Where You Work: Inpatient Settings

Suicide Prevention in K-12 Schools: Introduction to the Special Issue

Date: April 27, 2026

School-based mental health partnerships are vital for youth suicide prevention, especially in rural areas with limited access. Evidence shows asking about suicide does not increase risk and aids early intervention. Developing comprehensive, multi-tiered approaches, including tertiary supports like CAMS, and strengthening collaborations among schools, researchers, and communities are essential for scalable, effective prevention.

 

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About the Authors

Amy Brausch Ph.D.

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

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Kurt D. Michael, Ph.D.

Kurt D. Michael, Ph.D.
Kurt D. Michael, Ph.D. is Senior Clinical Director at the Jed Foundation and former Stanley R. Aeschleman Distinguished Professor of Psychology at Appalachian State University, where he spent 23 years building a nationally recognized program in rural school mental health and adolescent suicidology. Born and raised in Denver, Colorado, he earned his BA from the University of Colorado at Boulder, followed by his MS and PhD in Clinical-School Psychology from Utah State University, and completed his internship in Child Clinical Psychology at Duke University Medical Center. Dr. Michael founded the Assessment, Support, and Counseling (ASC) Centers — embedded school mental health partnerships serving rural K–12 communities in Appalachia — which annually reach 10–30% of enrolled students with services including crisis assessment, cognitive-behavioral therapy, and psychoeducational groups. He has been a leading voice in suicide prevention, lethal means counseling (CALM), and the implementation of CAMS with youth, and developed the Prevention of Escalating Adolescent Crisis Events (PEACE) Protocol, which has been adapted for use in rural and tribal communities across the country. His prolific research spans meta-analysis, crisis intervention, and rural mental health, including a landmark network meta-analysis on antidepressant efficacy in youth published in The Lancet. He is also co-editor of the Handbook of Rural School Mental Health and serves as Associate Editor of the Journal of Rural Mental Health. His work has been recognized with the Governor's UNC Board of Governors Award for Excellence in Public Service, among other honors.

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The Collaborative Assessment and Management of Suicidality vs. Treatment as Usual: A Retrospective Study with Suicidal Outpatients

This retrospective study compared CAMS — a collaborative, structured approach to suicide risk assessment — against standard care in 55 military outpatients. CAMS patients resolved suicidality faster (~7 sessions vs. ~11 for TAU) and used significantly less non-mental health medical care afterward. No differences were found in hospitalization or suicide attempt rates. The authors conclude CAMS shows early promise but call for larger, randomized studies to confirm results.

Authors: David A. Jobes, PhD, Steven A. Wong, PhD, Amy K. Conrad, MA, John F. Drozd, PhD, and Tracy Neal-Walden, PhD

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About the Author

David A. Jobes Ph.D. ABPP

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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Collaborative Assessment and Management of Suicidality in the Aftercare Focus Study: Costs, Benefits, Cost-Effectiveness, and Cost-Benefits

This dissertation by Phoebe McCutchan examines whether the Collaborative Assessment and Management of Suicidality (CAMS) — a suicide-focused therapy — offers economic advantages over standard care for recently discharged psychiatric patients. Using data from a randomized controlled trial, the study finds that CAMS was less costly, comparably or more effective at reducing suicidal ideation, and more cost-effective and cost-beneficial than standard care, suggesting it delivers better value in resource-constrained healthcare settings.

 

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The Suicide Status Form-4 (SSF-IV) as a Potentially Therapeutic Suicide Risk Assessment Tool

Date: March 22, 2024

The first direct empirical test of a long-standing claim: that the SSF — the core assessment instrument within CAMS — is not just a risk assessment tool but a therapeutic intervention in its own right. Working with 57 high-risk patients on an inpatient psychiatric consultation-liaison service at a Level 1 trauma center, the authors used CAMS-Brief Intervention (CAMS-BI) and tracked subjective distress (SUDS) across five time points within each session. Pre-to-post-session distress dropped significantly across patients, with a trend favoring Section A of the SSF.

Authors: Nicolas Oakey-Frost, Emma H. Moscardini, Tovah Cowan, Jessica L. Gerner, Kathleen A. Crapanzano, David A. Jobes, and Raymond P. Tucker.

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About the Author

David A. Jobes Ph.D. ABPP

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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Advancing Suicide Intervention Strategies for Teens (ASSIST): Study Protocol for a Multisite Randomised Controlled Trial

Date: December 12, 2023

ASSIST is the protocol for a three-arm RCT comparing the Safety Planning Intervention with structured follow-up (SPI+), the Collaborative Assessment and Management of Suicidality (CAMS), and enhanced usual care for adolescents transitioning from acute to outpatient care after a suicidal crisis. Conducted across two pediatric hospitals, it will help build the evidence base for brief, scalable, suicide-specific interventions for youth.

Authors: Molly Adrian, Elizabeth McCauley, Robert Gallop, Jack Stevens, David A Jobes, Jennifer Crumlish, Barbara Stanley, Gregory K Brown, Kelly L Green,  Jennifer L Hughes, Jeffrey A Bridge

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About the Author

David A. Jobes Ph.D. ABPP

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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Reducing Short-Term Suicide Risk After Hospitalization: A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality

Date: September 19, 2022

This randomized controlled trial tested whether the Collaborative Assessment and Management of Suicidality (CAMS), delivered through a “next-day appointment” outpatient clinic, reduced suicidal thoughts and behaviors more effectively than treatment as usual (TAU) for adults discharged after a suicide-related hospitalization. One hundred fifty participants — all with at least one lifetime suicide attempt — were randomized to CAMS or TAU and followed for 12 months.

Authors: Comtois, K. A., Hendricks, K. E., DeCou, C. R., Chalker, S. A., Kerbrat, A. H., Crumlish, J., Huppert, T. K., & Jobes, D.

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About the Author

David A. Jobes Ph.D. ABPP

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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The Content of Patient-Identified Suicidal Drivers within CAMS Treatment Planning

Date: December 12, 2022

CAMS treats suicide by targeting the “drivers” patients themselves identify as fueling their suicidality. Prior research mapped suicidal ideation on the Suicide Status Form into four dominant themes — relationships, role responsibility, the self, and unpleasant internal states — but the drivers brought into treatment planning had never been studied. Analyzing 332 drivers from 166 patients across two randomized controlled trials, Lynch, Bathe, and Jobes find the same four themes account for roughly 70% of the data, with direct implications for how clinicians focus suicide-specific care.

Authors: Thomas Lynch, Victoria Colborn Bathe, and David A. Jobes

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About the Author

David A. Jobes Ph.D. ABPP

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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What Stops People Seeking Help?

A compelling evidence-based talk examining why suicide prevention in the UK continues to fall short — not from lack of effort, but from intervening too late, persistent stigma, and treatments not designed for suicidality. Professor Zaffer Iqbal, Clinical Director of Psychological Services, University of Hull, presents a clear case for redesigning how and when we engage people at risk.

Suicide Risk Following Hospital Discharge

Posted on by erics

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

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

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

What Happens During Hospital Discharge?

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

Why Post-Discharge Care is Often Unsuccessful

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

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

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

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

Challenges Hospitals are Facing

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

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

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

Tia Tyndal, Ph.D.

How CAMS Can Help Address These Gaps

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

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

Complementary Solutions: EmPATH Units

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

Practical Steps Hospitals Can Take Now

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

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

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

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

A Better Path Forward

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

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

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

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

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

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

Frequently Asked Questions

Why is suicide risk higher after hospital discharge?

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

How long does suicide risk remain elevated after hospitalization?

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

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

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

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

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

How can hospitals improve suicide prevention after patient discharge?

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

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After Your Child’s Suicide Attempt

Posted on 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.