfortunately, EDs and psychiatric hospitals are not designed for autistic individuals’ needs from both an environmental perspective (e.g., sensory sensitivities to bright lights, crowdedness, unpredictability) and a treatment standpoint (e.g., stigma related to mental health in medical settings, lack of training related to autistic learning styles, and behavior management techniques). Sadly, this can then lead to negative or traumatic experiences, inappropriate treatments, excessive interventions (e.g., physical or chemical restraints, seclusion), and longer admissions (Gabriels et al., 2012; Klinepeter et al., 2024).

Adapting evidence-based suicide-focused treatments, such as Dialectical Behavioral Therapy (DBT) (Ritschel et al., 2022) and Safety Planning Intervention (Rodgers et al., 2023), remains an area of emerging research. Therefore, evidence-based suicidality treatment made for autistic individuals is a sparsely available, yet urgently needed service.

Clinical Insights

Unfortunately, many of the clinicians who treat suicidality or autism remained siloed in their respective treatment areas, without clear communication and overlap, despite extensive research and clinical experience on both sides. To treat suicidality in autism, it is necessary that these “worlds” collaborate, create synergistic relationships, and develop treatments to address this life-threatening phenomenon.

Recent work has suggested that some general changes to treatments can be helpful for autistic learning styles, such as visual supports, environment and sensory considerations, making language more concrete, caregiver collaboration, and embedding special interests into treatment (Schwartzman et al., 2021; Dickson et al., 2021).

As a result of this critical gap in services, a clinic was created to treat suicidality in autistic youth at a large children’s hospital, the Clinic for Autism and Suicide Prevention (CLASP). As mentioned above, collaboration between the autism center and the hospital’s department of behavioral and mental health was necessary and invaluable. The Collaborative Assessment and Management of Suicidality (CAMS was) incorporated as the primary treatment framework when appropriate, and autism-specific interventions were then plugged in to address specific drivers. The CAMS Framework® identifies the “drivers” that a patient says make them consider suicide as an option.

For example, if a patient identified difficulty with change as a driver, an autism intervention, such as Unstuck and on Target, was used. If a patient identified loneliness as a driver, then social skills practice or PEERS videos were incorporated to improve relationships. Additionally, interventions such as cognitive behavior therapy, dialectical behavior therapy, and trauma-focused cognitive behavior therapy were often used to address many other drivers such as conflict with others, traumatic experiences, or difficulty managing strong emotions.

The clinic provides individual weekly therapy to autistic youth experiencing suicidality and has successfully discharged several patients due to reduced suicidality. We have learned many key insights from this clinic and from the powerful, brave work these patients are doing. Below are some recommendations for working with autistic clients who experience suicidality.

Recommendations for clinical practice:

Consider whether there are outside factors which can be addressed or managed. For example, if a patient is struggling with bullying, consider whether school can intervene. Remember that autistic are neurodivergent individuals living in a world designed for neurotypical needs!
Take your time and expect that treatment progress may take longer. Negative repetitive patterns can be “stickier” in autistic individuals and breaking out of these cycles can require more effort and time.
Create structure when possible. CAMS forms (e.g., the Suicide Status Form, the Stabilization Support Plan for parents and caregivers and the CAMS Therapeutic Worksheet) are a great way to introduce a visual form and help clients know what to expect from session to session.
Determine whether expressing suicidal thoughts is a form of communication and if so, consider what the patient is communicating and whether this can be addressed. For example, if a patient repeatedly makes suicidal comments when transitioning away from a preferred activity (e.g., video game, favorite location), consider working on transitions with behavioral strategies. Think about whether there are other ways the patient can communicate their frustration.
Discuss what happens both for the patient and others when they share suicidal thoughts. First, understand what the patient is feeling and why they are sharing. Next, while openness is important, some individuals may not be aware of the procedures certain organizations have to follow when someone makes a suicidal comment (e.g., school policies, medical staff) and explaining what to expect can help reduce emotional overload.
Help increase emotional awareness. In some autistic clients, the ramp up to a crisis moment can be much faster than in non-autistic individuals, so increasing emotional self-monitoring can improve their ability to access coping strategies earlier.
Do not assume that physical social or human contacts are the only way to reduce suicidal risk. Perhaps there are other non-human or non-physical connections which can be important for coping, such as a preferred stimming object, online video game friends, or an important pet. Stimming (i.e., repetitive self-soothing movements, such as pacing, rocking, humming, finger tapping) can be helpful both during therapy and as part of a stabilization plan.
Do not assume that all autistic patients need autism-specific treatments. This can create barriers and close important doors to care. Some autistic patients benefit from working with clinicians experienced in autism, though this is not necessary for every patient. Our saying is “when you’ve met one autistic person, you’ve met one autistic person!”

Most importantly, remember that autistic clients often have amazing and powerful insight into their emotional experiences that leads to suicidality. Start with the patient perspective first, gather additional information, and empower the client to work collaboratively toward a life worth living one small step at a time!

Below are several helpful resources available online including those developed by autistic self-advocates:

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition). Arlington, VA: Author.

Badgett, N. M., Sadikova, E., Menezes, M., & Mazurek, M. O. (2023). Emergency department utilization among youth with autism spectrum disorder: exploring the role of preventive care, medical home, and mental health access. Journal of Autism and Developmental Disorders, 53(6), 2274-2282.

Cantor, J., McBain, R. K., Kofner, A., Stein, B. D., & Yu, H. (2022). Where are US outpatient mental health facilities that serve children with autism spectrum disorder? A national snapshot of geographic disparities. Autism, 26(1), 169-177.

Cassidy, S., Bradley, P., Robinson, J., Allison, C., McHugh, M., & Baron-Cohen, S. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. The Lancet Psychiatry, 1(2), 142-147. https://10.1016/S2215-0366(14)70248-2

Cervantes, P. E., Conlon, G. R., Seag, D. E., Feder, M., Lang, Q., Meril, S., … & Horwitz, S. M. (2023). Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. Autism, 27(3), 704-713.

Klinepeter, E. A., Choate, J. D., Nelson Hall, T., & Gibbs, K. D. (2024). A “whole child approach”: parent experiences with acute care hospitalizations for children with autism spectrum disorder and behavioral health needs. Journal of Autism and Developmental Disorders, 1-15.

Croen, L., Zerbo, O., Qian, Y., Massolo, M., Rich, S., Sidney, S. & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism, 19(7), 1-10. https://doi/abs/10.1177/1362361315577517

Gabriels, R. L., Agnew, J. A., Beresford, C., Morrow, M. A., Mesibov, G., & Wamboldt, M. (2012). Improving psychiatric hospital care for pediatric patients with autism spectrum disorders and intellectual disabilities. Autism research and treatment, 2012(1), 685053.

Hedley, D., Uljarević, M., Wilmot, M., Richdale, A., & Dissanayake, C. (2017). Brief report: social support, depression and suicidal ideation in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(11), 3669-3677. https://10.1007/s10803-017-3274-2

Hedley, D., Williams, Z. J., Deady, M., Batterham, P. J., Bury, S. M., Brown, C. M., … & Stokes, M. A. (2025). The Suicide Assessment Kit-Modified Interview: Development and preliminary validation of a modified clinical interview for the assessment of suicidal thoughts and behavior in autistic adults. Autism, 29(3), 766-787.

Horowitz, L. M., Thurm, A., Farmer, C., Mazefsky, C., Lanzillo, E., Bridge, J. A., Greenbaum, R., Pao, M., & Siegel, M. (2018). Talking about death or suicide: Prevalence and clinical correlates in youth with autism spectrum disorder in the psychiatric inpatient setting. Journal of Autism and Developmental Disorders, 48(11), 3702-3710. https://10.1007/s10803-017-3180-7

Jager-Hyman, S., Maddox, B. B., Crabbe, S. R., & Mandell, D. S. (2020). Mental health clinicians’ screening and intervention practices to reduce suicide risk in autistic adolescents and adults. Journal of Autism and Developmental Disorders, 50(10), 3450-3461.

McDonnell, C. G., DeLucia, E. A., Hayden, E. P., Anagnostou, E., Nicolson, R., Kelley, E., … & Stevenson, R. A. (2020). An exploratory analysis of predictors of youth suicide-related behaviors in autism spectrum disorder: implications for prevention science. Journal of Autism and Developmental Disorders, 50(10), 3531-3544. https://10.1007/s10803-019-04320-6

Navaneelan, T. (2012). Suicide rates: An overview. Ottawa (ON): Statistics Canada.

Oliphant, R. Y., Smith, E. M., & Grahame, V. (2020). What is the prevalence of self-harming and suicidal behaviour in under 18s with ASD, with or without an intellectual disability?. Journal of Autism and Developmental Disorders, 50(10), 3510-3524.

Ritschel, L. A., Guy, L., & Maddox, B. B. (2022). A pilot study of dialectical behaviour therapy skills training for autistic adults. Behavioural and Cognitive Psychotherapy, 50(2), 187-202.

Rodgers, J., Goodwin, J., Nielsen, E., Bhattarai, N., Heslop, P., Kharatikoopaei, E., … & Cassidy, S. (2023). Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial. Pilot and feasibility studies, 9(1), 31.

How CAMS Empowers Families to Support Suicidal Loved Ones

Posted on July 30, 2025January 28, 2026 by STOLBER Digital

Youth mental health remains a growing concern in the U.S. According to the Centers for Disease Control and Prevention (CDC), suicide is the second-leading cause of death for teens and young adults between the ages of 10–34 in the U.S. [1] Additionally, 36.7% of young adults ages 18–25 have mental health needs that are not being treated. [2]

It is common for family members, especially caregivers, to feel overwhelmed. They may wonder what to do when a loved one talks about suicide. CAMS (Collaborative Assessment and Management of Suicidality) is an evidence-based treatment for suicide that allows family members to be a part of the process. It puts emphasis on the “collaborative” aspect. Rather than teaching and handing off the tools to the at-risk person to manage themselves, CAMS strives to involve parents and caregivers. The Stabilization Support Plan is one way that CAMS does this. This plan provides guidance to family members to help support their child’s treatment moving forward. This helps create a bigger system of support for the person who is struggling.

The Role that Family Plays

Family members and caregivers play crucial roles in helping support their child’s mental health. Adolescence is often a time of instability and change—from changes in friendships to increased demands at school and other activities. Children and teens who are close with their family members have positive, built-in relationships with people they can rely on for help and support through the ups and downs. Here are a few specific ways that family members can help each other when it comes to mental health and suicide prevention.

Offering emotional support

In a healthy dynamic, family members can provide emotional support to one another. They provide safe spaces for each other to open up and share about their struggles. Families often have deep bonds from shared experiences, good and bad. They know each other’s history, struggles, and triumphs. They are often the first place that people go to with those struggles and triumphs. Having people available to lean on during these times can be extremely helpful.

Detecting early warning signs of suicide

Family members may be more in-tune and aware of certain warning signs, sensing when things seem “off.” They can easily detect abnormal behavior since they’re familiar with what normal behavior looks like. They are often able to be on alert for signs of distress. Being able to identify warning signs and abnormal behaviors in someone is a key first step to suicide prevention.

Being involved with treatment

When it comes to treatment, family members and caregivers are able to be more easily and seamlessly involved than those on the outside. Parents and caregivers can help their child stay healthy. They can manage logistics like scheduling and driving to appointments. They can also encourage their child to follow treatment plans.

Family: A Protective Factor

When talking about suicide, risk factors and protective factors are important to discuss. Risk factors are things that make suicide more likely. Protective factors are things that make suicide less likely. Some people are naturally more at risk than others depending on their background and living situation. According to the Suicide Prevention Resource Center, social isolation can be a big risk factor. Connectedness to other individuals, community, and family is a protective factor. [3] Therefore, it’s important for families to be present and know how to help their child or adolescent through their struggles.

Ways CAMS Supports Family Involvement

Unlike many other types of treatment methods, CAMS puts a large emphasis on collaboration when it comes to working with and supporting the at-risk individual. CAMS is set up to help family members be involved and take an active role in their loved one’s treatment, especially when dealing with parents and children. One way is through CAMS-4Teens®. CAMS-4Teens is a specific method of using the CAMS Framework® to treat children, teens, and young adults who are struggling with thoughts of suicide. Parents and caregivers are engaged in this process, as well. They are given expectations and information up front about the treatment. They are updated regularly as the treatment goes on. They join sessions to learn about their child’s “suicidal drivers.” They also discuss stabilization and support plans, among other topics.

Allowing parents to have a more active role in their child’s treatment allows for open communication and helps reduce the stigma about mental health and suicide. Parents and caregivers can learn about what leads to thoughts of suicide. They can also understand the CAMS therapy approach. This knowledge helps them better understand their child’s mind.

Benefits of CAMS for Families

CAMS not only benefits the person at risk, but it can help families as a whole grow closer and move forward together in confidence. Here are a few of the specific areas in which families can benefit when working with CAMS.

Insight into the issues

Many young people, especially teenagers, struggle with issues related to friendships, insecurity, and comparing themselves to their peers. In CAMS, the patient is always listened to first. This helps the therapist see the person’s suicidal thoughts from their point of view. This makes it easier to share these thoughts with family members who can then gain a better understanding.

Greater sense of control and direction

CAMS allows parents and caregivers the opportunity to get a glimpse into what is going on

and what their role is in helping their child. This is helpful for the children but also helpful for the parents. It gives them a greater understanding and knowledge about what tools and techniques their child is learning to deal with their difficult thoughts and feelings.

Strengthening trust and relationships

When mental health is openly talked about, trust is more easily built. Family members of any age can benefit from these open conversations around mental health and struggles. When parents and caregivers see how serious the issue is, it helps their child. They also learn what is being done to help. This way, the child can trust that their parents care about what is happening.

Increased confidence in dealing with a crisis

A common fear that many parents and caregivers have is that they will make a situation worse by saying or doing the wrong thing, particularly in a moment of crisis. CAMS works with parents to put a plan in place for dealing with emergencies. That way, if a crisis happens, parents and caregivers will know how to respond appropriately.

Warning Signs to Watch For

It’s always important to stay aware of the warning signs of suicide, especially because they may look different for people of different ages. Here are some warning signs to watch for from the Substance Abuse and Mental Health Services Administration (SAMHSA): [4]

Warning signs in adults:

Talking about or making a plan for suicide
Behaving recklessly or acting agitated
Talking about feeling trapped or like a burden
Increased use of alcohol or drugs
Withdrawing or isolating from others
Changes in sleep (increased or decreased)
Showing signs of rage
Displaying extreme mood swings

Warning signs in youth and children:

Expressing hopelessness about the future
Displaying severe or overwhelming emotional distress
Withdrawing or isolating from others
Changes in sleep (increased or decreased)
Sudden anger or hostility that seems out of character
Increased irritability

Supporting a loved one who is struggling with suicidal ideation can feel overwhelming and even scary, especially those who feel ill equipped. CAMS aims to help families by offering them a lifeline and including them on the healing journey. CAMS helps parents and caregivers by encouraging open talks about struggles. It focuses on what matters most to the person at risk. This way, they gain the tools and confidence to support their loved one on the path to recovery.

Curious to learn more about CAMS-4Teens? See more information in this article here: Proven CAMS-4Teens Strategies to Treat Adolescent Suicide. For those interested in or pursuing CAMS-Trained™ designation, check out our on-demand video CAMS-4Teens: Working with Parents. This 3-hour video training covers how therapists can work with parents to support the use of CAMS treatment with their child using the Stabilization Support Plan.

For more help and tips on supporting a loved one, see this guide from the Center for Suicide Research and Prevention with resources.

Remember, if you or someone you know is in crisis, reach out to the 988 Suicide & Crisis Lifeline via call, text, or online chat.

Sources:

[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf
[2] https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national.pdf
[3] https://sprc.org/risk-and-protective-factors/
[4] https://www.samhsa.gov/mental-health/suicidal-behavior/warning-signs

Best Therapies for Managing Suicidal Thoughts

Posted on July 30, 2025January 28, 2026 by STOLBER Digital

Navigating suicidal thoughts can feel isolating. However, suicidal ideation is more common than many may realize. In 2023, a combined 16 million adults and adolescents in the U.S. had “serious thoughts of suicide.” [1] These numbers show a major challenge in suicide prevention. They highlight a strong need for mental health support aimed at suicidal thoughts. Over the years, clinical trial researchers have developed several evidence-based therapies that provide relief and healing for those struggling with suicide. Whether you’re seeking support for yourself or a loved one, it’s important to understand which therapeutic approaches are available and are the most helpful for recovery.

Download the Evidenced-Based Therapy Comparison Chart

What Causes Suicidal Thoughts?

Suicidal thoughts, or suicidal ideation, can result from a number of causes. However, it ultimately stems from the specific struggles the individual is facing. Research has shown that relational, vocational, and self-oriented issues tend to be the most common root causes of suicidal ideation .[2] For example, a failed relationship or high stress at work could be a factor. Low self-esteem due to bullying could also be a factor. A person may face many struggles in life. These struggles can lead to negative thoughts and feelings of hopelessness. While mental health disorders and other risk factors can also play a role, it’s important that the deeper issues are addressed.

When talking about suicidal ideation, it’s also important to identify the two types: passive and active. Passive suicidal ideation is when a person has thoughts of suicide but is not actively making a plan to harm themselves. Active suicidal ideation is when the thoughts of suicide motivate a person to create a plan to carry it out in the nearterm future. Both types of suicidal ideation require some kind of intervention, though active ideation requires more immediate attention.

When to Seek Professional Help

If you find yourself thinking about suicide frequently and actively avoid the people, places, and hobbies you usually enjoy, you should reach out for help. Early intervention is key when dealing with suicidal thoughts. The earlier suicidal ideation is dealt with, the greater likelihood of healing and avoiding negative outcomes. Early intervention helps stop these thoughts from getting worse. It also helps the person build resilience. They can learn tools and coping skills to manage their negative thoughts. Evidence-based therapies are the best place to start.

For those who are dealing with active suicidal ideation (i.e. making a plan), immediate help is needed. The 988 Suicide & Crisis Lifeline is a free resource that is available 24/7 for those who are struggling. Don’t hesitate to reach out if you need someone to talk to.

What are Evidence-Based Therapies?

Evidence-based therapies are those that provide research-based support to those who are struggling with a specific issue, such as suicidal ideation. These have been tested through rigorous trials and case studies. Evidence-based therapies and treatments make sure people get care that has been well tested. This care is supported by large-scale research. It is better to see a professional who specializes in suicide-specific therapies. This is more effective than visiting a general doctor or therapist for mental health issues. This can greatly help those in need and give them the tools to move forward.

Types of Evidence-Based Therapies

Collaborative Management and Assessment of Suicidality (CAMS)
CAMS is widely recognized as the most effective treatment for those dealing with suicidal ideation. It is referenced in the Zero Suicide Toolkit and 2024 National Suicide Prevention Strategy. CAMS approaches suicidal ideation by first identifying the drivers of suicide and creating a plan to manage these drivers, helping reduce the risk of suicidal behavior. CAMS also uses quantitative and qualitative risk assessment in every session, including self reflection and discussion of risk factors, as well as methods to help people create a life that’s worth living.
Cognitive Behavioral Therapy-Suicide Prevention (CT-SP)
CBT is a type of talk therapy that has been effective for those dealing with issues such as depression, anxiety, eating disorders, and more. CT-SP is an intervention that specifically tailored to addressing those who are experiencing suicidal ideation. It takes the approach of helping individuals respond to their automatic thoughts, breaking negative patterns and building new, positive ones. One specific strategy in this therapy is the “Hope Kit” or “Hope Box.” This is a physical or digital space. Here, a person keeps important photos, notes, and other items. These items inspire them to keep living.
Brief Cognitive Behavioral Therapy (BCBT) is another form of CBT that is completed in a limited number of sessions, typically four to eight. Individuals will learn about the “suicidal mode” as well as self-soothing techniques and problem solving. Similar to CBT-SP, individuals will develop a “Hope Kit” and work to build new, positive thought patterns. The final phase of care involves creating a relapse prevention protocol.
Dialectical Behavior Therapy (DBT)
DBT helps people to embrace acceptance and learn coping strategies for times of dealing with distress. It is often used to treat those with borderline personality disorder (BPD), major depressive disorder, bipolar disorder, and those who are struggling with suicidal thoughts. Some goals of DBT include learning and developing emotional regulation, problem-solving skills, and distress tolerance.

See a comparison of evidence-based therapies and screening/assessment tools.

Other Types of Support
In addition to therapy, there are other methods of support that can be helpful, including online resources that are available anytime. Now Matters Now offers videos and resources that teach coping strategies and skills. They also offer free, online peer support meetings where members can share their stories and practice skills together. The Lived Experience Academy is another online resource that offers support for healing, recovery, and growth after a crisis.

Hope is Always Here

Managing suicidal thoughts can feel overwhelming, but it’s important to remember that you are not alone. There are many effective options for different people and their unique situations. These include evidence-based therapies, mindfulness, and peer support. If you or someone you know is struggling, reach out for professional help. For immediate needs, contact the 988 Suicide & Crisis Lifeline for via text, online chat, or phone call.

Download the Patient Journey Comparison Chart

Download the Full PDF

Sources:

[1] https://www.samhsa.gov/data/sites/default/files/NSDUH%202023%20Annual%20Release/2023-nsduh-main-highlights.
[2] https://onlinelibrary.wiley.com/doi/10.1521/suli.34.2.99.32788

Suicide Risks of Healthcare Workers in the US

Posted on April 19, 2025April 3, 2026 by STOLBER Digital

Healthcare workers play a crucial role in our world. From routine care to emergency situations, people in these professions are the ones we look to when we need care. However, even before the COVID-19 pandemic swept across the globe, the healthcare field had a reputation of being difficult. Healthcare professionals have historically been overworked, underappreciated, and dealt with issues such as stress, burnout, and other negative mental health outcomes.

Between 2008 and 2019, a survey studied six types of healthcare professionals, including doctors and nurses. It also looked at technicians, support staff, and social health workers, comparing them to workers outside of healthcare. The overall findings revealed that healthcare workers, specifically registered nurses, health technicians, and healthcare support workers, were at a greater risk of suicide than non-healthcare workers. Because suicide among healthcare workers is clearly an issue, it’s important to explore why this is the case and what steps can be taken for suicide prevention for healthcare workers.

COVID-19: Shedding Light on an Existing Problem

During the pandemic, healthcare workers were on the front lines. Clinics and hospitals quickly became overcrowded as COVID spread and people needed care and testing. A study from NCSBN found that 62% of nurses reported an increase in their workload during the pandemic. They also found that approximately 100,000 nurses left the workforce during the pandemic.

A reported 610,388 of nurses intended to leave the workforce by 2027, due to stress, burnout, and retirement. Another report from the Centers for Disease Control and Prevention (CDC) found that nearly half of all healthcare workers in the United States were experiencing burnout during the pandemic, intending to leave the field in 2022.

While the pandemic certainly increased the load that healthcare workers carried, it also made the public more aware of the struggles that those in healthcare-related professions experience on a regular basis. Issues such as poor working conditions, harassment, and chronic understaffing have been existing problems for decades.

According to the Occupational Safety and Health Administration (OSHA), 74% of workplace violence in the U.S. in 2013 took place in healthcare settings. These numbers only seem to be increasing. The 2023 CDC Vital Signs report found that the number of healthcare workers who experience harassment doubled from 2018 to 2022.

Violence in healthcare settings can happen for a number of reasons. Patients may lash out if they are anxious, in pain, or dealing with other mental health issues. Family members of

https://pmc.ncbi.nlm.nih.gov/articles/PMC10523169/

https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis

https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html

https://pmc.ncbi.nlm.nih.gov/articles/PMC5580583/#B3-ijerph-14-00879

https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html

patients may also act out due to anxiety or while seeing their loved one in pain. Some people may also expect care and service to be met to their specific standards. If it’s not, these people may become frustrated and take it out on the nurses and other professionals who are simply trying to do their jobs.

The pandemic also had lasting effects on other areas of practice. The pandemic presented unique obstacles for mental and behavioral healthcare professionals, both during and after the crisis. While frontline healthcare workers faced the pandemic’s immediate impacts, mental healthcare workers are managing its long-term effects.. Many people have turned to therapy to help them process everything that happened. As a result, mental healthcare workers have also seen an increased workload, causing them to deal with burnout as well.

Factors that Lead to Suicide in Healthcare Workers

Working in a healthcare-related field often contributes to high amounts of stress and pressure. Caring for others requires a person to set aside their own needs in order to prioritize someone else’s. However, when a person is constantly neglecting their own needs for hours or even days at a time, it can lead to long-term negative effects on their physical, mental, and emotional well-being.

1. Burnout

Burnout is one of the biggest stressors that healthcare workers face. Nurses often work long shifts, sometimes over 12 hours at a time, while physicians may work upwards of 60 hours per week. Depending on the day’s demands, they may be taking on more tasks than time allows. This was especially true during the pandemic when healthcare facilities were dealing with staffing shortages due to illness and struggled to keep up with the demand for care.

Burnout can lead to many issues, including risk of medical errors and inefficiency. According to the Mayo Clinic, when someone experiences physical burnout, it’s like missing out on the productivity of seven entire classes of medical school graduates. Studies have shown that as many as 75% of all healthcare professionals struggle with burnout, with up to 12% of these individuals dealing with suicidal ideation.

2. Lack of Support

Being without support is another common issue affecting many in the healthcare industry. In the nursing field, this may look like insufficient staffing, lack of resources, and demanding workloads. Nurses may be assigned to more patients than they are able to properly care for when staffing is low or a hospital is busy. High demands and pressure from other staff may lead to presenteeism. Presenteeism is when an employee is physically at their job despite being ill or unwell to the point of not being able to perform their role effectively. Nurses have the highest rates of presenteeism in the workforce.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6367114/

https://pmc.ncbi.nlm.nih.gov/articles/PMC9098943/

3. Trauma

Finally, exposure to trauma plays a huge role in one’s mental health. Nurses in particular are exposed to traumatic situations regularly, especially in emergency settings. The pandemic brought about a whole new level of this as more of the population was dealing with severe illness. Being exposed regularly to people who are suffering can lead to compassion fatigue and secondary traumatic stress, which both can cause symptoms such as increased anxiety and irritability. It may even lead to post traumatic stress disorder or other issues such as substance use disorders.

Nursing Shortage in the United States

It’s no surprise that nurses and other healthcare professionals are leaving the field, especially after the pandemic. Unfortunately, this leaves healthcare facilities at a loss and puts a greater burden on those who continue to stay and work. The World Health Organization (WHO) has reported that by 2030, the world may be short of 5.7 million nurses.

The U.S. in particular has been seeing a decrease in nurses, which is alarming as the Baby Boomer generation continues to age, needing increased care. Additionally, nursing school enrollment may not be keeping up with the demands of projected care needs. The American Association of Colleges of Nursing (AACN) reported drops in both PhD and master’s nursing programs by 3.1% and 0.9%.

Further Impact on the Community

When healthcare workers are undervalued, it can have serious consequences that affect the rest of the community. There are many ways in which the lack of support can have lasting impacts, especially since the pandemic.

1. Reduced Quality of Care

As stated earlier, when healthcare staff are overworked, there is an increased risk of errors. This can lead to mistakes in patient care. The quality of service may decline. Patients might become dissatisfied. They might avoid seeking care when needed.. Over time, this could lead to a wider distrust in the healthcare system as a whole.

2. Strained Relationships

Those working demanding healthcare jobs may not have the time or energy to give to other relationships in their life. Because of this, they may become detached. When nurses and healthcare professionals are seen as detached, it affects public opinion. It can make them seem impersonal or rude. This contributes to a negative view of the field. As a result, people may hesitate to receive care. They may also be less likely to pursue jobs in the industry.

https://www.beckershospitalreview.com/nursing/world-may-be-short-5-7m-nurses-by-2030-4-report-takeaways/

https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage

3. Financial Toll

High employee turnover due to poor working conditions and employees’ mental health issues can have negative financial consequences and lead to higher operational costs. This can create ripple effects through the community, making care more expensive and difficult to access for many.

Prevention Strategies for Healthcare Professionals

Healthcare workers may be reluctant to seek help due to the fact for several reasons. Those with demanding work schedules and long shifts may struggle to find the time needed to pursue therapy or other support.

There is also the fear that seeking help may impact one’s career in the healthcare field. People in various types of caretaking roles are expected to “have it all together.” Because so much time is spent caring for others, the thought of caring for themselves may not cross their mind as frequently as it should. However, there are steps that can be taken to help protect healthcare workers’ mental health.

1. Reducing Stigma

Open conversations about mental health are essential. This is especially true in workplaces. Healthcare settings, in particular, need this openness. It helps reduce the stigma. It keeps mental health a priority for everyone. Fostering these conversations is an easy first step among colleagues. Check in with each other after long days or tough moments. Acknowledge difficult situations and process through them together.

2. Expanding Resources for Mental Health and Suicide

Another important element is having resources readily available for staff to access when they’re struggling. Employee assistance programs (EAPs) and other support groups are a good step, as well as providing access to mental health screening tools. However, larger scale change needs to happen for there to be a true difference made.

In 2024, Australia introduced a Nurse and Midwife Health Program. It aims to support those in the workforce. This encourages them to stay in the field. Nurses, midwives, and students can speak with peers. These peers have experienced similar situations. They offer practical support. Similarly, in 2024, Canada launched a toolkit. It is intended for use across their healthcare system. This toolkit focuses on eight themes and is aimed at helping healthcare employers retain their employees. While the U.S. has taken a few steps toward providing resources, there is more that can be done to support healthcare workers and ensure better working conditions. Suicide prevention training for healthcare professionals and other mental health services need to be easily accessible to help those who are struggling.

https://www.canada.ca/en/health-canada/news/2024/03/improving-the-working-lives-of-nurses-across-canada.html?utm_source=chatgpt.com

3. Encouraging Future Generations

Additionally, it is crucial to encourage the next generation to pursue a career in healthcare. It is rewarding and beneficial for others and themselves. Several statewide initiatives are helping address the nurse shortage. These initiatives make education more accessible for interested students. However, larger-scale change is necessary. This change is needed for others to feel a sense of safety. They need to feel safe entering a demanding profession. Healthcare is known for being physically, mentally, and emotionally demanding.

Those who work in a profession of caring for others often have the hardest time caring for themselves. However, this is not their fault. There are larger issues at play that make it extremely difficult for people in professions such as nursing to have the time and resources to be able to support themselves. The pandemic also added another layer of complication to an already struggling system.

For U.S. healthcare professionals, suicide and mental health issues are growing concerns. These should not be ignored. Burnout and high numbers of healthcare workers leaving the field should continue to be studied since these go hand-in-hand.

Change needs to happen so that healthcare professionals don’t continue to suffer. Patients deserve to see healthcare workers who are feeling their best and can perform their job to the best of their ability. Ensuring the safety of those in healthcare roles is more than simply an ethical responsibility. It is an essential step toward creating a more sustainable healthcare system for all.

Remember, if you or a loved one are struggling, the 988 Suicide & Crisis Lifeline is available.

The Role of Family Estrangement in Suicidal Ideation: Understanding the Connection and Finding Hope

Posted on April 15, 2025January 27, 2026 by STOLBER Digital

Family is a central part of most people’s lives, but when family relationships are strained, it can bring immense pain and grief. Lack of family support can play a huge role in many aspects of a person’s life, including their mental health.

The topic of family estrangement has historically been understudied and under researched. Because all scenarios are unique, it’s difficult to compare different people’s experiences. Family estrangement, however, is surprisingly common, and it’s important to be aware of the ways it can affect you or someone you know.

Understanding Estrangement

Estrangement is defined as no longer being on friendly terms with a person or group of people – usually someone you were previously close with. According to some studies, as many as one in four people are estranged from at least one family member. ¹ Causes of family estrangement vary greatly depending on the situation and people involved. However, there are some common factors that often play a role.

Unresolved issues: When families have issues that have been swept under the rug for years, this can cause a deep rift. Examples are significant life changes that occurred in the family (such as divorce) or persistent emotional issues (such as pressure or favoritism) that were never addressed.
Generational trauma: Trauma can sometimes be passed down from one generation to the next. This creates a cycle that is hard to break.
Differences in lifestyle or beliefs: People change as they grow. These changes can lead to different views or beliefs. Other family members may feel threatened or uncomfortable with these differences. This can cause conflict in relationships.
Addiction or abuse: In some extreme situations, such as addiction or abuse, estrangement may be necessary for the safety of you and others.

Estrangement and Suicidal Ideation: The Connection

Family estrangement results in many complicated feelings. It’s no surprise that it has a negative impact on a person’s life, contributing to higher levels of depression. ² Suicidal ideation can result from these depressed feelings combined with other emotions and struggles that build up over time.

Isolation and rejection are two common feelings people facing family estrangement may experience. Being left without the support of someone you’ve grown up with can be a challenging shift. It also makes joyful seasons, like holidays or family celebrations, become complicated, painful, and lonely for those left out.

Guilt is another challenging feeling. In some situations, the person who has been estranged is left wondering if they could have prevented the situation. They may be blamed by family members for causing the problem in the first place.

If someone needs to distance themselves from a family member for safety, they might feel guilty. They may struggle with not being able to help that person. These feelings can be tough when you have a family member with a serious addiction. It is hard when they refuse to get help.

Additional Risk Factors

Family estrangement can cause strong negative feelings. However, it’s also important to think about other risk factors. These factors may be present when someone is having thoughts of suicide.

People with a history of mental health issues are at higher risk. This also includes those who feel socially isolated.

Having a history of unhealthy coping methods, like using drugs and alcohol, can also lead to thoughts of suicide. Community and social factors can also play a role. For example, there may be a stigma around seeking help. People might also have limited access to mental health resources. ³

Support Beyond Family

When someone is dealing with family estrangement, it’s important for them to find outlets for support, whether it be friends or support groups in their community. Having people to turn to during both tough times and joyous moments is essential to maintaining mental well-being and fostering a sense of motivation and purpose.

Therapy is also crucial when dealing with family estrangement. A therapist can help you untangle the layers of complicated and conflicting emotions you may be experiencing as well as help you learn healthy coping skills.

Moving Forward

Not every instance of family estrangement is permanent. Sometimes, it can be possible to find reconciliation and healing. This usually happens gradually through small steps of communication with clear boundaries from both parties. Working with a family therapist can be helpful when mending these relationships.

However, not every scenario benefits from finding a resolution. There are times when estrangement is permanent, whether by your choice or someone else’s. In these instances, speaking with a therapist can be helpful in learning to grieve, accept the situation, and move forward.

Family estrangement is incredibly complex and can leave lasting impacts. When estrangement leads to suicidal ideation, it’s crucial to seek help or recognize the warning signs in others who are struggling. Healing and recovery are possible through avenues such as therapy and support groups. If you or someone you know is struggling, reach out to the 988 Suicide & Crisis Lifeline.

Colorado’s Blueprint for Suicide-Specific Care: How Children’s Hospital Colorado’s Crisis Clinic Empowers Youth through Collaborative Models

Posted on February 9, 2025January 28, 2026 by erics

The United States is experiencing a national emergency in child and adolescent mental health. According to the recent Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023, surveying high school students, experiences of violence, poor mental health, and suicidal thoughts increased over the past decade. Today, suicide is the second leading cause of death for youth and young adults ages 10-24. In Colorado—a state with one of the nation’s highest suicide rates historically—the youth mental health crisis is especially severe. Only 22% of youth who have a mental illness are receiving care.

While the Office of Suicide Prevention (OSP) within the Colorado Department of Public Health and Environment has made significant strides in the state’s suicide prevention, intervention, and postvention efforts, a critical gap in pediatric mental health services remains. In response, Children’s Hospital Colorado (Children’s Colorado) is addressing the high number of children and adolescents experiencing suicidal thoughts, behaviors, and other mental health concerns that are overwhelming pediatric emergency departments and inpatient units.

The Pediatric Mental Health Institute (PHMI), a department within Children’s Colorado, developed a groundbreaking outpatient Crisis Services strategic plan to build a robust continuum of care for youth experiencing mental health crises, including suicidal thoughts and behaviors. The first initiative in this plan—the launch of a rapid-access, time-limited Crisis Clinic—is showing early success in transforming pathways to care for youth at risk for suicide. Enhanced by the Collaborative Assessment and Management of Suicidality (CAMS) Framework®, this innovative model is redefining crisis intervention and expanding access to timely, evidence-based treatment.

Housed on the University of Colorado’s (CU) Anschutz Medical Campus and in partnership with the CU Department of Psychiatry, the Crisis Clinic started seeing its first patients in June 2024. By blending models from leading thought partners across the nation, selecting the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) Framework® to treat patients, and leveraging a multidisciplinary team approach, the Crisis Clinic is transforming mental health for youth across the state through accessible and tailored outpatient services, empowering patients and families in their fight against suicide.

Blending Care Models to Build a Groundbreaking Outpatient Clinic

As part of the growing youth mental health crisis in Colorado and across the nation, children and adolescents experiencing suicidal thoughts and behaviors often seek care at the emergency department. From there, providers typically refer them to inpatient psychiatric units or discharge them with recommendations for outpatient services. However, due to hospital boarding, long waitlists, insurance limitations, and other barriers to accessing care, patients and families often face difficulties navigating mental health systems and connecting to care.

In response to this complex crisis and the need for more rapid-access care pathways, Children’s Colorado took action through advocacy and coordinated strategic planning efforts. Under the leadership of Dr. Beau Carubia, child psychiatrist and Medical Director for the Consultation-Liaison/Emergency (CL/ED) Division; Dr. Anastasia Klott, child psychiatrist and Interim Associate Medical Director of Crisis Services; and Betsey Bucca, LCSW, Associate Clinical Manager of Consultative/Crisis, the experienced mental health providers at Children’s Colorado came together to create something different. Dr. Collette Fischer, psychologist, joined the team as the Interim Program Director of Crisis Services, and in collaboration with process improvement specialists, the team worked to design and implement new models of care.

Their broad Crisis Services strategic plan takes a comprehensive, three-pronged approach to bridge mental health care gaps, integrating rapid-access outpatient care, enhanced emergency department triage, and short-term inpatient stabilization to ensure youth receive timely, individualized support.

Their vision was to first launch the rapid-access Crisis Clinic to provide immediate, evidence-based suicide-focused treatment in an outpatient setting for patients who neither required higher levels of care nor had an established mental health provider. Borrowing inspiration and guidance from other leading institutions nationwide, they developed a flexible, holistic approach that would meet the unique needs of each child.

The Crisis Clinic narrowed its focus to serving youth experiencing suicidal ideation and attempts. Today, the Crisis Clinic serves youth ages 10-17 who experience a range of suicidal ideation, from distressing thoughts to plans and attempts.

Choosing the CAMS Framework for Proven, Evidence-Based Treatment

As part of a multi-year project to implement the Zero Suicide framework across all clinical sites and levels of care at Children’s Colorado, leaders of the Crisis Clinic selected the CAMS Framework for its effectiveness and adaptability. Dr. Fischer, Dr. Klott, Dr. Carubia, and Dr. Jessica Hawks, Clinical Director and incoming Chief of Psychology, were familiar with these models from their research on system-wide transformation and patient-centered care. Additionally, they were familiar with the CAMS Framework based on discussions with a former colleague, and now current faculty at the University of Washington, Dr. Eileen Twohy. “CAMS was the best fit given the amount of evidence backing it,” explained Dr. Klott.

When they explored CAMS further, they discovered that they could tailor the framework to each patient’s unique needs, which aligned seamlessly with their strategic vision. The framework consists of first gathering information about a patient’s experiences and suicide risk, followed by developing a treatment plan, a stabilization plan, and treating patient-identified “drivers” (the problems that compel the patient to consider suicide). Dr. Fischer added, “Because CAMS is a framework, it allows for flexible treatment planning, helping us remain focused on reducing suicide by addressing those unique drivers.”

The Crisis Clinic prioritizes education about the CAMS Framework and its approach to ensure families understand the care model. Alongside partners at OSP, over 40 providers across their network of care participated in the CAMS training. Additionally, Crisis Clinic providers have completed training in CAMS-4TeensⓇ and CAMS Brief Intervention (CAMS-BI™).

Support from the CAMS-care team has prepared the Crisis Clinic to successfully anticipate setbacks with patients, without which the patients might have been re-admitted to higher levels of care. Dr. Fischer added, “The CAMS Framework has been powerful not only for our patients but also for our clinicians.” Most notably, it provides a common language and ensures objectivity through tools like the Suicide Status Form (SSF), which supports outpatient treatment decisions.

Clinicians at Children’s Colorado often refer to a quote that Dr. Jobes shares in training materials: “CAMS empowers clinicians by empowering their patients.”

Leveraging a Multidisciplinary Team Approach for Holistic Pediatric Care

In addition to the CAMS Framework, the Crisis Clinic transforms pediatric mental health care through a multidisciplinary approach. The team consists of Advanced Practice Providers, Behavioral Health Clinicians, Care Coordinators, Psychiatrists, a Psychiatric Pharmacist, and Psychologists, each collaborating to provide holistic services to patients and their families. The roles of a pharmacist for optional medication management and care coordinator for continuity of care ensure a patient-centered, seamless experience during treatment and the post-discharge transition to outpatient or community mental health resources.

Over 6-8 visits, patients work with a dedicated clinician who uses CAMS and complementary modalities to address the drivers of suicidality. The first session spans two hours and entails comprehensive assessment and care planning, with subsequent one-hour sessions focused on progress and adjustment.

Simultaneously, a second clinician supports the family through education, including providing psychoeducation, lethal means counseling, and safety planning. The co-clinician and caregivers use the CAMS Stabilization Support Plan (SSP) to provide ongoing support for the patient’s suicidality.

At the end of each session, the multidisciplinary team huddles amongst themselves to align on progress. They then sync up with the patient and family to plan for the week ahead. Dr. Klott reflected on the process, remarking, “This level of acuity and volume would be overwhelming to navigate alone.”

The Gary Pavilion at Children’s Hospital Colorado at the University of Colorado’s (CU) Anschutz Medical Campus houses the child and adolescent psychiatry program.

Transforming Communities One Patient and Family at a Time

Between June and December 2024, the Crisis Clinic pilot served 21 patients using the CAMS Framework across 128 total treatment sessions. Patients accessed timely care, with referrals placed before discharge from the emergency department and an average wait time of just 4.6 business days before starting therapy. Overall, the clinical team has observed stabilization in patient-reported ratings related to suicide risk.

According to initial feedback, patients report they learned coping mechanisms and identified contributing drivers of their suicidal thoughts. They valued feeling heard and understood without pressure. They improved communication with family members. They highlighted the importance of efforts to address self-hate and promote self-forgiveness. Dr. Fischer acknowledged how the rapid-access Crisis Clinic is disrupting patterns otherwise seen in the youth mental health crisis, “Without a clinic like this, patients might come back to our Emergency Departments 10 times worse 10 weeks later.”

Beyond offering direct support with the Crisis Clinic and CAMS, Children’s Colorado is spearheading a cultural shift, encouraging open conversations about suicide to reduce the stigma. This includes community screenings and dialogues around the documentary, My Sister Liv, which emphasizes that talking openly about suicidality reduces suicidality rather than increases it. They also share tools such as hotlines and community resources. By addressing a crisis through a suicide-specific lens, they underscore their mission to treat crises not just as moments of distress but as opportunities to empower patients and families toward healing.

Through rapid outpatient services to divert unnecessary hospitalizations, the evidence-based CAMS Framework for patients and their families, and a multidisciplinary care team, Children Colorado’s Crisis Clinic is redefining suicide-specific care for youth in Colorado. While much work remains to reach more youth experiencing mental health crises and close the care gap in Colorado, the Crisis Clinic’s unique, blended model sets a powerful example for other providers focused on reducing youth suicidality to follow.

Colorado’s Blueprint for Suicide-Specific Care: How the Office of Suicide Prevention Channels Limited Resources into Lasting Impact

Posted on August 20, 2024January 28, 2026 by erics

Colorado has historically faced some of the highest suicide death rates in the United States. In 2020, 21.5 per every 100,000 people died by suicide, compared to 13.5 per every 100,000 people nationally. However, in 2022, after a 15-year high, Colorado’s suicide statistics began trending downward. Since then, suicide rates have remained steady and show promising signs of continued improvement.

Behind this remarkable progress is the Colorado Office of Suicide Prevention (OSP)—a small yet mighty team leading the state’s suicide prevention, intervention, and postvention efforts. By securing competitive state and federal grant funding, implementing a comprehensive suicide-care strategy rooted in evidence-based practices like the Collaborative Assessment and Management of Suicidality (CAMS), and addressing diverse community needs, Colorado is catalyzing lasting change and providing a blueprint for other states and organizations to follow.

The Colorado Office of Suicide Prevention (OSP)

OSP was established in 2000 within the Prevention Services Division of the Colorado Department of Public Health and Environment as the state’s lead entity for suicide prevention. Under the leadership of Director Lena Heilmann, the dedicated team of eleven works tirelessly to enhance suicide-specific care across the state.

Anchored in six core pillars—Connectedness, Economic Stability, Education and Awareness, Improving Access to Safer Suicide Care, Lethal Means Safety, and Postvention—OSP collaborates with communities and agencies across every county in Colorado to develop and implement equitable strategies to reduce suicidal despair, attempts, and deaths. Funding local initiatives, fostering collaborative partnerships, targeting high-risk populations and areas, and training individuals to handle suicidal crises, are a few components of their comprehensive, statewide approach.

Despite resource limitations, competitive state and federal grants have made their growth, strategic approach, and progress possible.

Three Foundational Elements of OSP’s Success

1. Maximizing Resources through Federal Grants

OSP leverages competitive state and federal funding to support its comprehensive, community-based approach to suicide-specific care. They maintain continuous efforts by leveraging diverse funding sources, avoiding funding shortages between grants.

To date, OSP has secured all eligible federal grant options. For example, in FY 2022-23, of their $5.19 million budget, $3.3 million came from federal grant funds, including:

SAMHSA Zero Suicide Federal Grant
SAMHSA GLS Youth Suicide Prevention Federal Grant
SAMHSA National Strategy for Suicide Prevention Federal Grant
CDC Comprehensive Suicide Prevention Federal Grant
Public Health and Human Services Block Grant

The evidence-based Collaborative Assessment and Management of Suicidality (CAMS) and Zero Suicide frameworks are critical components of comprehensive suicide prevention. OSP collaborates with the CAMS-care team to secure grants, embedding both frameworks into their grant funding to achieve specific goals and enhance suicide prevention efforts.

2. Implementing a Comprehensive and Aligned Approach

OSP collaborates with and engages various stakeholders, including communities and agencies across Colorado, to coordinate suicide prevention programs and efforts. Their comprehensive state-wide approach includes:

Funding local initiatives
Targeting high-risk populations and areas
Implementing primary prevention strategies
Training individuals to respond to crises
Addressing lethal means safety
Supporting those impacted by suicide
Leading collaborative partnerships

Embracing the Whole System of Care

OSP’s unified strategy, based on a comprehensive approach that Zero Suicide plays a critical role in, ensures they address all aspects of suicide prevention, intervention, and postvention. This creates a seamless continuum of care for individuals to receive the best possible support. This holistic approach allows for early identification and intervention, continuous support throughout recovery, and effective postvention efforts to mitigate the impact of suicide on families and communities, ensuring no one falls through the cracks.

Prioritizing CAMS and Zero Suicide Frameworks

Evidence-based frameworks, such as CAMS, are the most effective suicide treatment methods. OSP incorporates these frameworks into their health systems, supporting training, suicide-specific care plans and continuous quality improvement activities across the state. For example, through the 2018 GLS grant, OSP trained 980 providers in CAMS during five training programs. More recently, in FY 22-23, they trained 350 providers during six training programs.

The flexible nature of CAMS allows for its adoption across various demographics and care settings. OSP’s initiatives have encouraged providers to integrate CAMS into everyday practice, spurring a cultural shift within the entire system of care toward more empathetic, honest, and trust-based patient interactions. As CAMS training becomes standard, it ensures consistent, high-quality care despite clinician turnover, improving suicide prevention practices statewide.

Tailoring Interventions through an Equity Lens

OSP prioritizes equity in its programming, customizing interventions to the specific needs of different demographics and communities. OSP targets groups with the highest suicide rates in Colorado, such as LGBTQ+ individuals, veterans and their families, and workers in high-risk industries, such as construction, oil and gas, and first responders. This helps ensure that their initiatives include culturally appropriate information that address the needs of these communities.

Director Lena Heilmann reflects, “The more comprehensive and aligned our programs are, the more reductions we see in suicide fatality rates. That level of coordination and thoughtfulness will hopefully keep our rates in the direction of decreasing.”

3. Addressing Diverse Communities through Innovative Solutions

OSP meets community needs by observing what works and adapting strategies when necessary. In close collaboration with CAMS-care, they use innovative solutions to enhance their suicide prevention efforts. Recent examples of how OSP and CAMS have collaborated to amplify efforts span boosting training participation numbers to developing the clinician locator.

Training Engagement

When OSP received the GLS grant in 2018, they initiated five CAMS trainings statewide. Unlike the areas of Loveland and Lakewood that saw high attendance, Pueblo only had nine attendees. However, these nine attendees were so impressed with how in-depth the training was that they brought their organizations the following year, increasing participation.

Clinician Locator

When community partners began asking OSP for a list of CAMS Trained™ providers, OSP approached CAMS-care for help. Together, we launched the CAMS Clinician Locator to connect people to CAMS-trained providers, with options to filter by those who serve youth, offer telehealth, and accept Medicare and Medicaid.

CAMS Certification and Train the Trainer Programs

Following high participation rates in recent CAMS trainings, OSP is emphasizing advancing providers from CAMS Trained to CAMS Certified™ to meet higher standards of evidence-based care. Additionally, they are funding a number of CAMS Certified clinicians to become CAMS Internal Trainers to create more sustainable training practices and facilitate quicker onboarding of new staff.

Highlights of Colorado’s Success

Securing competitive grant funding, implementing a comprehensive and aligned approach, and meeting the community’s needs have not only elevated Colorado’s quality of care but also contributed to notable successes in the state’s fight against suicide.

In addition to the overall decrease in its state age-adjusted suicide mortality rate, other impressive state-wide statistics thanks to OSP’s efforts include:

Decreased youth suicide deaths: In 2022, the youth suicide rate dropped to 8.53 per 100,000 from 13.06 per 100,000 in 2021.
Increased support for youth: In 2021, over 73.5% of high school students reported that they had an adult to go to for help with a serious problem.
Decreased Emergency Department visits: The age-adjusted rate for suicide-related visits dropped from 162.12 per 100,000 in 2018 to 151.92 per 100,000 in 2022.
Decreased hospitalizations: Suicide-related hospitalizations dropped from 3,165 cases (56.01 per 100,000) in 2018 to 2,734 cases (47.51 per 100,000) in 2022.

These are just a few of OSP’s many key FY 22-23 successes. Most recently, the 2024 National Strategy for Suicide Prevention highlights OSP’s work as a model for supporting upstream comprehensive community-based suicide prevention.

A Blueprint for Saving Lives

The Colorado Office of Suicide Prevention has laid a solid foundation for continued improvement in suicide fatality rates across the state. The Zero Suicide and CAMS frameworks serve as cornerstones of this foundation, driving suicide-related outcomes in a positive direction. While much work remains until the suicide mortality rate reaches zero, OSP’s approach serves as a powerful model for other state and local organizations to follow.

Wherever you are in your suicide prevention journey, CAMS-care is here to support you. Whether you are looking for help applying for state or federal grant funding, repurposing existing funding into a more effective strategy, or finding the latest suicidology resources, we would love to hear from you. Contact us anytime.

Together, we can elevate suicide-specific care and save more lives.

Jumping in the Hole

Posted on June 11, 2024January 28, 2026 by erics

This guy’s walking down a street when he falls in a hole. The walls are so steep he can’t get out. A doctor passes by, and the guy shouts up, “Hey you, can you help me out?” The doctor writes a prescription, throws it down in the hole and moves on. Then a priest comes along, and the guy shouts up, “Father, I’m down in this hole, can you help me out?” The priest writes out a prayer, throws it down in the hole and moves on. Then a friend walks by. “Hey Joe, it’s me, can you help me out?” And the friend jumps in the hole. Our guy says, “Are you stupid? Now we’re both down here.” The friend says, “Yeah, but I’ve been down here before, and I know the way out.”

“Noel” (2000) The West Wing, Season 2, Episode 10

I suffered for years with constant thoughts of ending my life, eventually coming to find comfort in them, like a blanket that would keep me warm on cold winter nights. On the few occasions that I would share this with people, I was either dismissed outright or met with hostility, fear, or was shamed. While it was painful and difficult for me to understand these responses, as if my verbalization of these thoughts could infect the other person, I have never been able to understand why I was met with these same responses from the mental health professionals who were supposed to be helping me.

By my sophomore year in college, I had taken definitive action to end my life three times. Although I had been in therapy at the time of each attempt, I never told anybody. There had already been power struggles about thoughts of ending my life, having been dismissed by one therapist and threatened with hospitalization by another; sharing about actual attempts was off the table. At age 19, l was starting with a new therapist. I was suicidal, self-destructive, and distrustful–my prior experiences had taught me to keep secrets. I do not have memories of our first few sessions, but at some point early on my new therapist asked what I thought my life would be like when I was 25 and I answered honestly, saying “I don’t plan to live that long.”

Instead of being dismissive, moralizing or threatening he was empathetic, compassionate and genuinely interested in what I had to say about my own experience; I was in unfamiliar territory. Over the next six months, I slowly learned how to trust another person and he tried everything to help me. We started an interactive journal, each writing in a notebook and passing them back and forth at each meeting to have something between our sessions. On a beautiful spring day following an especially difficult session, we spent an hour talking and walking around a DC neighborhood instead of sitting in the office. I remember a particularly painful session where we both sat on the floor and I just cried, remarking that I hated crying in public and him responding with, “I don’t consider myself public.” I did not realize it at the time, but somewhere along the way, he had jumped down into the hole with me and was desperately trying to help me find my way out.

Seven months after we started working together, on a Tuesday evening, I experienced an acute suicidal crisis. The thoughts that had always been comforting were terrifying; I was incredibly agitated, self-destructive, and very determined. Nothing good was going to come out of that night but instead of doing the same thing I had done on three previous occasions, I picked up the phone. Despite our collective best effort to keep me out of the hospital, that is where I ended up–but I was alive and it was because of the strength of the relationship we had forged. It very easily could have ended differently.

In the following weeks and months, that relationship was my sanctuary providing protection from the life I was trying to figure out if I was even interested in living. He was unwavering in his position that my life was worth saving and steadfast in his commitment to help me but was always, always respectful when I often did not feel the same way. Slowly, over time, my position changed. It was not a linear path, I certainly took the long road to get there, and he stood next to me the entire way.

A year ago, I never would have even considered sharing my story but as I read the lived experience stories of others, it became clear that my experience is different in two significant ways. First, we tried many different types of medication, alone and in combination, but nothing worked. Despite what is often reflected in these stories, medication does not work for everybody and if it’s not working for you please know that you are not alone. Recovery is possible without medication and while I wish it had worked, that was not to be part of my story and it may not be part of your story either. Second, and most importantly, I had a therapist who was an expert in treating suicide. For me, this was the game-changer.

As I shared, I saw other mental health providers prior to finding the therapist who would ultimately save my life. While I liked all of them, they were either not trained in how to manage a patient with suicide or were working within a system that was not set-up to manage a patient with suicide. Treating suicide is not something that most professionals are taught in training programs and many mental health systems still use threats, coercion, and practices like no-suicide contracts, which do more damage than good.

If you work within these systems, I implore you to work to change them and if you are a provider who may not be familiar with evidence-based treatments and brief-interventions for suicide, please explore the resources available to learn more and get the training necessary to implement them adherently. I am not a mental health provider, but I have been told by many that it is incredibly scary to work with people with suicide and I believe this to be true. But standing up at the top of the hole and looking down is not what a person in the fight for their life needs or, frankly, deserves.

Perspective from a person with lived experience of serious thoughts of suicide.

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