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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.

Supporting Clients Between Sessions: Peer Support and New Data from NowMattersNow

When clients are struggling most, support often needs to extend beyond the therapy hour. This webinar introduces Now Matters Now’s (NMN) three free programs, with a focused look at NMN Peer Support Meetings and new engagement and outcomes data, highlighting how peer support can complement CAMS-informed care between sessions.

Ursula Whiteside, PhD

About Ursula Whiteside Ph.D.

Dr. Ursula Whiteside is a licensed psychologist, certified DBT clinician, and founder/CEO of NowMattersNow.org. She trained for over a decade directly with Dr. Marsha Linehan, the creator of Dialectical Behavior Therapy. Today, NowMattersNow.org hosts the world’s largest lived-experience DBT skills library, offers free weekly DBT Peer Support Meetings, and provides a brief intervention for overwhelming suicidal urges.

Dr. Whiteside serves as Clinical Faculty at the University of Washington and as national faculty for the Zero Suicide initiative. She is co-founder of United Suicide Survivors International and advises on AI chatbot development, centering the lived experience, preferences, and safety of suicidal users. Dr. Whiteside is open about her experiences with intense emotions and suicidal thoughts.

 

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.

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The Network Effect: Turning Connection into Protection in Suicide Prevention

Communities are made up of relationship networks, but we rarely consider how the structure of these networks—and the interaction between them—shapes suicide prevention. Prof. Tony Pisani reveals how shared trusted connections promote protection, why even small changes in networks make a difference, and how organizations can strengthen these networks to better serve people in their communities. Drawing on research and case examples from high schools, healthcare, and the military, Tony highlights innovative, network-informed approaches. Through reflective exercises, attendees will explore how these insights apply to their life, team, and work, leaving with actionable strategies to build networks that promote connection and wellbeing.

Holly Wilcox, PhD

About Tony Pisani, Ph.D.

Tony Pisani is a Professor of Psychiatry and Pediatrics at the University of Rochester Center for the Study and Prevention of Suicide and the founder of SafeSide Prevention has devoted his career to preventing suicide and promoting wellbeing, combining research at University of Rochester with practical implementation as the founder of SafeSide Prevention. Author of more than 40 peer-reviewed papers and host of the Never the Same Podcast, his work spans research, education, and real-world implementation across healthcare, military, and community settings in the US, Australia, and New Zealand.

 

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.

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Autism Spectrum Disorder (ASD) and Suicidality

Posted on by erics

Please note the following post uses identity-first language, though acknowledges that preferences may differ between self-advocates.

Background

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by ongoing differences and challenges in social communication and restricted and repetitive behaviors (American Psychiatric Association, 2013). Research has highlighted increased early death in autistic individuals, and suicide is a primary cause (Cassidy et al., 2014). Autistic adults are at increased risk for suicide compared to non-autistic adults (Hedley et al., 2017). In a study of a large, diverse population of adults in the United States, the risk of suicide attempts was five times higher for autistic adults than for non-autistic adults (Croen et al., 2015). While suicide research has largely focused on autistic adults so far (McDonnell et al., 2020), autistic youth are also more likely to attempt and die by suicide (Navaneelan, 2012). A study of autistic individuals aged 4-20 years evaluated during a psychiatric hospital stay found that 22% of autistic youth commonly talked about death or suicide (Horowitz et al., 2018). While studies differ about exact prevalence rates, experts agree that there is reason for concern.

Despite the increase in research and autistic self-advocacy groups’ attention on this topic, there continues to be a major lack of tools to manage suicidal behaviors in the autistic population. Therapists feel less confident providing care to autistic individuals experiencing suicidal thoughts (Jager-Hyman et al., 2020). The good news is that there are efforts to validate screening tools for use with autistic adults, including screeners (e.g., SBQ-ASC, SIDAS-M, STUQ), and more in-depth assessment tools such as the Suicide Assessment Kit-Modified Interview (Hedley et al., 2025). However, these tools are designed for adults, and there are not yet appropriate for autistic youth. This is important when considering existing screening tools, given that autistic individuals may not always exhibit traditional suicide symptoms and warning signs. For example, autistic individuals may present with facial expressions which may not directly match their emotional experience (e.g., laughter when anxious or depressed) or have difficulty verbalizing their thoughts, feelings, and experiences when overwhelmed (Oliphant et al., 2020).

While quality access to mental health services is a problem for all children and adolescents, this challenge is worse for autistic individuals and their families (Cervantes et al., 2023). In fact, many providers do not accept autistic patients. In a study of over 6,000 outpatient mental health facilities in the United States, only half offered services to autistic children (Cantor et al., 2022), which is particularly concerning given this group’s increased mental health care needs. When these needs go unmet, autistic youth are more likely to present to Emergency Departments (EDs) (Badgett et al., 2023). Unfortunately, EDs and psychiatric hospitals are not designed for autistic individuals’ needs from both an environmental perspective (e.g., sensory sensitivities to bright lights, crowdedness, unpredictability) and a treatment standpoint (e.g., stigma related to mental health in medical settings, lack of training related to autistic learning styles, and behavior management techniques). Sadly, this can then lead to negative or traumatic experiences, inappropriate treatments, excessive interventions (e.g., physical or chemical restraints, seclusion), and longer admissions (Gabriels et al., 2012; Klinepeter et al., 2024).

Adapting evidence-based suicide-focused treatments, such as Dialectical Behavioral Therapy (DBT) (Ritschel et al., 2022) and Safety Planning Intervention (Rodgers et al., 2023), remains an area of emerging research. Therefore, evidence-based suicidality treatment made for autistic individuals is a sparsely available, yet urgently needed service.

Clinical Insights

Unfortunately, many of the clinicians who treat suicidality or autism remained siloed in their respective treatment areas, without clear communication and overlap, despite extensive research and clinical experience on both sides. To treat suicidality in autism, it is necessary that these “worlds” collaborate, create synergistic relationships, and develop treatments to address this life-threatening phenomenon.

Recent work has suggested that some general changes to treatments can be helpful for autistic learning styles, such as visual supports, environment and sensory considerations, making language more concrete, caregiver collaboration, and embedding special interests into treatment (Schwartzman et al., 2021; Dickson et al., 2021).

As a result of this critical gap in services, a clinic was created to treat suicidality in autistic youth at a large children’s hospital, the Clinic for Autism and Suicide Prevention (CLASP). As mentioned above, collaboration between the autism center and the hospital’s department of behavioral and mental health was necessary and invaluable. The Collaborative Assessment and Management of Suicidality (CAMS was) incorporated as the primary treatment framework when appropriate, and autism-specific interventions were then plugged in to address specific drivers. The CAMS Framework® identifies the “drivers” that a patient says make them consider suicide as an option.

For example, if a patient identified difficulty with change as a driver, an autism intervention, such as Unstuck and on Target, was used. If a patient identified loneliness as a driver, then social skills practice or PEERS videos were incorporated to improve relationships. Additionally, interventions such as cognitive behavior therapy, dialectical behavior therapy, and trauma-focused cognitive behavior therapy were often used to address many other drivers such as conflict with others, traumatic experiences, or difficulty managing strong emotions.

The clinic provides individual weekly therapy to autistic youth experiencing suicidality and has successfully discharged several patients due to reduced suicidality. We have learned many key insights from this clinic and from the powerful, brave work these patients are doing. Below are some recommendations for working with autistic clients who experience suicidality.

Recommendations for clinical practice:

  • Consider whether there are outside factors which can be addressed or managed. For example, if a patient is struggling with bullying, consider whether school can intervene. Remember that autistic are neurodivergent individuals living in a world designed for neurotypical needs!
  • Take your time and expect that treatment progress may take longer. Negative repetitive patterns can be “stickier” in autistic individuals and breaking out of these cycles can require more effort and time.
  • Create structure when possible. CAMS forms (e.g., the Suicide Status Form, the Stabilization Support Plan for parents and caregivers and the CAMS Therapeutic Worksheet) are a great way to introduce a visual form and help clients know what to expect from session to session.
  • Determine whether expressing suicidal thoughts is a form of communication and if so, consider what the patient is communicating and whether this can be addressed. For example, if a patient repeatedly makes suicidal comments when transitioning away from a preferred activity (e.g., video game, favorite location), consider working on transitions with behavioral strategies. Think about whether there are other ways the patient can communicate their frustration.
  • Discuss what happens both for the patient and others when they share suicidal thoughts. First, understand what the patient is feeling and why they are sharing. Next, while openness is important, some individuals may not be aware of the procedures certain organizations have to follow when someone makes a suicidal comment (e.g., school policies, medical staff) and explaining what to expect can help reduce emotional overload.
  • Help increase emotional awareness. In some autistic clients, the ramp up to a crisis moment can be much faster than in non-autistic individuals, so increasing emotional self-monitoring can improve their ability to access coping strategies earlier.
  • Do not assume that physical social or human contacts are the only way to reduce suicidal risk. Perhaps there are other non-human or non-physical connections which can be important for coping, such as a preferred stimming object, online video game friends, or an important pet. Stimming (i.e., repetitive self-soothing movements, such as pacing, rocking, humming, finger tapping) can be helpful both during therapy and as part of a stabilization plan.
  • Do not assume that all autistic patients need autism-specific treatments. This can create barriers and close important doors to care. Some autistic patients benefit from working with clinicians experienced in autism, though this is not necessary for every patient. Our saying is “when you’ve met one autistic person, you’ve met one autistic person!”

Most importantly, remember that autistic clients often have amazing and powerful insight into their emotional experiences that leads to suicidality. Start with the patient perspective first, gather additional information, and empower the client to work collaboratively toward a life worth living one small step at a time!

Below are several helpful resources available online including those developed by autistic self-advocates:

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition). Arlington, VA: Author.

Badgett, N. M., Sadikova, E., Menezes, M., & Mazurek, M. O. (2023). Emergency department utilization among youth with autism spectrum disorder: exploring the role of preventive care, medical home, and mental health access. Journal of Autism and Developmental Disorders, 53(6), 2274-2282.

Cantor, J., McBain, R. K., Kofner, A., Stein, B. D., & Yu, H. (2022). Where are US outpatient mental health facilities that serve children with autism spectrum disorder? A national snapshot of geographic disparities. Autism, 26(1), 169-177.

Cassidy, S., Bradley, P., Robinson, J., Allison, C., McHugh, M., & Baron-Cohen, S. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. The Lancet Psychiatry, 1(2), 142-147. https://10.1016/S2215-0366(14)70248-2

Cervantes, P. E., Conlon, G. R., Seag, D. E., Feder, M., Lang, Q., Meril, S., … & Horwitz, S. M. (2023). Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. Autism, 27(3), 704-713.

Klinepeter, E. A., Choate, J. D., Nelson Hall, T., & Gibbs, K. D. (2024). A “whole child approach”: parent experiences with acute care hospitalizations for children with autism spectrum disorder and behavioral health needs. Journal of Autism and Developmental Disorders, 1-15.

Croen, L., Zerbo, O., Qian, Y., Massolo, M., Rich, S., Sidney, S. & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism, 19(7), 1-10. https://doi/abs/10.1177/1362361315577517

Gabriels, R. L., Agnew, J. A., Beresford, C., Morrow, M. A., Mesibov, G., & Wamboldt, M. (2012). Improving psychiatric hospital care for pediatric patients with autism spectrum disorders and intellectual disabilities. Autism research and treatment, 2012(1), 685053.

Hedley, D., Uljarević, M., Wilmot, M., Richdale, A., & Dissanayake, C. (2017). Brief report: social support, depression and suicidal ideation in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(11), 3669-3677. https://10.1007/s10803-017-3274-2

Hedley, D., Williams, Z. J., Deady, M., Batterham, P. J., Bury, S. M., Brown, C. M., … & Stokes, M. A. (2025). The Suicide Assessment Kit-Modified Interview: Development and preliminary validation of a modified clinical interview for the assessment of suicidal thoughts and behavior in autistic adults. Autism, 29(3), 766-787.

Horowitz, L. M., Thurm, A., Farmer, C., Mazefsky, C., Lanzillo, E., Bridge, J. A., Greenbaum, R., Pao, M., & Siegel, M. (2018). Talking about death or suicide: Prevalence and clinical correlates in youth with autism spectrum disorder in the psychiatric inpatient setting. Journal of Autism and Developmental Disorders, 48(11), 3702-3710. https://10.1007/s10803-017-3180-7

Jager-Hyman, S., Maddox, B. B., Crabbe, S. R., & Mandell, D. S. (2020). Mental health clinicians’ screening and intervention practices to reduce suicide risk in autistic adolescents and adults. Journal of Autism and Developmental Disorders, 50(10), 3450-3461.

McDonnell, C. G., DeLucia, E. A., Hayden, E. P., Anagnostou, E., Nicolson, R., Kelley, E., … & Stevenson, R. A. (2020). An exploratory analysis of predictors of youth suicide-related behaviors in autism spectrum disorder: implications for prevention science. Journal of Autism and Developmental Disorders, 50(10), 3531-3544. https://10.1007/s10803-019-04320-6

Navaneelan, T. (2012). Suicide rates: An overview. Ottawa (ON): Statistics Canada.

Oliphant, R. Y., Smith, E. M., & Grahame, V. (2020). What is the prevalence of self-harming and suicidal behaviour in under 18s with ASD, with or without an intellectual disability?. Journal of Autism and Developmental Disorders, 50(10), 3510-3524.

Ritschel, L. A., Guy, L., & Maddox, B. B. (2022). A pilot study of dialectical behaviour therapy skills training for autistic adults. Behavioural and Cognitive Psychotherapy, 50(2), 187-202.

Rodgers, J., Goodwin, J., Nielsen, E., Bhattarai, N., Heslop, P., Kharatikoopaei, E., … & Cassidy, S. (2023). Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial. Pilot and feasibility studies, 9(1), 31.

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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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

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.

The Role of Family Estrangement in Suicidal Ideation: Understanding the Connection and Finding Hope

Posted on by STOLBER Digital

Family is a central part of most people’s lives, but when family relationships are strained, it can bring immense pain and grief. Lack of family support can play a huge role in many aspects of a person’s life, including their mental health. 

The topic of family estrangement has historically been understudied and under researched. Because all scenarios are unique, it’s difficult to compare different people’s experiences. Family estrangement, however, is surprisingly common, and it’s important to be aware of the ways it can affect you or someone you know.

Understanding Estrangement

Estrangement is defined as no longer being on friendly terms with a person or group of people – usually someone you were previously close with. According to some studies, as many as one in four people are estranged from at least one family member. 1 Causes of family estrangement vary greatly depending on the situation and people involved. However, there are some common factors that often play a role. 

  • Unresolved issues: When families have issues that have been swept under the rug for years, this can cause a deep rift. Examples are significant life changes that occurred in the family (such as divorce) or persistent emotional issues (such as pressure or favoritism) that were never addressed.
  • Generational trauma: Trauma can sometimes be passed down from one generation to the next. This creates a cycle that is hard to break.
  • Differences in lifestyle or beliefs: People change as they grow. These changes can lead to different views or beliefs. Other family members may feel threatened or uncomfortable with these differences. This can cause conflict in relationships.
  • Addiction or abuse: In some extreme situations, such as addiction or abuse, estrangement may be necessary for the safety of you and others.


Estrangement and Suicidal Ideation: The Connection

Family estrangement results in many complicated feelings. It’s no surprise that it has a negative impact on a person’s life, contributing to higher levels of depression. 2  Suicidal ideation can result from these depressed feelings combined with other emotions and struggles that build up over time. 

Isolation and rejection are two common feelings people facing family estrangement may experience. Being left without the support of someone you’ve grown up with can be a challenging shift. It also makes joyful seasons, like holidays or family celebrations, become complicated, painful, and lonely for those left out.

Guilt is another challenging feeling. In some situations, the person who has been estranged is left wondering if they could have prevented the situation. They may be blamed by family members for causing the problem in the first place. 

If someone needs to distance themselves from a family member for safety, they might feel guilty. They may struggle with not being able to help that person. These feelings can be tough when you have a family member with a serious addiction. It is hard when they refuse to get help.


Additional Risk Factors

Family estrangement can cause strong negative feelings. However, it’s also important to think about other risk factors. These factors may be present when someone is having thoughts of suicide.

People with a history of mental health issues are at higher risk. This also includes those who feel socially isolated.

Having a history of unhealthy coping methods, like using drugs and alcohol, can also lead to thoughts of suicide. Community and social factors can also play a role. For example, there may be a stigma around seeking help. People might also have limited access to mental health resources. 3


Support Beyond Family

When someone is dealing with family estrangement, it’s important for them to find outlets for support, whether it be friends or support groups in their community. Having people to turn to during both tough times and joyous moments is essential to maintaining mental well-being and fostering a sense of motivation and purpose. 

Therapy is also crucial when dealing with family estrangement. A therapist can help you untangle the layers of complicated and conflicting emotions you may be experiencing as well as help you learn healthy coping skills.


Moving Forward 

Not every instance of family estrangement is permanent. Sometimes, it can be possible to find reconciliation and healing. This usually happens gradually through small steps of communication with clear boundaries from both parties. Working with a family therapist can be helpful when mending these relationships. 

However, not every scenario benefits from finding a resolution. There are times when estrangement is permanent, whether by your choice or someone else’s. In these instances, speaking with a therapist can be helpful in learning to grieve, accept the situation, and move forward.

Family estrangement is incredibly complex and can leave lasting impacts. When estrangement leads to suicidal ideation, it’s crucial to seek help or recognize the warning signs in others who are struggling. Healing and recovery are possible through avenues such as therapy and support groups. If you or someone you know is struggling, reach out to the 988 Suicide & Crisis Lifeline. 

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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