Where You Work: Inpatient Settings

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.

Fact vs Fiction: What Actually Works in Contemporary Clinical Suicidology- 2025 CAMS Update

Much of what is done in the name of clinical care for suicidal risk is based a well-established history that centers on controlling a person who is suicidal largely out of fear and a presumption that providers know best what the person needs. Importantly, clinical research is increasingly showing that many common practices for suicidal risk are ineffective or may actually increase risk. This presentation systematically reviews the history of dealing with suicidal risk from its medieval origins, through decades of a carceral medical model approach, right up to present day suicide-focused interventions that reliably and effectively decrease suicidal suffering and related behaviors. This presentation separates fact from fiction–what actually works based on clinical science, in marked contrast to largely fear-based clinical practices that have little to no empirical support too often relying on habit or wishful thinking. To this end, the presentation considers screening for suicidal risk, the use of voluntary and involuntary hospitalization, safety-plan type interventions and other acute interventions, as well as suicide-focused treatments that reliably reduce suicidal risk. Various challenges to enhancing clinical suicide care are considered along with recommendations for the way forward.

David A. Jobes, PhD

About David A. Jobes, Ph.D., ABPP

David A. Jobes, Ph.D., ABPP, is a Professor of Psychology, Director of the Suicide Prevention Laboratory, and Associate Director of Clinical Training at The Catholic University of America. Dr. Jobes is also an Adjunct Professor of Psychiatry, School of Medicine, at Uniformed Services University. He is the author of seven books and hundreds of articles and book chapters. He is the creator of the Collaborative Assessment and Management of Suicidality (CAMS) and one of the founders of CAMS-care, LLC (a professional training and consultation company). Dr Jobes is the recipient of many awards such as the 2022 Alfred M. Wellner Award for Lifetime Achievement (for research excellence) from the National Register of Health Service Psychologists and the 2025 “Erwin Ringel Service Award” for contributions to suicide prevention from the International Association of Suicide Prevention (IASP). He is a Fellow of the American Psychological Association and is board certified in clinical psychology (American Board of Professional Psychology). Dr. Jobes maintains a private clinical and consulting practice in Washington DC and in Maryland.

Edwin Boudreaux, PhD

About Kevin Crowley, Ph.D.

In addition to serving as a CAMS-care Senior Consultant, Dr. Kevin Crowley works as a Staff Psychologist at Capital Institute for Cognitive Therapy, LLC, and as a Lecturer at The Catholic University of America. He has conducted risk assessments, delivered suicide-specific treatments, and provided suicide-focused consultation and training through the VA Health Care System and outpatient private practices since 2010. He has also been involved in several suicide-focused program evaluations and formal research projects through The Catholic University of America’s Suicide Prevention Laboratory (Washington, DC) and the Rocky Mountain MIRECC for Suicide Prevention (Denver, CO). Dr. Crowley’s research to date has emphasized brief interventions for reducing shame and suicide risk, understanding suicide “drivers,” and considerations for optimizing the effectiveness of suicide-focused training. He has presented this research and offered clinical workshops at the annual conventions of both the American Association of Suicidology and the Association for Behavioral and Cognitive Therapies.

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Healthcare System-based Case Formulation of Suicide Events after Acute Care

This presentation will focus on exploring foundational principles of healthcare system-based case formulation using the Exploratory, Preparation, Implementation, and Sustainment (EPIS) implementation science model. Learners will develop skills for applying the formulation approach to identify the proximal and distal causes of process failure within health systems that lead to adverse suicide-related events.

Edwin Boudreaux, PhD

About Edwin Boudreaux Ph.D.

Edwin D. Boudreaux, PhD, is a clinical health psychologist with a significant focus on suicide prevention and intervention. He holds the position of Professor of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences at the UMass Chan Medical School. Dr. Boudreaux is also the Vice Chair of Research for the Department of Emergency and Co-Director of the Center for Accelerating Practice to End Suicide (CAPES).
He received his undergraduate education at the University of Louisiana and earned his PhD from Louisiana State University, where he studied health psychology. He completed his internship at the Medical University of South Carolina, specializing in addiction treatment. Dr. Boudreaux is licensed as a clinical psychologist in Massachusetts and has a strong background in integrating behavioral health across various medical settings, including emergency medicine, inpatient, and primary care.

 

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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Suicide Risks of Healthcare Workers in the US

Posted on by STOLBER Digital
Suicide Risks of Healthcare Workers in the US - Feature Image

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

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

COVID-19: Shedding Light on an Existing Problem

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

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

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

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

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

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

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

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

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

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

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

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

Factors that Lead to Suicide in Healthcare Workers

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

1. Burnout

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

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

2. Lack of Support

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

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

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

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

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

3. Trauma

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

Nursing Shortage in the United States

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

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

Further Impact on the Community 

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

1. Reduced Quality of Care

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

2. Strained Relationships

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

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

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

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

3. Financial Toll

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

Prevention Strategies for Healthcare Professionals

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

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

1. Reducing Stigma

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

2. Expanding Resources for Mental Health and Suicide

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

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

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

3. Encouraging Future Generations

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

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

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

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

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

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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2024 CAMS Update and Introducing CAMS Brief Intervention

2024 CAMS Update and Introducing CAMS Brief Intervention

In this suicide prevention month webinar, Dr. Jobes will discuss recent updates based on clinical trial research, clinical use of CAMS, and training developments related to CAMS. With five on-going randomized controlled trials and a series of recent publications, there is much news to report on all things CAMS. Dr. Jobes will then be joined by Dr. Ray Tucker who will present on the emerging use of CAMS as a single-session brief inpatient and/or emergency department intervention with promising preliminary evidence. There are now several new research efforts to replicate and extend early CAMS-BI™ findings. Join us for this exciting update and introduction to CAMS BI as a novel and much needed suicide-focused brief 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.

Dr Raymond Tucker Headshot

About Dr. Raymond P. Tucker

Associate Professor of Psychology, Louisiana State University (LSU)
Clinical Assistant Professor of Psychiatry, Louisiana State University Health Sciences Center (LSUHSC)/Our Lady of the Lake (OLOL),
Raymond P. Tucker is a licensed clinical psychologist and associate professor of psychology at Louisiana State University. There he teaches undergraduate courses in psychology, graduate courses in clinical psychology, and founded the LSU Mitigation of Suicidal Behavior research laboratory. As a clinical assistant professor of psychology at LSUHSC/OLOL, he trains medical staff/students in suicide-specific evidence-based assessment and intervention protocols.

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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.

Zero Suicide – Outcomes and Opportunities

Zero Suicide - Outcomes and Opportunities

The Zero Suicide model was launched in 2012 as part of the National Action Alliance for Suicide Prevention. Consistent with the National Strategy for Suicide Prevention, Zero Suicide called for improved suicide identification and care in health care systems and promoted use of evidence-based practices by health care providers. Seven core elements comprise the model: “Lead”, “Train”, and “Improve” are the structural components embedded throughout the system and necessary for change, success, fidelity, and continuous quality improvement. “Identify”, “Engage”, “Treat”, and “Transition” are clinical components of the model and define the care patients should receive. Despite evidence supporting each component, use of the full model within systems of care varies.

Over 38% of individuals have made a healthcare visit (e.g., primary care, emergency department, specialty care, etc.) within the week before their suicide attempt and 95% have had a healthcare visit within the preceding year. While this varies across race and ethnicity, these are clearly missed opportunities to identify and care for people at risk for suicide.

Seeing suicide as a never event forces the organization to use best practices, apply continuous quality improvement, and emphasize reducing errors while holding the system to account, not the individual. The clinical science of treating suicidality has evolved such that we now have several proven suicide-specific treatments with additional promising treatments in development. However, graduate programs, professional certification, and continuing education rarely focus on suicide-specific treatments as a competency for graduation or licensure and clinicians report a lack of comfort, confidence, and skill in delivering suicide care.

The Zero Suicide approach has demonstrated notable reductions in suicide and suicide behaviors as well as improvements to using evidenced-based practices. This webinar will describe the Zero Suicide model, discuss challenges, disparities, and opportunities regarding uptake of the unique components of the model, and share how organizations can get started on their Zero Suicide implementation efforts.

Julie Goldstein Grumet, PhD

Julie Goldstein Grumet, PhD

Julie is Vice President for Suicide Prevention Strategy and the Director of the Zero Suicide Institute at the Education Development Center. She provides strategic direction to health care systems to improve the identification and treatment for people at risk for suicide. She has collaborated on numerous grants and publications about systems-based approaches to suicide prevention. Julie’s primary responsibility is to advance the development, dissemination, and effective implementation of comprehensive suicide care practices in various settings. She has expertise in behavioral health transformation, state and local community suicide prevention, quality improvement, and the use of evidence-based practices for suicide care in clinical settings. Julie has a Ph.D. in Clinical Psychology from The George Washington University and lives in Silver Spring, MD.

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Innovations in Clinical Suicide Prevention: 2023 CAMS Update and the 3rd Edition of “Managing Suicidal Risk”

Innovations in Clinical Suicide Prevention: CAMS Update and the 3rd Edition of "Managing Suicidal Risk” On-Demand Webinar

This webinar provides a major update on the use of CAMS focused on the third and final edition of “Managing Suicidal Risk: A Collaborative Approach” published by Guilford Press. This webinar delves into the latest research and tools presented in the new book, written for mental health clinicians dedicated to treating their patients experiencing serious thoughts of suicide.
Explore the key highlights of the new book, including the:

  • Updated Suicide Status Form (SSF-5) for comprehensive risk assessment and suicide-focused treatment
  • CAMS-4Teens®: Engaging parents and families in adolescent care using the new Stabilization Support Plan (SSP)
  • Exploration of post-suicidal life and the optional Living Status Form (LSF)
  • Further insights on CAMS driver-oriented treatment planning
  • Major revision of the CAMS Therapeutic Worksheet
  • Suicide Status Form is available digitally for telehealth and electronic health records

Don’t miss this opportunity to hear directly from Dr. Jobes during Suicide Prevention Awareness Month. Hosted by Dr. Kevin Crowley, clinical psychologist, private practitioner and CAMS Consultant.

 

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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.