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Best Therapies for Managing Suicidal Thoughts

Posted on 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

Jumping in the Hole

Posted on 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.

Big Ideas for Advancing Suicide Prevention

Posted on by erics

The recent end of the Spring 2023 semester marked my 40th year of working in the field of suicide prevention. During my first year in graduate school at American University, I took a remarkable class with Dr. Lanny Berman in the Spring of 1983. Lanny would soon become my major professor and the person who steered me into the world of suicidology. His course was entitled “Suicide, Death, and Life-Threatening Behavior,” and it was an eye-opening immersion into this important area of study. During that memorable semester, Lanny and I began a productive collaboration that led to my master’s thesis, my doctoral dissertation, many journal articles, book chapters, and a couple of books. Through my work with Lanny I had the good fortune to meet and work with many of the founders and heroes of the field, including Ed Shneidman, Bob Litman, Norman Farberow, Jerry Motto, and Marsha Linehan. Little did I know sitting in Lanny’s class all those years ago that my nascent interest in suicidology would evolve into a remarkably rewarding career that has been singularly dedicated to this important cause.

My Final Decade of Suicide Research

As I enter into my final decade of work in this field, I find myself at the ripe old age of 64 reflecting on the many challenges, abject failures, and dead ends that are inherent to the study of suicide. But through a lot of hard work, perseverance, and good fortune, there have been noteworthy successes. Chief among these has been the creation of CAMS and a rigorous line of clinical research to prove its effectiveness. And now with ten published open trials, seven published randomized controlled trials (RCTs), and two supportive meta-analyses, the question of whether CAMS works has been answered. The replicated and independent clinical trial data show that CAMS reliably reduces suicidal ideation (SI) and overall symptom distress, while it also consistently increases hope and decreases hopelessness. Of course, additional research questions still linger. For example, does CAMS reliably reduce suicide attempts and self-harm? And what exactly is the “secret sauce” of CAMS—the moderators, mediators, and mechanisms that make it work like it does? As for suicidal behaviors, I am delighted to note the publication of a new inpatient RCT of CAMS that was conducted in Germany showing that CAMS significantly reduced suicide attempts during the high-risk post-discharge period. Moderators, mediators, and mechanisms of CAMS are being further investigated within five ongoing RCTs of CAMS (and additional clinical trials of CAMS are now being developed). Building on this robust foundation of clinical evidence, our professional training company, CAMS-care, has trained thousands of clinicians across the nation and around the world. But from my perspective, perhaps the most exciting developments of all is the publication of the 3rd—and final—edition of the Guilford Press book, Managing Suicidal Risk: A Collaborative Approach. After two years of exhaustive work, this definitive source book on CAMS will prove to be a fitting capstone to the Guilford Press book series.

A Lack of Progress in Reducing Suicidal Suffering

While all these CAMS-related developments are exciting, I nevertheless find myself feeling frustrated and frankly impatient about the relative lack of progress overall within the larger field of suicidology. After 40 years of hammering away, I find myself craving more impactful changes and innovations to meaningfully reduce suicide-related suffering that can ultimately prevent this leading cause of death. So to this end, I would like to note and explore four particularly compelling big ideas that could make a meaningful impact as I further reflect on this field to which I have dedicated my professional life.

Focusing on Suicidal Ideation

Several years ago I found myself ruminating over the rejection of a manuscript from a peer review scientific journal. One particular reviewer pointedly dismissed various significant findings from a CAMS RCT because the intervention had failed to reduce suicide attempts. On the heels of this rejection, I began musing about the issue of “only” reducing suicidal ideation as a major criticism of CAMS. I then started to look at this critique differently. I began to question the behavioral bias that has dominated the field and I started to formulate an argument for the importance of suicidal ideation in and of itself. In fact, I have come to believe that reducing suicidal ideation may actually be a more important outcome vs. solely focusing on suicide attempt and self-harm behaviors. This train of thought was something that I had memorably discussed with my friend and colleague Dr. Thomas Joiner. I thus emailed Thomas and we ultimately wrote a well-received editorial entitled “Reflections on Suicidal Ideation” that was published in the journal Crisis—The Journal of Crisis Intervention and Suicide Prevention . In this piece, we argued that from a population perspective, that the biggest challenge we face in suicide prevention (by far) is the population of people who report “serious thoughts of suicide” in a given year. According to a recent SAMHSA (2022 ) survey, the population with serious SI included 15,600,000 American adults and adolescents in 2021 (the most recent year of data collection). Mind you, this number dwarfs the population that attempt suicide (1.7 adults in 2021) and is well over 300 times greater than the number of those who die by suicide. As Thomas thoughtfully noted, this is a profound level of human suffering. We argued that identifying and helping this enormous population upstream, could result in fewer attempts and suicides downstream. We consequently asserted that a shift in the field was needed to more fully appreciate and investigate the importance of SI as a means of decreasing this pervasive form of human suffering. Importantly, while there are excellent treatments that reduce suicidal behaviors (e.g., DBT, CT-SP, and BCBT) they do NOT reliably reduce suicidal ideation. Since this piece, we have endeavored to shift thinking within the field to meaningfully increase a focus on suicidal ideation within our collective research, clinical practices, prevention programming, and policy-related work.

Jaspr Health – Providing Hope during ED Visits

One summer day some years ago I was on a call with my colleagues Drs. Linda Dimeff and Kelly Koerner who were telling me about the successful use of an avatar named “Nurse Louis” and how this avatar-based technology demonstrated success related to discharge orders with medical surgical patients in a study conducted by Boston College investigators. The conversation evolved as we talked about the experiences of patients who are suicidal within emergency departments (ED) and I noted an extensive literature about how negative the ED experience can be for such people. This call became the genesis of a whole new avatar intervention that led to a NIMH-funded Small Business Innovation Research (SBIR) grant and the creation of an avatar based on my likeness named “Dr. Dave” that would be used to engage patients who were suicidal in the ED . Our novel tablet-based digital intervention integrated key elements of CAMS (among other related interventions from DBT and elsewhere). The striking initial success of this intervention was also in part due to the input of people with lived experience (of having been suicidal) which led to the integration of this important voice in developing the application and in the form of video testimonial stories of recovery and hope. Further NIMH SBIR funding led to an evolved intervention named “Jaspr Health” which was further shaped and refined based on input from a panel of people with lived experiences (and Dr. Dave was “retired” to my relief). Even though our RCT of Jaspr was cut short by EDs being overrun by Covid-19 patients, the obvious success within our underpowered clinical trial nevertheless provided ample and convincing evidence of the effectiveness of this novel intervention. Importantly, across my travels I have never heard of any ED experiences for patients who are suicidal being characterized as positive—not in the US, China, Uruguay, Australia, or throughout Europe. And yet with Jaspr, patients in the ED were having notably positive experiences and their Jaspr “favorites” could be downloaded to their smart phone for later use. Doctors get full reports based on CAMS aspects of the app which also ensures that certain Joint Commission institutional requirements are met as well. This remarkable line of innovation and clinical research is ongoing and reflects a fresh and exciting solution for a particularly infamous worldwide need—providing effective suicide-focused care in emergency departments for those patients who struggle with suicidal thoughts and behaviors.

The Hope Institute – Keeping Suicidal Patients out of the Hospital

Another undeniably compelling and recent development in suicide-focused clinical care is The Hope Institute that has been developed by my colleague Derek Lee in Perrysburg Ohio. The Hope Institute is an outpatient crisis setting that employs the use of both CAMS and DBT to stabilize patients who are suicidal using next day appointments (NDAs) and frequent visits (up to four times/week in some cases) to reliably stabilize patients in 5-7 weeks. The key within this model is that all care is suicide-focused and fundamentally evidence-based with proven clinical interventions. Perhaps most importantly, The Hope Institute singularly aspires to achieve stabilization as a worthy and valuable clinical goal in and of itself. Staff morale is high as clinicians do remarkable life-saving work. We are now in the process of standing up additional Hope Institutes in multiple different locations. The field needs this kind of model that emphasizes evidence-based, least-restrictive, cost-effective, suicide-focused clinical care to help people who struggle so that they can become stable and able to manage their suicidal thoughts, feelings, and behaviors. In my view, The Hope Institute is proving to be an exciting and notable clinical game-changer.

Mental Health Service Corp

Finally, I have been preoccupied with the idea of a “Mental Health Service Corp” since 2016. Given that 15.6M Americans wrestle with serious thoughts of suicide, we will frankly never have a sufficiently large and trained clinical workforce to begin to deal with the obvious and pressing needs of this considerable population (and research shows that many in this group do not want conventional mental health care). Given these considerations, a Mental Health Service Corp reflects one of my favorite pie in the sky big ideas that could significantly change the field. To have a Peace Corp-level national initiative to create a substantial paraprofessional workforce that could person the 988 Suicide & Crisis Lifeline, provide peer-support, work at respite and retreat centers for suicide stabilization, and with proper training and supervision even provide various evidence-based resources (e.g., safety planning, lethal means safety, and caring contacts) could have a profound impact. This concept was potentially under consideration by team members of the losing 2016 Presidential candidate. And while the concept did not play out then, it is nevertheless a compelling big idea that could be transformative if the political stars and will of the people were ever to align to make a significant difference in the larger suicide prevention workforce.

* * * * *

So, after 40 years, these are some of the big ideas to which I am drawn. I believe these ideas could make a meaningful difference for those who struggle in the most profound manner possible—considering suicide as an alternative to suffering. While progress is clearly being made, I am impatient. Far too many people continue to suffer, and too many people get hospitalized and medicated in ways that may not be helpful and might in fact be harmful. If we aspire to make a lifesaving difference, we must endeavor to think outside the box and fully embrace compelling big ideas to advance the field of suicide prevention.

988 and the State of Suicide Treatment in the US

Posted on by erics

On July 16, 2022, the United States took an enormous step forward in crisis care and suicide prevention with the launch of a nationwide 3-digit, 24/7 helpline, known as “988.”

In parallel with 911, the FCC designation of this easy-to-remember number for the Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline), marks an important shift in the way that suicidal thoughts and actions are prioritized, identified, and treated in the United States. And it’s already revolutionizing how individuals living with suicidal thoughts connect to life-saving resources across the US.

But it’s not enough.

The State of Suicide Treatment & Prevention in the US

In 2020, the CDC reported over 312,000 emergency visits for “self-harm injuries” and 45,979 suicide deaths, making suicide the 12th leading cause of death in the US. Suicide was the third leading cause of death for Americans ages 10-24 and the 12th leading cause of death overall.

There are 12.2 million adults and 3 million adolescents in the US with serious thoughts of suicide and yet current wait times for behavioral health care and the treatment of suicidal thoughts can be months. And unfortunately, the launch of 988 will not alleviate this crisis of care on its own.

According to the HHS Assistant Secretary for Mental Health and Substance Use, and leader of the Substance Abuse and Mental Health Services Administration (SAMHSA), Miriam E. Delphin-Rittmon, Ph.D., the demand for timely, effective mental health and suicide interventions is only going to increase — even as federal investment reaches an all-time high.

“Recent investments made in the [988] Lifeline have already resulted in more calls, chats, and texts answered even as volume has increased, but we know that too many people are still experiencing suicidal crisis or mental health-related distress without the support they need.”

In 2021, the National Suicide Prevention Lifeline received 3.6 million calls, chats, and texts. SAMHSA expects that number to at least double within the first full year after the 988 transition.  According to Vibrant Emotional Health, call volumes to 988 are up 45% compared to the week before 988 went live and 66% compared to the same time in 2021.

How to Improve Suicide Treatment & Prevention at Scale

Creating an easy-to-use nationwide suicide prevention helpline is a fantastic tool that is already making a tangible impact on Americans’ lives. But 988 is just the first step in solving our national suicide crisis.

Suicide prevention and mental health crisis services will continue to overwhelm existing systems until we do these two things:

  1. Integrate evidence-based suicide treatment methods directly into the electronic health record (EHR) via the Suicide Status Form (SSF) so that every clinician has access to a simple, effective tool to assess and treat suicidal thoughts in a growing client population.
  2. Provide next-day suicide interventions across the country, regardless of location, with help from organizations like The Hope Institute.

Here’s how healthcare providers can build on the momentum of the 988 launch to create a better suicide response system and take the next steps in suicide treatment and prevention in the US.

Improving the Electronic Health Record with Evidence-Based Care

The biggest hurdle for effective suicide treatment and prevention in the US isn’t a lack of effective treatment models. In fact, the Collaborative Assessment and Management of Suicidality (CAMS) is one of four evidence-based treatments that are trusted by the Joint Commission, Surgeon General and the CDC.

CAMS itself has more than 30 years of evidence, five published randomized control trials, and two meta analyses one of which shows that CAMS is a “Well Supported” treatment by CDC criteria and is even proven to “reduce hopelessness and increase hope” in as few as six sessions.

So if the problem with suicide prevention isn’t a lack of effective treatment methods, what is the issue?

One of the biggest limiting factors in the US for improving suicide crisis care is the current Electronic Health Record (EHR) — or more accurately, the lack of evidence-based methods for suicidal treatment and prevention within most EHRs.

However, CAMS can change that with an 8-page form — the Suicide Status Form — that is a proven and reliable multi-purpose clinical tool once it’s included in the medical record.

How the SSF works

Simply put, the SSF functions as a clinical roadmap within CAMS for assessments, treatment planning, tracking ongoing risk, and clinical outcomes for suicidal ideation. It does this in three-parts:

1. Initial session (Pages 1-4)

The first session of CAMS includes a therapeutic assessment completed by the client and the clinician, and the development of a stabilization and a treatment plan for two “drivers” that the client says makes them consider suicide.

2. Interim (Pages 5 & 6)

In each interim session of CAMS, the clinician treats the client’s drivers and checks with the client to ensure the stabilization plan and treatment plan are working.

3. Outcome (Pages 7 & 8)

The final session of CAMS is held when the clinician and the client is behaviorally stable and able to manage suicidal thoughts and feelings.

Learn how to use the Suicide Status Form

The goal is to build the Suicide Status Form directly into the medical record itself, integrating this effective method into the diagnosis, treatment, and even the billing model for clients across the country for continuity of care no matter where you are. Meta analytic research has even shown that collaboratively completing the assessment portions of the SSF is a therapeutic experience for the client in itself.

One substantial obstacle to the adoption of this evidence-based treatment has been the lack of adoption of this tool into EHRs.

Fortunately, that’s changing as more healthcare record providers recognize the need for integrated systems that streamline assessments, guide treatment, and improve client outcomes within increasing client populations — especially at scale.

Who is currently using the SSF?

At CAMS-care we are proud to say that we have partnered with several healthcare leaders to include the SSF in their platforms and client records including:

  • Epic
  • Netsmart
  • InSync
  • Psyquel
  • Bhworks – a School Mental Health Management System
  • NeuroFlow – a leading Health Integration Solution

These Electronic Health Record and Health Management platforms recognize that having access to evidence-based care within clients’ records is essential for clinicians to meet the complex needs of growing client populations. And that need is quickly being felt as 988 rolls out across the country.

The first crucial step in improving suicide outcomes is to integrate an evidence-based framework — like CAMS and the Suicide Status Form (SSF) — directly into the electronic health record so that every clinician has access to tools backed by more than 30 years of clinical trial evidence.

The next step is changing the way we respond to suicide crises by providing interventions as quickly as possible — ideally within 24 hours of first contact.

The Importance of Next-Day Suicide Interventions

SAMHSA has created new federal resources to help states, territories, tribes, and mental health and substance use disorder professionals better respond to suicide crisis events, and 988 is a large part of that effort that will undoubtedly help millions of Americans.

However, treatment and prevention still largely occur at the state or local level, and that’s where 988 currently falls short.

Today, many suicide crisis interventions involve routing people to emergency departments where they can wait for hours—or even days—for treatment. The other alternative is waiting months for an appointment with a community mental health center (where care is typically not suicide focused or evidence-based). Obviously, neither of these is optimal.

Not only are most EDs ill-equipped to assess, treat, and track suicidal thoughts, they’re also unable to keep up with the increased demand from 988. Relying on either option to treat and prevent suicide leads to wasted resources, or worse, a lack of trust in the system from clients in desperate need of urgent care.

SAMHSA has designed a 988 crisis response system — a Mobile Crisis Team — for people who are in immediate danger to themselves. And while it’s essential that these systems are implemented, most people with serious thoughts of suicide don’t want or need to be picked up and taken to a Crisis Facility.

In fact, according to National Lifeline data, less than 10% of callers are high-risk cases that require immediate intervention on this scale.

The other 90% of callers to 988 can simply benefit from a trained crisis line specialist to provide a Safety Plan and a next-day appointment to receive evidence-based treatment that specifically addresses thoughts of suicide.

And the good news is there’s a way to integrate 988 with existing institutions, like the Hope Institute, to provide better, more timely suicide interventions at locations across the country.

How The Hope Institute works

The Hope Institute integrates the best practices of a modern crisis care continuum with next-day appointments, taking referrals from emergency rooms and hospitals and relieving the strain of suicidal distress on schools, colleges, jails, sheriff’s offices, and first responders. Even better, treatment begins within 24 hours of referral.

Outpatient or telehealth—sometimes offering multiple sessions per week based on need — further increases reach across strained healthcare networks and remote rural areas with few to no services.

Hope Institutes use a combination of evidence-based, suicide-focused treatments, including the Collaborative Assessment and Management of Suicidality (CAMS) and group skills in Dialectic Behavioral Therapy (DBT).

Moreover, Hope Institutes are small, calm, and stigma free, staffed by clinicians who focus exclusively on suicide cases. And the results are clear.

Hope Institute clients are stabilized in an average of 6 weeks (adolescents in an average of 5.2 weeks). Even more impressive, a Hope Institute can be opened in just 90 days and an 18 clinician center can treat over 3,000 clients each year.

Next Steps: How to Include CAMS in your EHR

988 is changing the conversation around suicide treatment and prevention. But there’s still a long way to go to improve suicide crisis care in the US.

It’s time to integrate evidence-based best practices into your EHR, and support more responsive, effective, targeted next-day suicide interventions to communities across the country at scale.

Contact our team today to learn more about the Suicide Status Form (SSF), how you can integrate evidence-based frameworks like CAMS into your EHR, or how to bring The Hope Institute into your community.

Derek Lee – derek@thehopeinstitute.net

Andrew Evans – andrew@cams-care.com

For more information about 988, our partners at NeuroFlow wrote a helpful blog post discussing the new hotline.

For training in evidence-based, suicide-focused treatment visit CAMS Training Products.

Suicide Risk Factors and Warning Signs: What we’ve learned from the research

It’s important to understand that there are many potential suicide risk variables, the following are a subset of variables with strong empirical research support.

SUICIDE RISK FACTORS

Suicide risk factors are diverse and multifaceted, encompassing a range of individual, social, and environmental factors. They include personal characteristics such as mental health conditions, previous suicide attempts, substance abuse, and other factors. Understanding and addressing these factors can aid in suicide prevention efforts.

History of Suicidal Behaviors

The history of previous suicide attempts has long been considered a major risk factor related to future suicidal behavior. The risk of such future behavior increases significantly with any past attempt behaviors, particularly a multiple-attempt history of two or more bona fide attempts. 

Suicidal Thoughts & Ideation

When a person has suicidal thoughts, the details and frequency of these thoughts are critical. It’s important to determine whether such thoughts are a brief passing fantasy or something they have explored, made a plan and taken specific actions. By directly asking a person whether they are thinking about taking their life, with appropriate follow-up questions, you will be better able to assess their risk of suicide. Contrary to some popular beliefs, several research studies have clearly shown that asking a person suicide-related questions WILL NOT put the idea of suicide in their head.

Do not be afraid to ask, something like:  “It sounds like you are having a difficult time, have you ever wished you were dead?” or “ It sounds like you are really struggling, have you ever wished you could just go to sleep and not wake up?”.  

  • If the answer is “no”, ask: “In the past three months, have you thought about taking your life, or prepared to do anything that could end your life?”
  • If the answer is “yes” ask: “Have you thought about how you might do this?”

Asking your friend or family member to describe their suicide-related thoughts and provide specifics on the frequency and duration of these thoughts will not only help you better understand your loved-one’s struggles and suicide risk factors, but also send them a clear message that you truly hear them and want to listen. You are telling them that they are not alone and you are willing to try and understand their pain.  

Suicide Plan

While suicidal thoughts are an important suicide risk factor, research has indicated that the specific details and seriousness of planning and preparing for suicide can be predictive of the likelihood of future death by suicide. In other words, someone with a vague, inexact, or nonspecific plan is generally much less serious about taking their life, as opposed to someone with a plan that includes a particular method, place, time, and date for how they will end their life.   

The next important question to ask a friend or family member who has shared their suicide plan with you is whether they have access to the item or method they plan to use for carrying out the plan, such as a stash of sleeping pills or access to a firearm. These items are referred to as “lethal means”, and limiting their access can be an important step in suicide prevention. You might ask: “Have you started to work out the details of how you plan to kill yourself?” or “Do you have an idea of where and when you will do it?”

If your friend or family member does have access to the lethal means that they describe in their suicide plan, your next critical step is to work with them to develop a “safety strategy” to remove their direct access to the lethal item, at least until their suicidal crisis is over. For example, are they willing to let you hold their pills for safe keeping?  Are they willing to let an appropriate and trusted friend or relative keep their gun until their suicide crisis is over? Are they willing to take a different route to work or school so that they do not walk by railroad tracks?  Are they willing to avoid parking their car in a tall parking structure?  

Suicide Preparation

In general, preparation behaviors are often related to organizing the suicide attempt action itself, such as obtaining the lethal means, as well as doing research to determine a lethal dose of drugs or determining a suitable location where the possibility of interruption or intervention may be reduced. Other preparation behaviors may include putting one’s affairs in order, such as writing a will, writing suicide notes, shooting a good-bye video, posting a cryptic Facebook message, doing a favorite activity one final time, saying a final good-bye to friends and family, or giving away prized possessions. All of these behaviors may indicate significantly increased suicidal risk for the individual. In these circumstances, you might ask: “Have you collected pills?” or “Have you obtained a gun?” or “Have you given away valuables, written a will or a suicide note?

Suicide Rehearsal

“Rehearsal behaviors” is a suicide risk factor that typically involves the acting out of the planned suicide attempt. For example, someone may obtain a rope, find a beam in the garage, secure the rope at a certain length, position a short stool, and even step up on the stool and place the rope around their neck without actually stepping off the stool to make the attempt. Such rehearsal behavior is serious.  You might ask: “Have you held the gun, but changed your mind?” or “Have you cut yourself?” or “Have you hung a rope?”

WARNING SIGNS of Suicidal Ideation

In contrast to risk factors “warning signs” for suicide typically center on being extremely upset and agitated —when someone feels totally out of control. Warning signs for suicide suggest an immediate risk of self-destructive behavior. For example, in the case of heart disease (which is the #1 cause of death around the world), many people have both short and long term risk factors (e.g., obesity, hypertension, high cholesterol, and smoking) but do not die of heart disease. In contrast, someone with such risk factors might have key warning signs that prompt urgent intervention to avert a heart attack (e.g., chest pains, pain in their left arm, feeling faint). 

Below are various topics when experienced in a very serious manner can contribute to imminent for self-harm behaviors, such as cutting or burning one’s skin, over-dosing and suicide attempts.

Severe Substance Abuse

The extremely excessive use of alcohol or drugs during a crisis can directly contribute to being highly upset and out of control which may trigger individuals to harm themselves or even make a suicide attempt.

Impulsivity in Decision Making

Generally, impulsivity refers to the lack of ability to think through the consequences of one’s actions, in other words “acting without thinking”. Suicide attempts and deaths often occur when someone is upset, distressed, anxious, highly emotional and/or highly impulsive. The risk is further increased if impulsive behaviors are essentially self-destructive, for example, a history of fighting, pathological gambling, kleptomania, or other similar impulsive disorders.  

Extreme Reaction to a Death or Significant Loss

For many years, suicidologists have known that suicides often occur after someone has experienced a loss, which may seem to trigger the suicidal act. Such losses may be big or small; it can be one particularly significant loss or an accumulation of several lesser losses. Examples may include a divorce, a romantic breakup, a financial disaster, loss of a job, the death of a loved one or a pet— any event that has significant meaning to the person. Additionally, suicide-triggering losses can be symbolic—for example, retirement from a meaningful career. Although losses often contribute to the circumstances leading up to a suicide, usually such losses are not the only reason for suicidal behavior. 

Critical Relationship Problems

Research studies have shown that relationship issues are often the number one suicide-related concern of people struggling with suicidal thoughts. These problems could be romantic issues or relationships with friends, parents or siblings. In contrast, we also know that social relationships can protect a person against suicide. It is important to not let the highly suicidal person be or feel alone. The perception of being a burden to others can be a particularly important relationship problem when experienced by someone who is extremely upset. Experiencing oneself as a burden on others can create a dangerous downward spiral, wherein the individual experiencing suicidal ideation is disinclined to seek help. In the mind of the person with suicidal thoughts, their suicide can be perceived as a “gift” to the people in their lives who they believe are “weighed down” with the troubles of the person who struggles with suicide. 

Chronic Pain and Severe Health/Pain Problems

There are studies that suggest that general health-related issues, particularly if these issues are constantly occurring or chronic, may be related to suicidal thoughts and behaviors – particularly if these issues are chronically occurring or terminal in nature. While many people live out their lives in chronic physical pain, other can find such pain to be utterly unbearable, which may lead to increased suicidal thoughts as a way to finally escape the pain. 

Serious Sleep Problems & Insomnia

Sleep problems related to insomnia, hypersomnia, and nightmares have been shown to be significant suicide risk factors in adolescents and adults and the lack of sleep impacts REM sleep which is critical to everyone to maintain, and the heightened stress levels caused by lack of proper sleep can exacerbate a sense of peace and calm.   

Legal/Financial Crisis

Legal problems can contribute significantly to suicidal risk.  There is often a window of considerable suicidal risk shortly after a person is first faced with a legal accusation. Similarly, financial issues from poverty, unemployment, credit card debt, payday lenders, owing back taxes, and simply not being able to make ends meet can all contribute to increased suicidal risk. 

Choosing to Live: How to Defeat Suicide Through Cognitive Therapy

Choosing to Live: How to Defeat Suicide Through Cognitive Therapy, by Thomas Ellis and Corey Newman. Award winning book that includes Appendix A: Guide for Concerned Family Members and Friends. Addresses some of the questions frequently asked by friends and family members of persons struggling with suicide thoughts and behaviors.

Choosing to Live: How to Defeat Suicide Through Cognitive Therapy

Suicide is Different Website

Suicide is Different: A web-based resource that provides support to those supporting someone who is thinking about suicide. Here you can learn more about suicide through activities and videos, plan ahead for your own wellness as a suicide caregiver and connect with group support and workshops.

How NeuroFlow is Combining Technology and Treatment to Prevent Suicide

Posted on by erics

NeuroFlow and CAMS-care partner to offer an evidence based therapeutic framework for suicide-specific assessment and treatment on electronic medical records.

Enhancing an already unique partnership, CAMS-care and NeuroFlow are once again teaming up to help create a happier and healthier world. The latest element of the partnership now gives clinicians using NeuroFlow access to the CAMS evidence based Suicide Status Form to treat patients with serious thoughts of suicide.

According to the Substance Abuse and Mental Health Services Administration, there are 12.2 million adults and 3 million adolescents in the United States who are thinking of ending their lives. The Joint Commission, the Surgeon General, the CDC and Zero Suicide all reference the Collaborative Assessment and Management of Suicidality (CAMS) as one of a handful of evidence-based treatments that clinicians should use to reduce suicidal ideation.

Most clinicians today either don’t know that evidence-based treatments exist, have not been trained, or lack access to them in their electronic medical records. Building on an already existing, mission-aligned partnership between the two organizations, this development addresses these issues directly by getting evidence-based resources to care providers when it matters most.

“NeuroFlow is committed to integrating technology with evidence-based practices. Our partnership with CAMS-care provides a solution for the Treat step in Zero Suicide, putting clinicians on the NeuroFlow platform at the forefront of suicide prevention with access to tools that properly Identify, Engage and Treat the patient,” noted Matt Miclette, Head of Clinical Operations.

About NeuroFlow

NeuroFlow provides best-in-class technology and care services for the effective integration of behavioral health. NeuroFlow’s HIPAA-compliant platform supports over 14 million users across 300 health systems, payors, and organizations, helping them capture behavioral health insights and take action to proactively manage individuals and populations holistically.

Visit the NeuroFlow site

About the CAMS Framework®

Developed by David A. Jobes, Ph.D., ABPP, the Collaborative Assessment and Management of Suicidality (CAMS) Framework is a both a clinical philosophy of care and a therapeutic framework for suicide-specific assessment, management, and treatment of a patient’s suicidal risk. With an evidence base supported by multiple randomized controlled trials (RCTs) from around the world, CAMS focuses on empathy, honesty, and collaboration to form a strong alliance between the caregiver and patient to motivate the patient to save their life instead of ending it.

View the Suicide Status Form

About CAMS-care

Our mission is to save lives through effective care by training clinicians to treat suicidal patients. We have developed CAMS Trained™ and CAMS Certified™ designations, which licensed clinicians can achieve through completing training and gaining hands-on experience in the CAMS Framework. Never again feel unprepared when working with a person with serious thoughts of sucide.

Learn more about CAMS-care training & certification

First Touch: Administrative Policy vs. Caring Concern, Empathy, Validation, and Truth

Posted on by erics

“I sure hope I can get her to come back so I can do CAMS with her. I think she would really benefit…but I’m afraid that she may have been scared off by our bio-psycho-social intake!”

This was said to me on a coaching call last week with a savvy Licensed Professional Counselor (LPC) I had previously trained, along with others who work with veterans and their dependents. This colleague was referring to the 19-year old dependent of a divorced veteran, who had been referred by her veteran father after she made a low-lethality overdose. The patient had just endured a 2-hour intake process required by agency policy, and this counselor was having trouble reaching her after her experience.

This account pains me greatly, and it is certainly not the first time I have encountered this problem – the effects of extremely long intake processes and administrative paperwork that most clinical settings require before any therapeutic care is provided to suicidal patients. I have been told by such agencies that “there are no exceptions.” So, even though a person is struggling with acute suicidal thoughts and/or behaviors, he or she must first endure hours of questions – some as inane as their birth order and whether they were delivered by forceps – before receiving any therapeutic assessment or suicide-specific treatment.

I believe there is often a unique moment, a window, of potential engagement that is squandered by unnecessarily long intake interviews and administrative paperwork. Administrative exceptions can and should be made for those who struggle with suicide. If we truly aim to clinically prevent suicides, the first touch experience for patients should be one of caring concern, empathy, validation, and truth – in other words, the CAMS assessment. I know this to be true because a published metanalysis proves that the CAMS assessment functions as a “therapeutic assessment” and further, we know from a randomized controlled trial (RCT) that suicidal patients prefer CAMS to usual care.

I face opposition to my position on the matter regularly. I win some, and I lose many. My first significant win occurred many years ago in a randomized controlled trial at a large VA Medical Center. In this instance, The Joint Commission’s “staff expert” was insisting on the first contact with the suicidal patient to be a 2-hour intake interview. The Chief of the service sided with me and agreed CAMS should be the first touch. I was thrilled to take the “win”.

However, at another large military medical center we were discussing how an abbreviated version of CAMS could be used in their emergency department, and the debate did not go my way. In this instance, not only was the provider arguing to initiate contact with a suicidal patient with an exhaustive intake procedure, but also stated “we could never engage on the topic of suicide so directly and quickly without forming a relationship first”, which he described as chatting about “the weather, sports, and the usual stuff”. I adamantly shared my opinion that such superficial chit-chat is ridiculous (it not only trivializes the seriousness of the patient’s suicidality, it is also transparently patronizing) and is no way to form a meaningful clinical relationship with a suicidal person.

As you might guess, I didn’t make many friends that day. Instead I was summarily dismissed, with the suggestion that I knew nothing about their military suicide patients and the challenges they faced. In truth, I have worked with suicidal military veterans for over 30 years, covering all four branches of the armed forces. I was appointed to a Veterans Blue-Ribbon panel by the Secretary of the VA, and to the Department of Defense Suicide Prevention Task Force. I was selected as a member of these investigative groups to become intimately knowledgeable of this “military suicide problem” in order to develop solutions. Finding the solutions was not the most difficult task – getting military mental health settings to implement them proved to be almost impossible.

The negative and vexing experiences these rigid and fruitless intake procedures cause simply must be reconciled with the reality of the challenges facing the suicidal person—and their provider—each time someone struggling seeks help that might avert a suicide outcome. The reality is that it is very scary for many to seek mental health care at all, let alone seeking care when one is contemplating ending their life by suicide. To be greeted by a stack of administrative documents and then subjected to an exhaustive “required” intake interview experience that may last up to two hours throws cold water on a patient’s motivation to seek care—it can be an instant turn off. Such requirements may close a window of opportunity to help save a person’s life through an evidence-based, suicide-focused treatment like CAMS. If we truly aim to clinically prevent suicides, the first touch experience for that patient should be one of caring concern, empathy, validation, and truth. Not data gathering and procedure-for-the-sake-of-procedure.

Our clinical experience and extensive research have shown that CAMS can be used to create a strong therapeutic relationship, forged in the crucible of the suicidal crisis. This is because CAMS providers go right into the patient’s suicidal struggle as they quickly engage with empathy, collaboration, and honesty using the Suicide Status Form.

I understand how people get comfortable with how things have always been done and fall into an “if it ain’t broke, don’t fix it” mentality. But what if it is broken? What if there is research evidence that proves it is broken, and by not fixing it many lives are lost? Shouldn’t we step out of this “comfort zone”? There are examples all around us of courageous people taking a stand to change policies that are wrong and harmful to individuals. It won’t be easy and it will be a long process, but those of us who believe in putting our patients first must fight for what the research is telling us and fix the currently broken mental health care system.

I will continue to beat this drum. In the meantime, for those mental health professionals who approach me with their challenges of how to effectively engage a suicidal patient when burdened with long intake interview requirements, I recommend that they not give up on the person. Follow up with the patient by phone or e-mail to get them to come back for a CAMS assessment and treatment. Additionally, when sending e-mail, include information about CAMS (Fact Sheet for CAMS Patients). Besides working to change the system from within, it may be the best we can do for now. Lack of purposeful and caring follow-up may result in lost opportunities, and I fear possibly lost lives.

I do hope that 19-year-old patient comes back to give CAMS a try – it could make all the difference in her world and give her a second chance at life.

Jaspr: Using Avatars in Emergency Departments with Suicidal Patients Brings New Hope

Posted on by erics

It was a hot summer afternoon half a dozen years ago and I was talking to a couple of new colleagues, Dr. Linda Dimeff and Kelly Koerner, both of whom had trained under and worked with my research mentor Marsha Linehan (the famous developer of Dialectical Behavior Therapy–DBT). Linda was describing to me a fascinating study that was conducted at the University of Boston using a computer-based avatar of a medical-surgical discharge nurse (named “Nurse Louise”). The clinical trial study that we were discussing compared the impact of the Nurse Louise avatar to a living discharge nurse in terms of patient compliance with discharge orders. To my amazement the outcomes for the avatar “nurse” were far superior to the living nurse with significant reductions in recidivism (among other desirable outcomes).

Linda then asked me about the general experience of suicidal patients in emergency departments (EDs), which I knew to be uniformly negative (both as a clinician and from the relevant ED/suicide literature). Linda then proposed something outlandish: that we go for a NIMH Small Business Innovation Research (SBIR) grant to create an all new avatar-based intervention using a modified version of CAMS as the heart of the assessment and intervention.

Cams-care Image
“Dr. Dave” – the first avatar

Ultimately this initial conversation led to a “proof of concept” Phase I NIMH SBIR grant that supported the creation and preliminary investigation of “Dr. Dave”—a rather pedestrian avatar based on me! The patient will work through a CAMS-based Suicide Status Interview (SSI) assessment for suicidal ED patients while they wait, often for many hours, to see their ED doctor for evaluation and treatment disposition.

The Phase I study was a resounding success and we published an initial paper of our findings in a peer-review journal. The success of this proof of concept lead to a Phase II SBIR grant from NIMH to conduct a randomized controlled trial (RCT) of this new ED-based intervention.  I have come to truly love this line of research for many reasons.

Perhaps foremost in my mind, is that with some exceptions (for example, the inspired work by Dr. Ed Boudreaux), the ED has largely been completely ignored as a place to effectively work with suicidal risk. And yet every day around the world, suicidal people sit 6, 10, or 20 hours sometimes being “boarded” overnight waiting to see their ED doctor. For patients struggling with acute suicidal pain this ED wait is an intolerable eternity and it is not uncommon that patients simply give up and walk out the door.

Another amazing thing about this research has been the incredible engagement of people with lived experience (those individuals who have previously been suicidal, made attempts, and sat in ED for countless hours). We have harnessed the power of this perspective which has transformed the Dr. Dave avatar experience into “Jaspr Heath” which is now a multipurpose tablet-based engagement experience that still features the CAMS-based SSI assessment and a version of CAMS intervention in the form of a Stabilization Plan. Dr. Dave is gone and has been replaced by a virtual guide named “Jasper” (a little cartoon character) or a pleasant looking woman, by the name of “Jaz” (a much better alternative to my original avatar, which frankly, frightened my wife and kids).

Cams-care Image

“Jasper” or “Jaz” can then introduce a full array of options to engage the suicidal ED patient, including education about the ED experience and what to expect while they are there. Patients are offered access to a menu of “Comfort and Skills” which is content to help them learn new options for coping, ranging from DBT-inspired coping skills to comforting video content of puppies playing, a crackling fireplace, to distracting techniques, etc. There is also an option to engage in video content of people with lived experience who provide hope and inspiration through their own stories of despair and redemption and lessons learned.

The Jaspr Health patient engagement ultimately produces a detailed report for busy ED providers that provides key assessment information about the patient’s suicidal risk, their CAMS-inspired Stabilization Plan, information about their access to lethal means (and willingness to secure such means), and further considerations that should help shape and inform an optimal disposition plan for the patient. For their engagement with Jaspr, patients are provided a digital companion app of their “favorite” content from the Jaspr engagement that they can download to their smart phone or laptop.

To get a taste of the Jaspr experience, check out a 2 minute YouTube video at:  https://www.youtube.com/watch?v=l9zbM8jEsvY&feature=youtu.be)

As per Phase II, in the last year we began using Jaspr Health in a rigorous RCT within ED care at the famed Mayo Clinic in Rochester MN. It is fair to say, that doing ED-based research is challenging even in the best of circumstances. But adding the worldwide COVID-19 pandemic to the mix made our ED-based research impossible to further pursue and the RCT was abruptly interrupted in March to accommodate needed ED space and focus on COVID-19 patients. With about a third of the sample recruited, we went ahead and did a preliminary analysis of the 30+ ED patients that had been engaged in the RCT prior to COVID-19 preempting further RCT data collection. With limited statistical power (due to the small sample), we were nevertheless thrilled with significant and favorable findings fully supporting the use of Jaspr Health. I will leave the particulars for a later blog as the study and our preliminary results are now under review in a paper that we recently submitted to a peer-reviewed journal. But suffice it to say, even we were stunned by the incredibly positive results from suicidal ED patients’ engagement with Jaspr. We are planning to continue the Jaspr RCT when the COVID-19 transmission and infection rates become more stable.

The Jaspr research experience has been an unexpected gift within my professional life. I have never been particularly savvy with technology and as a provider and professor of clinical psychology, I am very biased to favor a live person-to-person clinical engagement between a provider and patient. But the Jaspr experience has taught me new lessons about what can work in the service of saving lives. The technology of Jaspr is impressive. The ED experience is uniformly negative, but the Jaspr engagement makes it much more tolerable and ensures that time in the ED a productive and valuable experience for the patient with benefits for busy ED providers as well.

These benefits of Jaspr need not end as the patient leaves the ED because they will have access to Jaspr-based content that is downloaded to their phone or laptop. I am a pragmatist, and with 10,600,000 adult Americans struggling with serious suicidal ideation each year, we need any and all help possible to address that suffering in the service of saving more lives from suicide. As our research continues to unfold, I am convinced that Jaspr can play a key role in that pursuit.