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

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

The Power of CAMS

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

Applying Self-Determination Theory to CAMS

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

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

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

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

Benefits of Evidence-Based Treatment

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

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

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