Other Topic: Lethal Means Safety

After Your Child’s Suicide Attempt

Posted on 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.

New Directions in Suicide Safety Planning: The Project Life Force (PLF) Intervention

Dr. Goodman describes the development and testing of a novel treatment – “Project Life Force (PLF)” – which combines aspects of two evidence based treatments: Suicide Safety Planning and Dialectical Behavior Therapy Skills. The intervention is delivered in a group format and virtually since the pandemic. PLF framework, clinical data and implementation efforts were reviewed.

Marianne Goodman, PhD

Marianne Goodman, MD

Dr. Goodman has been a full time VA clinician (psychiatrist)-scientist at the James J. Peters VA Medical Center (JJPVA) for twenty-five years. In addition to being the Director of the VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), she was the Director and developer of the JJPVA Dialectical Behavioral Therapy (DBT) Clinical and Research program from 2002-2015 and Director of the JJPVA Suicide Prevention Clinical Research Program from 2015-present. Her expertise is in the management of high risk suicidal and emotionally dysregulated Veterans and is considered one of the top suicide prevention experts in the VA system, actively involved in clinical care, research and education. Additionally, she has been the recipient of several prestigious awards for her involvement in suicide prevention and DBT treatment including the New York Federal Executive Employee Outstanding Individual Achievement Award for her Clinical DBT Program for Suicidal Veterans (2009), VISN 3 Network Director’s Achievement Award for Training VISN 3 Clinicians in DBT (2012), and the New York State Excellence in Suicide Prevention Award for Implementation of Zero Suicide in a Healthcare Setting (2018).
In 2015, she shifted her research direction to focus on treatment development for suicide prevention and designed “Project Life Force” (PLF) a novel group intervention that adapts DBT, combining emotion regulation skills with suicide safety planning and lethal means safety which was initially funded with a VA RR&D SPiRE pilot grant (2016-2018), and more recently funded with a multi-site VA RCT with a CSRD Merit (2018-2024). This intervention has moved to full telehealth delivery and with a 2021 SPRINT pilot award expanded to target populations of suicidal rural Veterans (PLF-RV). Dr. Goodman will present on her Project Life Force Intervention.

David A. Jobes, PhD

About David A. Jobes Ph.D. ABPP

David Jobes, PhD, ABPP, is the founder of CAMS-care, LLC. He began his career in 1987 in the Counseling Center of the Catholic University of America, where he developed a suicide risk assessment tool for college students that evolved into CAMS. Dr. Jobes is now a Professor of Psychology and Associate Director of Clinical Training at Catholic; he has trained thousands of mental health professionals in the United States and abroad in evidence-based assessment and treatment of suicide risk and the use of CAMS.

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10 Tips for Clinical Management of Suicide Risk

10 Tips for Clinical Management of Suicide Risk On-Demand Webinar

In this hour-long webinar, “10 Tips for Clinical Management of Suicide Risk,” clinicians often face anxiety and uncertainty in managing and treating suicide risk. This presentation will highlight ten helpful and scientifically informed tips that clinicians can begin to use immediately in the context of their practice.

Marjan G. Holloway, Ph.D.

About Marjan G. Holloway, Ph.D.

Dr. Holloway is a Professor of Medical and Clinical Psychology and Psychiatry at Uniformed Services University (USU), a Diplomate of the Academy of Cognitive Therapy, and an Adjunct Faculty Speaker and Consultant at the Beck Institute for Cognitive Behavior Therapy and the Zero Suicide Institute. She completed her postdoctoral training in 2005 at the Center for the Treatment and Prevention of Suicide at the University of Pennsylvania under the mentorship of Dr. Aaron T. Beck. As the Founder and Director for the USU Suicide Care, Prevention and Research Initiative, Dr. Holloway and her team have developed and disseminated a number of evidence-informed psychosocial programs to address the public health burden of suicide as highlighted by (1) the Air Force Guide for Suicide Risk Assessment, Management, and Treatment; (2) the Chaplains-CARE program; (3) Special Operations Cognitive Agility Training (SOCAT); (4) Rational-Thinking and Emotional-Regulation through Problem-Solving (REPS) for newly enlisted military personnel; (5) Mil-iTransition for Service members receiving unfit for duty determinations; and (6) Post-Admission Cognitive Therapy (PACT and PACT-Together) for psychiatric inpatient settings and Intensive Outpatient Programs. Dr. Holloway maintained a part-time private clinical practice for 15 years, shifting recently to a consulting practice.

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Lethal Means Safety and CAMS

Posted on by erics

It is interesting how ideas and constructs within suicide prevention that have been around for many years can rather suddenly become popular. For example, the notion of “lethal means safety” (LMS) has been around for as long as I have been in suicide prevention (which is now pushing 40 years).

We used to refer to LMS as “restricting access to lethal means,” but there was a sense that firearm owners might be sensitive to this language as a threat to their second amendment rights. And if there is one thing that is true in the world of suicide prevention, it is that words matter! The most striking example is “committing suicide,” which has now been banished within the field because of how it criminalizes the behavior (“die by suicide” is less stigmatizing). Indeed, recent LMS research has shown the referring to “firearms” is less off-putting to people who own them than the word “guns”—which is good to know! In any case, within contemporary legislation and policy, a particular emphasis on LMS has become red hot.

Understanding Lethal Means Safety

Simply stated, LMS broadly refers to any clinical, community-based, or policy-driven effort that literally blocks or hinders ready access to potentially lethal means that could be used in a suicide to end one’s life. The range of examples is extensive. In the United States, our #1 method choice is by firearm, and brilliant work has been done in recent years in this area by Mike Anestis at Rutgers, Kathy Barber and Matt Miller at Harvard, and Craig Bryan at Ohio State University. While it has been contentious, sincere efforts to engage the firearm community have led to some valuable shared perspectives that can be good for suicide prevention. But there are many other means, including hanging, jumping, drowning, helium “Exit Bags,” medications, razors/knives, carbon monoxide car exhaust, etc.

The Nuances of Lethal Means Interventions

Major population-level increases in suicides have been linked to certain lethal means. A decade ago, dramatic increases in female suicides in rural China were due to toxic pesticides. During the 1970s, Brits in the UK were using lethal coal gas fumes for suicides. These examples are well known because rather simple interventions that involved locking up pesticides and switching over to less toxic forms of coal directly reduced suicides in China and England, respectively.

Keith Hawton at Oxford did a clever study in the UK limiting daily access from pharmacies of over-the-counter pain-relievers and the use of blister packs that literally made it more difficult to gather a lethal dose (of the English equivalent to Tylenol) reduced overdose behaviors! My friend Konrad Michel in Switzerland has been the leader in the use of netting sites where people jump to their death.

During one family vacation, we visited a public park with Konrad at a palace in Bern where netting had been installed below a balcony of an infamous jumping location. Interestingly this net reduced suicide jumps to zero even though one can walk to the end of the balcony and jump off the side, but apparently, no one does this! So lethal means interventions do not have to be 100% foolproof; sometimes symbols of deterrence are quite effective.

Effective Lethal Means Safety Interventions

Within one early CAMS clinical trial, a patient lived in a group house where a loaded handgun was left on the dining room table for anyone that needed it! This was easily removed with the encouragement of the patient’s CAMS clinician. But then the patient had a prized knife collection and, when he became psychotic, he was tempted to stab himself in the eye (a rather gruesome method with uncertain lethality). He refused to surrender or give his beloved knives to another party for safekeeping.

Undeterred, the resourceful CAMS clinician bought him a metal box for his knives with a padlock and gave him the key. On top of his box was a taped copy of his CAMS Stabilization Plan. The patient was moved and grateful for this gift from his intrepid provider.

I once had a patient who almost jumped to her death but for a last-minute grab of her boyfriend (who I called to rescue her) as she started going over the railing. Following a two-week psychiatric hospitalization, we all agreed to have her life-saving boyfriend (who was a carpenter) build a wooden buttress to the sliding glass door to her balcony so she could not jump to her death.

Many of us who have seen suicidal patients over many years have countless stories of lethal means safety interventions that we have orchestrated that have made our patients immediately safer and less tempted by readily available lethal means. In my professional trainings, I often note that ready access to lethal means poses a “rival” approach to suicide-focused treatment for addressing the needs that underlie all potential suicides (e.g., unbearable suffering, isolation, financial ruin, etc.—what we call “drivers” within the CAMS Framework®). By removing temptation, the patient is more inclined to get needs met differently, more therapeutically, and the risk of suicide death decreased accordingly.

The CAMS Evidence-Based Approach to Lethal Means Safety

Within CAMS, lethal means safety is central to the evidence-based treatment framework. In fact, discussing access to lethal means is the first step in the CAMS Stabilization Plan. My friends Barbara Stanley and Greg Brown have developed the famous Safety Plan Intervention, which is a “first cousin” of the CAMS Stabilization Plan and Rudd and Bryan’s Crisis Response Plan. But in contrast to the CAMS Stabilization Plan, “Making the environment safe” is Step # 6 of the Safety Plan. The reason LMS is the first consideration of the CAMS Stabilization Plan is because of the differences between a one-shot Safety Plan Intervention and on-going treatment of suicidal risk, which is the emphasis in CAMS.

A common goal in “standard” CAMS is to keep a person who is suicidal out of the hospital if at all possible. In my view, the decision not to hospitalize a patient in CAMS is almost always rooted in the quality of the Stabilization Plan we are able to negotiate with the patient. If there is strong push back about lethal means, we may have no choice but to hospitalize. But if I can persuade a patient to surrender a stash of pills to their partner for safekeeping or convince another patient to use a cable lock on their firearm for the duration of our treatment, the need to hospitalize is often eliminated. We can then proceed in good faith to complete the balance of the CAMS Stabilization Plan, which focuses on different problem-solving techniques, who to contact in crisis, identifying people who will help decrease interpersonal isolation, and addressing potential barriers to receiving CAMS-guided care. CAMS Treatment® planning then concludes with a discussion of patient-defined drivers and how we plan to target and treat those problems and issues over the course of using CAMS. LMS is thus central to the CAMS Framework.

Unconventional Care Saves Lives

Several years ago, I was in the lab watching a digital recording of a CAMS session for fidelity purposes in our Army randomized controlled trial of CAMS. One of my favorite therapists in the study was working with a challenging case of a Soldier who had been repeatedly sexually assaulted. In turn, she kept a handgun in a side table drawer next to her bed for protection. However, her method for suicide would be to use this very firearm. She was emphatic that removing the gun was simply not negotiable because of the rapes she had endured—a definite therapeutic standoff!

The clinician thoughtfully considered the potential clinical standoff for a moment and then proposed the following: make a box to store the gun and to put a picture of the Soldier’s niece on the box as a reminder about why she should fight to live (her niece was her #1 Reason for Living on the SSF assessment). The Soldier readily agreed. I was worried, but the clinician felt confident in his intervention. In her next CAMS session, the patient brought in a work of art: a beautiful wooden box that she made in a shop with decoupaged images of the beloved niece! In my consultation with the provider, I pushed to swap-out the firearm with a taser, but the patient had zero interest in my helpful LMS suggestion! This remarkable woman responded beautifully to CAMS in 8 sessions.

In any final successful course of CAMS-guided care, there is a question about “what made the difference?” on the final outcome-disposition SSF. This Soldier, without hesitation, said, “CAMS showed me I could get my needs met without resorting to suicide…and you let me keep my gun!”

Suicide and Older Adults: On-Demand

Suicide and Older Adults: On-Demand

Dr. Jobes and his special guest expert Dr. Yeates Conwell discuss suicide among older adults with an eye to research and evidence for effective approaches to its prevention.

The suicide rate among older adults is higher overall than at other points in the life course and poses particular challenges for prevention. Older adults take their own lives with high lethality of intent and utilize firearms more often than younger age groups. Suicide attempts are also less frequent and older adults less often express suicidal ideation than younger adults. While interventions must be aggressive in the actively suicidal older person, the lethality of suicidal behavior in older adults underscores the need for relatively greater emphasis on upstream preventive interventions.

In addition to access to deadly means, risk factors for completed suicide in later life can be characterized as “the 5 Ds”: demographic characteristics (male, older, unmarried), depression, disease (physical illness), disablement, and disconnectedness. Because older adults who take their own lives are more likely to be seen in primary care than mental health care settings, primary care-based integrated care models hold promise for reducing suicide in this age group. Social disconnectedness, which is made worse by the “social distancing” required by the coronavirus pandemic, is also a modifiable state for which community-based services and supports should be mobilized.

At the conclusion of this webinar, participants will understand the scope of the problem of suicide in older adults, factors that place older people at increased risk for suicide, and evidence for effective approaches to its prevention.

Dr. Yeates Conwell

About Dr. Yeates Conwell

Yeates Conwell, M.D. received his medical training at the University of Cincinnati and completed his Psychiatry Residency and a Fellowship in Geriatric Psychiatry at Yale University School of Medicine. He is now Professor of and Vice-Chair of Psychiatry, University of Rochester School of Medicine and Dentistry, where he is Director of the Geriatric Psychiatry Program and the UR Medical Center’s Office for Aging Research and Health Services, and Co-Director of the UR Center for the Study and Prevention of Suicide. In addition to teaching, clinical care, and service system development, Dr. Conwell directs an interdisciplinary program of research in aging, mental health services, and suicide prevention.

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Challenges of Assessing and Treating Youth Suicide: A Solution in CAMS-4Teens®

The news of rising teen suicide rates is difficult to ignore. Every few months, the media reports on another study that documents how much teen suicide rates have increased in the past 20 years. Rates jumped from 6.8 deaths per 100,000 people in 2000 to 10.6 deaths per 100,000 people in 2017.1 Suicide is now the second-leading cause of death for 15- to 24-year-olds, with only motor vehicle accident deaths outnumbering it. Researchers have noticed trends in suicide rates among girls and young women increasing, as well as for young black men.1,2

Researchers and mental health professionals are struggling to identify causes for these trends and to quickly identify effective prevention and treatment strategies to address this major public health concern. While many research studies report on trends in rates among certain gender and ethnic groups, it is extremely difficult to identify causes for rising suicide rates. Our best educated guesses about this alarming trend relate to added stress caused by:

  • addiction in families (as seen in the opioid crisis),
  • the use of social media and the associated feelings of inadequacy, loneliness, and the pressures of “keeping up” with friends,3
  • lack of access to mental health resources in schools and communities,
  • lack of suicide-specific training for mental health professionals, and
  • evidence that the current generation of youth experience more depression, anxiety, and stress in general than prior generations4.

All of these issues combined with easier access of searching, finding, and being exposed to media that depict or offer information on suicide may be impacting the increase.

Obstacles to Treatment

A major obstacle to reducing the rise of suicide rates across all age groups is the lack of evidenced-based care available for individuals who are suicidal5. Funding for research on suicide treatment lags far behind other health issues. For decades, researchers and mental health professionals did not include suicidal individuals in studies that tested promising new treatments because it was considered too risky. These barriers have brought us to our current state of feeling far behind in terms of knowing what works best for treating suicide. The National Institute of Mental Health has identified research on suicide as an area of priority, and more studies are being funded to help evaluate what methods work best for prevention, screening youth for suicide risk, and finding the best possible treatments.6

There are many layers of prevention and treatment that can be implemented for youth suicide. Many states have suicide prevention centers within their public health departments, which are tasked with implementing prevention programs in communities and schools and training mental health professionals in their state on best practices for working with suicidal patients. Within schools, Signs of Suicide has been found to be an effective gatekeeper training program that teaches teens about recognizing suicide risk in their peers and the steps they should take to connect their friends with resources.7 The Good Behavior Game is a classroom-management system that is used for second-graders and focuses on minimizing aggressive and disruptive behavior, and amazingly has shown long-term reductions in suicidal behavior as kids move through adolescence.8

Existing Treatment Programs

From a treatment standpoint, few treatments specific to suicide exist that have been shown to provide best clinical care for suicidal teens. Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are both used for teens with suicide risk. CBT works well as a treatment for depression and anxiety-related disorders, and it can also be used to help someone understand their thoughts about suicide and their feelings of hopelessness.9 DBT specifically addresses self-harming behavior and teaches teens important coping skills to use in place of self-harm.10

Safety-planning interventions and crisis response plans are useful when used in conjunction with DBT or CBT, as they provide concrete steps for teens and their families to follow when the teen is in crisis or thinking seriously about suicide.11,12

Advantages of CAMS with Youth and Teen Suicidality

Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic assessment and treatment framework that combines all elements from these treatments into one approach. First, CAMS provides a thorough risk assessment in the first session and uses the Suicide Status Form (SSF) to gather valuable information about a teen’s current experience and overall suicide risk.

With CAMS, the entire assessment approach is collaborative. The therapist sits next to the teen (if they are comfortable with it), encouraging the feeling that they are literally on the same page. Because many adolescents may be hesitant or suspicious of the treatment process, CAMS emphasizes transparency and empathy. Instead of a therapist sitting across from the teen with a clipboard and taking notes (that the teen can’t see) while asking questions, the teen is either writing their responses on the Suicide Status Form themselves (first page), or they are watching the therapist write down their responses (second page). The therapist and the teen write the treatment plan together, identify the top two drivers together, and create the stabilization plan together.

We have seen the CAMS approach work very well with teens (CAMS-4Teens), both in our own practices and with consultation and case presentations from other clinicians, as well as in research. A recent study found that the Suicide Status Form works just as well for assessing teen’s suicide risk as it does with adults. Teens in the study were able to understand and rate constructs like psychological pain, hopelessness, and self-hate in a way that was helpful to determining their overall level of distress and suicide risk.13

Once the therapist and teen identify the top two drivers for the treatment plan, the therapist explains what the goals and objectives will be, and which interventions they will use to help achieve those goals. Many teens have some version of self-hate as a driver for suicide. Therapists can make simple goals of decreasing self-hate and identify interventions to target that driver. Examples of interventions may be CBT interventions for increasing self-esteem or behavioral activation for getting teens out of the house and connected to the community and causes they care about (e.g., mentoring younger kids, animal shelters, volunteer work). Furthermore, elements from CBT, DBT skills, problem-solving, interpersonal therapy, and many other methods can be integrated into the CAMS Treatment® plan to target and treat drivers.

Especially for teens in an acute suicidal state, sometimes it is extremely helpful to first identify the problem. The CAMS Assessment® provides a guided walk-through of the teen’s life at that moment, and if a particular stressor or issue is uncovered as being related to the current suicidal thoughts, it can be addressed quickly in treatment. Teens can be overwhelmed with situational factors that feel unsurmountable. We have observed CAMS to be very useful in breaking down these factors into more manageable pieces that the teen can then recognize as treatable.

Tips for Using CAMS with Teens and Adolescents (CAMS-4Teens)

We have assembled some general tips for using CAMS with teens that may be helpful. Before making any major modifications to the Suicide Status Form (SSF) for use with teens, we decided to test it in its existing form. Our hunches were correct: we discovered that CAMS does not need to be radically changed for use with youth (ages 12-17).13

However, other slight procedural recommendations are helpful to keep in mind. First, some youth may need slower pacing for the assessment. It may take more time to explain concepts like psychological pain and agitation. Also, it may take some time to think about how to explain these concepts in a variety of ways.

Second, if the assessment is taking longer than usual, it is beneficial to prioritize getting the stabilization plan completed and in place. As much as possible and practical, intensive outpatient treatment is the goal of CAMS. This is largely achieved by having a solid stabilization plan/safety plan in place. It is very helpful to identify any supportive adults in the teen’s life that they can list on their stabilization plan as someone they can contact in a crisis. You may need to be creative in identifying these adults (e.g., parents, older siblings, other relatives, coaches, pastors, school counselors, etc.).

Third, some youth may respond better with a “parallel assessment” in which you are still gathering the information for the SSF while they are engaging in some other activity (coloring, fidget toys, etc.).

The last tip is focused on how to work with parents and caregivers during the course of CAMS Treatment. It is essential that other adults in the teen’s life are aware of the stabilization plan, understand how to respond to the child in a crisis, and can help assure access to lethal means are limited. We recommend completing the SSF with just the teen present, and then inviting the caregivers into the session at the end to review the stabilization plan. Caregivers may have a wide variety of emotional reactions to their suicidal teen, and it’s important to provide education on suicide in general, and the process of CAMS. Parents and caregivers may need their own support via therapy or community support groups.

In Conclusion

Thus far we have confidence from recent research results that the SSF is appropriate for teens,13 and that CAMS is a promising evidence-based treatment for suicidal teens.14,15 We know that CAMS is an effective treatment for adults,16 and that many clinicians are using CAMS with youth ages 12+ with success.

Our consultants provide on-going support to clinicians using CAMS with teens, and the overwhelming response from clinicians has been positive. They describe CAMS as useful with all types of teens – from those who are very expressive and talkative as CAMS helps organize their thoughts and feelings, to those who may be more reserved as CAMS allows them to express themselves through the SSF without needing to verbalize everything.

The next phase of CAMS-4Teens research includes randomized clinical trials (RCT), which are the gold standard in treatment research, to gather more evidence for the effectiveness of using CAMS with youth. We see a bright future in which CAMS will be available as an evidenced-base intervention for suicidal youth, a group for which having effective treatment will make a big impact and save lives.

    1. Curtin, S. C., & Heron, M. (2019). Death rates due to suicide and homicide among persons aged 10–24: United States, 2000–2017. NCHS Data Brief, no 352. Hyattsville, MD: National Center for Health Statistics.
    2. Miron, R., Yu, K-H., Wilf-Miron, R., & Kohane, I. S. (2019). Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA, 321, 2362-2364.
    3. Twenge, J. M. (2017). Have smartphones destroyed a generation? The Atlantic, https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/.
    4. Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017. Journal of Abnormal Psychology, 128, 185-199.
    5. Jobes, D. A., & Joiner, T. E. (2019). Reflections on suicidal ideation. Crisis, 40, 227-230.
    6. Research Prioritization Task Force. (2014). A prioritized research agenda for suicide prevention: An action plan to save lives. National Action Alliance for Suicide Prevention.

http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/Agenda.pdf

  1. Seltine, R. H., James, A., Schilling, E. A., & Glanovsky, J. (2007). Evaluating the SOS suicide prevention program: a replication and extension. BMC Public Health, 7, 161.
  2. Wilcox, H. C., Kellam, S. G., Brown, C. H., Poduska, J. M., Ialongo, N. S., Wang, W., & Anthony. J. C. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug and Alcohol Dependence, 95 (s1), s60-s73.
  3. Stanley, B. Brown, G., Brent, D. et al. (2009). Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment model, feasibility, and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1005-1013.
  4. McCauley, E., Berk, M. S., & Asarnow, J. R. (2018). Efficacy of Dialectical Behavior Therapy for adolescents at high risk for suicide. JAMA Psychiatry, 75, 777-785.
  5. Stanley, B., & Brown, G. K. (2012). Safety Planning Intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19, 256-264.
  6. Bryan, C. J., Mintz, J., Clemans, T. A., Burch, T. S., Leeson, B., Williams, S., & Rudd, M. D. (2017). Effect of Crisis Response Planning on patient mood and clinician decision making: A clinical trial with suicidal U.S. soldiers. Psychiatric Services, 69, 108-111.
  7. Brausch, A. M., O’Connor, S. S., Powers, J. T., McClay, M. M., Gregory, J. A., & Jobes, D. A. (2019, early on-line). Validating the Suicide Status Form for the Collaborative Assessment and Management of Suicidality in a clinical adolescent sample. Suicide and Life-Threatening Behavior. DOI: 10.1111/sltb.12587
  8. O’Connor, S. S., Brausch, A. M., Ridge Anderson, A., & Jobes, D. (2014). Applying the Collaborative Assessment and Management of Suicidality (CAMS) to suicidal adolescents. The International Journal of Behavioral Consultation and Therapy, 9, 53-58.
  9. Jobes, D. A., Vergara, G. A., Lanzillo, E. C., & Ridge-Anderson, A. (2019). The potential use of CAMS for suicidal youth: Building on epidemiology and clinical interventions. Children’s Health Care, 48, 444-468.
  10. Jobes, D. A. (2015). Managing suicidal risk: A collaborative approach (2nd edition). New York: Guilford.

About Amy Brausch Ph.D.

Amy Brausch Ph.D.
Dr. Amy Brausch is an Associate Professor of Psychological Sciences at Western Kentucky University where she founded the Risk Behaviors and Suicide Prevention Laboratory in 2011. She completed her Ph.D. in clinical psychology at Northern Illinois University in 2008, following her clinical internship at Utah State University Counseling and Psychological Services Center. Dr. Brausch’s research program broadly focuses on youth suicide risk assessment, prevention, and treatment. Specifically, her work has also focused on the overlap between nonsuicidal self-injury and suicide risk, the overlap between body image, disordered eating, and self-harm, and the role of emotion dysregulation in NSSI and suicide risk. Her work has been funded by the Kentucky Biomedical Research Infrastructure Network and the National Institute of Mental Health. Dr. Brausch has collaborated with Dr. Jobes on research related to CAMS-4Teens, including a validation study of the Suicide Status Form for adolescents. As a Senior Consultant with CAMS-care, LLC, Dr. Brausch has provided training in CAMS to mental health providers in the United States and Australia at community mental health centers, university counseling centers, school districts, and local and state mental health suicide prevention organizations.

Gun Safety and Suicide Prevention

Perhaps you’ve personally known someone, or treated someone, who attempted suicide using a firearm. Chances are, it was a man – and chances are, the attempt was fatal.

Guns and Suicide in the United States

Studies show that 76% of those who die by suicide in the U.S. are men, and 60% of male suicides are by firearm. Tragically, death is the result of over 80% of firearm suicide attempts. Since men are more likely to use firearms in suicide attempts, and since using a firearm results in a higher likelihood of death than other methods (such as overdose or suffocation/hanging), overall more men than women die as a result of suicide. For instance, approximately 77% of those who die by suicide during their first attempt are men and most of these deaths are by firearm.1

Addressing the Intersection of Firearms and Suicide:

Regardless of the gender of suicide-by-firearm victims, increased awareness of firearm safety can go a long way in preventing gun deaths and reducing suicide rates. Here are some ways that we can help to prevent suicide by firearms in our communities:

Access to Firearms for At-Risk Individuals: Trigger Locks, Gun Safes & More

While most gun owners feel that guns make them safer2, this is likely not true if a person in the household is suicidal. In fact, studies show that access to a firearm increases the risk of death by suicide by as much as three times for everyone in the household.3

One major action that can help save lives is to provide information about removing firearms, or installing trigger locks, firearms safes, and other methods of securing to not only individuals at risk for suicide but also to their loved ones.

Provide Counseling on Firearm Safety

CAMS-care, which uses an evidence-based therapeutic framework for suicide-specific assessment and treatment of a patient’s suicidal risk, recommends a collaborative discussion between a healthcare provider and patient (and ideally the patient’s family or other support network) about how to stay safe. The CAMS-care assessment includes questions about access to firearms as well as personalized discussion of how to be safe with them. Recommendations for safety are not prescriptive; they are decisions made via collaborative problem solving. For some, the solution may be to remove firearms from the house altogether. For others, it may mean securing firearms in a gun safe with ammunition stored separately, and for others putting a picture of a loved one by the firearm is the only agreed upon deterrent.

Increase Public Awareness of Firearm Safety to Prevent Suicide

They say “it takes a village to raise a child,” and the same could be said of preventing suicide. Public awareness campaigns about firearms safety in suicide prevention can reduce the number of deaths by suicide in our communities.

Campaigns launched by law enforcement, medical professionals, and gun shop owners can also help prevent suicide. For example:

  • Police and other law enforcement agencies can expand existing gun licensing and safety training requirements for new or prospective gun owners to include suicide prevention information.
  • Firearms dealers, gun range owners, or retailers can offer suicide prevention-specific information in sponsored gun safety courses.
  • Physicians and other medical professionals can discuss firearms safety and suicide risk with patients.

The Role of Gun Control Laws

Grass-roots efforts by concerned citizens to raise awareness of firearms safety and suicide prevention can also help make our communities safer. However, it’s important to recognize that individual efforts are most effective when complemented by comprehensive gun control laws that address firearm accessibility and ownership. Implementing stricter gun regulations and background checks can serve as pivotal measures in preventing impulsive acts of self-harm. By combining the power of community-driven initiatives with formal legislation, we create a more comprehensive approach for addressing gun deaths.

How Gun Safety Can Promote Suicide Prevention

The road to preventing firearm suicides through gun safety is not a straight path, but by embracing responsible firearm ownership, education, and community collaboration, we can collectively move towards a safer society. By fostering open discussions, advocating for gun safety policies, and promoting mental health awareness, we can help reduce firearm suicides in the U.S.

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Over half of the adults in America know someone who has died by suicide.4 Perhaps with greater awareness of the role that firearms safety can play in suicide prevention, our loved ones and patients will have a better chance of surviving a suicide attempt, or even ultimately avoiding suicidal behavior altogether.

 

References:

1 Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. American journal of psychiatry, 173(11), 1094-1100.

2 Igielnik R, Brown A. Key takeaways on Americans’ views of guns and gun ownership. Pew Research Center. June 22, 2017. https://pewrsr.ch/2sZzPjv.

3 Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: A systematic review and meta-analysis. Annals of Internal Medicine. 2014; 160: 101–110.

4  https://www.rasmussenreports.com/public_content/lifestyle/general_lifestyle/september_2017/more_than_half_of_americans_know_someone_who_committed_suicide

For more information

To learn more about how gender and gender identification affects suicidality, read “The Gender Paradox of Suicide: How Suicide Differs Between Men, Women, and Transgender/Gender Diverse Individuals” by Dr. Raymond P. Tucker.

About Raymond P. Tucker Ph.D.

Raymond P. Tucker Ph.D.
Raymond is an Assistant Professor of Psychology at Louisiana State University (LSU) where he founded the Mitigation of Suicidal Behavior (MOSB) Laboratory in 2017. He also is a Clinical Assistant Professor of Psychiatry at Louisiana State University Health Sciences Center /Our Lady of the Lake Medical Center. He finished his Ph.D. in clinical psychology from Oklahoma State University in 2017 following his clinical internship at VA Puget Sound. Raymond's research broadly focuses on the enhancement of theoretical models of suicide and suicide risk assessment tools, particularly in underserved populations (e.g., Veterans, Transgender and Gender Diverse adults). Raymond began his tenure as a CAMS consultant in 2019 after receiving a state-level grant to implement CAMS across the Our Lady of the Lake Regional Medical Center in Baton Rouge L.A. He is a former board member of the American Association of Suicidology and is a current faculty member at the National Suicidology Training Center.