Who You Treat: Adults

The Hope Institute Approach to Suicidal Risk

Date: March 10, 2025

The Hope Institute offers a groundbreaking alternative to traditional suicide care. Rather than relying on costly emergency visits or hospitalizations, THI provides intensive, evidence-based outpatient treatment using two proven approaches — CAMS and DBT — to stabilize individuals in crisis and help them build a life worth living. With a 98% successful discharge rate and treatment costs significantly lower than conventional care, The Hope Institute is redefining what effective suicide-focused care looks like.

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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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KVC Health Systems’ 6-Step Guide to Implementing CAMS with Private Funding

Date: February 18, 2026

KVC encourages ongoing training to support our teams in providing high-quality, evidence-based services to their clients.

 

“Nearly every person in this world has been touched by suicide in some way.”

Dr. Megan Moore sees this reality every day. As the Senior Director of Innovation and Impact with KVC Behavioral HealthCare Kentucky, a subsidiary of KVC Health Systems, she’s worked tirelessly alongside her 2,800 colleagues across 65 locations in five states to eradicate suicide, which takes about 50,000 lives in the U.S. each year.

Moore knew that achieving this ambitious goal wouldn’t be possible overnight. But by equipping clinicians with the competence and confidence to deliver timely, individualized care, including treating the drivers of each patient’s suicidal ideation, KVC could strengthen its approach to suicide prevention and save more lives.

In 2024, together with Chad Anderson, LSCSW, KVC’s Chief Clinical Officer based in Kansas, who brought deep clinical expertise and system-wide leadership, they integrated the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) framework into their system of care. With an engaged cohort of leaders and clinicians, private philanthropic funding, and a collaborative partnership with CAMS-care, the KVC team moved from concept to implementation in just four months.

KVC’s early results of clinician engagement and patient outcomes are incredibly exciting. Their practical six-step approach offers a replicable blueprint for other mental health organizations with limited time and resources to similarly strengthen their suicide prevention practices and join us in advancing a world without suicide.

Connection as the Foundation for Saving Lives

At the heart of both KVC and CAMS is the shared belief that connection saves lives. Connection is what fosters health and healing. In suicide prevention, connection is especially critical, both in terms of a patient’s relation to family and community and ensuring a coordinated approach to services. When a person who is suicidal has access to timely, individualized, and connected care at the ideation stage, we can minimize the risk of ideation becoming behavior. Fewer attempts mean fewer deaths and lower health system costs.

At KVC, connection is ingrained across its entire system of care. Through their Safe and Connected™ practice model, they support families and communities with high-quality mental health and family-strengthening services spanning the continuum of care from in-home to inpatient treatment. Access to healthcare (both physical and mental) and community support is limited in rural areas. In the past two decades, suicide rates have increased 46% in non-metro areas (compared to 27.3% in metro areas). Many of KVC’s locations are in rural communities to meet this growing need for services, often providing in-home treatment and wraparound support, where access to services can be limited, and transportation is a barrier for those who need it most.

CAMS is an evidence-based, suicide-focused framework that operationalizes this approach to suicide prevention. Dr. Mariam Gregorian, CAMS Consultant, explains, “The CAMS Framework® is the most effective treatment for the largest population — the 16.9 million Americans who experience serious thoughts of suicide each year.” Through its collaborative, flexible process, clinicians and patients jointly identify and treat the personal drivers of suicidality as early as possible. It also serves as an umbrella framework that integrates seamlessly into existing models of care, strengthening what clinicians are already doing while aligning teams around a shared, proactive prevention strategy.

The natural synergy between KVC’s connection-first culture and CAMS’ focus on proactively and collaboratively treating suicidal drivers planted the seeds for change.

Discovering CAMS to Treat Suicidal Drivers

KVC’s first exposure to CAMS happened in the early 2000s. Megan Moore met Dr. Melinda Moore, CAMS Consultant, suicide loss survivor, and professor at Eastern Kentucky University, at a training hosted by her agency in Lexington, KY. What Megan Moore learned about CAMS changed the way she thought about suicide. She no longer saw suicide as a symptom of depression, but as the specific focus of care.

Moore and Anderson were curious to learn more about CAMS and its potential to strengthen KVC’s approach to suicide prevention. They also wanted to bring in other members of their clinical leadership team for their feedback. Through both virtual and in-person conversations, Gregorian helped them understand their options and their advantages in a systemic way.

After previewing some of the CAMS training products, the KVC team became determined to integrate CAMS as an evidence-based practice into their system of care. Because no two patients are alike and insurance policies vary by state, Anderson envisioned adding CAMS as another tool in clinicians’ toolkits. Anderson recalls, “We saw how CAMS saves lives. Why wouldn’t we invest in it?”

Implementing CAMS into KVC’s System of Care

Moore and Anderson approached this process with thoughtfulness and intentionality to minimize resources and maximize impact. Here are the six steps that took them from planning to implementation.

Step 1: Identify and Empower Champions

Every system-wide change needs a strong leader behind it. For KVC, that was Moore and Anderson. They’re both visionaries with a deep understanding of both clinical practice and implementation science. They built momentum, provided ongoing support and communication, and kept their teams informed and engaged from pilot toimplementation.

Step 2: Establish a Pilot Group

In January 2024, KVC launched a small, multidisciplinary pilot group. It consisted of approximately 32 clinicians and senior business leaders from its six subsidiaries: KVC Kansas, KVC Kentucky, KVC Missouri, KVC Nebraska, KVC West Virginia, and Camber Mental Health, KVC’s network of inpatient mental health hospitals and residential treatment centers.

Anderson describes, “We were all in it together.” Energy and engagement levels were high. The cohort established regular touch points and met consistently for 12 months. During this time, they received monthly consultation calls, peer support, and case review. Leadership actively participated alongside clinicians, ensuring they stayed in lock step throughout the process.

Step 3: Secure Funding

To begin the CAMS training process, KVC needed funding. Each of the six nonprofit subsidiaries operates independently, so each led respective efforts to secure funding. They focused their efforts on reaching out to existing networks, with support from their KVC Foundation team.

As a result of their outreach, an anonymous private funder awarded $25,000 to fund the CAMS pilot program to include 32 clinicians and trainers across the health system. The donor asked that KVC also use their gift to attract additional funders to support more clinicians and trainers beyond the pilot. While additional funding would be needed to scale, this first seed funding established a proof of concept to begin the CAMS training process.

Step 4: Conduct CAMS Trainings

In February 2024, 32 clinicians and clinical leaders participated and completed the CAMS Trained™ program.Throughout the program’s 10 hours of online coursework and 4 hours of consultation calls, KVC clinicians worked closely with Dr. Gregorian, Dr. Melinda Moore, and the entire CAMS team to gain direct skills, knowledge, and confidence to effectively assess and treat suicidal patients. This pilot group also completed role-play training and the CAMS-4Teens® training to learn how to work with adolescents and their parents/caregivers.

Moore, Anderson, and other cohort leaders stayed closely engaged throughout the training to ensure everyone continued to feel informed and empowered. Gregorian also remained involved to support the clinicians through consultation calls and answering questions as they arose.

Step 5: Put CAMS into Practice

The key to implementation would come from giving clinicians the opportunity to apply CAMS in practice and build their confidence.

In April 2024, 10-15 clinicians began utilizing CAMS with patients. This phased approach allowed the team to focus first on successful uptake of the model, ensuring clinicians felt supported as they navigated suicide-specific conversations and interventions using a new framework. Moore reconnected with Dr. Melinda Moore, the CAMS-care Consultant who hosted the role-play training and consultation calls for the cohort.

Step 6: Scale Across the System of Care

After the initial CAMS training and implementation with 32 clinicians across the health system, KVC continued seeking funding to scale the model.

KVC Kansas secured a new $35,000 grant from the state to train 40 more clinicians in CAMS and the team began to identify and create a plan.

Camber Mental Health, KVC’s team of inpatient and residential psychiatric treatment experts, budgeted $18,000 to train 12 therapists in CAMS (3 per campus). They plan to seek state funding to train the remainder of their clinicians in CAMS.

In 2025, the State of Kansas made a second gift of $35,000 to train staff in Dialectical Behavior Therapy (DBT), to treat the drivers identified in the CAMS Framework and strengthen treatment for youth experiencing foster care.

The Kentucky team also found local partners who wanted to invest in suicide prevention in the community. In May 2025, Lexington, KY-based Valvoline, a national leader in automotive maintenance, partnered with KVC Kentucky by contributing funding to train 53 clinicians in CAMS.. Valvoline’s donation also provided long-term sustainability of the model, funding three licensed practitioners to become CAMS trainers.

In total, in just under two years, KVC has trained 100 clinicians in CAMS across three subsidiaries. Their goal is to train all 450 clinicians nationwide.

While all six of KVC’s local teams have recognized the benefits and plan to implement CAMS, their timelines have varied based on their ability to secure funding. KVC’s teams in Missouri, Nebraska and West Virginia are still in the process of seeking funding to begin training.

Leaning On Each Other to Save Lives

Implementing new and different modalities into your system of care takes work. It takes resources — time, money, and effort. For mental health organizations, many of whom are already stretched thin, implementing something new may feel overwhelming and complicated. Our hope is that this guide can provide a practical model for replicating KVC’s successful implementation through its dedicated leadership, efficient resource use, and collaborative partnership with CAMS.

One of the key components to strengthening your system of care is, of course, funding. Government grants used to be a primary source of funding for mental health services. But recent uncertainty emphasizes the importance of diversifying your pipeline so people can receive the right life-saving support at the right time.

Private philanthropic funding is a critical and effective source. Where to search for it may not be obvious at first. But sometimes we find it in the most unexpected and creative places— like the initial private funder who provided KVC with $25,000 to kickstart training or Valvoline’s larger partnership to save lives.

Anderson shares, “Anyone can do this. It’s not too expensive. It’s not out of reach. But you don’t need to do it alone. Lean on us. Take what KVC has learned and achieved as an organization, and do it even better.”

Please reach out to the CAMS-care team here to learn more. Connecting with you to help you strengthen your system of care is why we’re here.

We are made to live in connection with others. Together, we are committed to creating a world without suicide.

LEARN MORE: KVC Health Systems Funding Proposal Template

The Rollins College Wellness Center focused on reducing student hospitalizations using the CAMS Framework®

All across the country college wellness and counseling centers are dealing with an increasing number of students with suicidal thoughts.  Rollins College in Winter Park, Florida is no exception. The Counseling and Psychological Services (“CAPS”) at Rollins Wellness Center adapted the CAMS protocol as the assessment and treatment method for suicidal clients in May of 2016.

Prior to May 2016 counselors and trainees were trained to utilize a thorough clinical interview and suicide assessment scale to evaluate the severity of the client’s suicidal thoughts. Focus of the session was to assess the degree of risk, stabilize, create a safety plan, and engage clients’ personal resources.  If the client could not commit to safety and become stabilized, the client would be encouraged to go to a crisis stabilization and receiving unit (hospital). If the client would not voluntarily go to the hospital, a decision would be made to hospitalize the client through the Baker Act, a Florida law that allows people with mental illnesses to be held involuntarily for up to 72 hours in a mental health treatment facility if they meet certain criteria.

Research shows that clients are more at risk for completing suicide after involuntary hospitalization. Additionally, the Baker Act requires the client to be restrained in handcuffs during the transport to the hospital. This can be a traumatic experience for an 18-25-year-old whose mental health is already compromised.

Connie Briscoe became the Director of the Wellness Center in 2014.  Connie is a psychologist and certified QPR (Question, Persuade, and Refer) trainer. Connie believed in a more structured, peer-reviewed, and researched instrument to be the standard way for counselors to determine the level of risk with students with suicide ideation.  Connie and Nadine Clarke, Assistant Director of Counseling/Clinical Coordinator chose the CAMS (Collaborative Assessment and Management of Suicidality) Framework and presented the instrument to counselors at CAPS. Nadine purchased Dr. Jobes first book on CAMS for all counselors and incoming interns in May of 2015. All full-time counselors were individually trained through Dr. Jobes’ training videos. Nadine trained incoming interns at their orientation in August and CAMS became the official assessment and treatment method for elevated, high-risk suicide ideation.

Nadine attended the American Association of Suicidality Conference in May of 2016 and met Dr. Jobes. She had the opportunity to ask him specific questions on the use of CAMS with Cluster B diagnosis and other difficult situations. Upon her return to the college, Nadine worked with Connie and the college’s risk management office to secure more in-depth live training. Dr. Kevin Crowley trained the staff in the use of CAMS on January 17, 2017. CAPS also purchased 12-one-hour phone consultations with Kevin. Kevin provided those consultations on an as-needed basis during the clinical group supervision period. This proved helpful in deepening the understanding of CAMS as a treatment in working with clients.

All full-time permanent counseling staff have a copy of Dr. Jobes 2nd Edition Managing Suicidal Risk, a Collaborative Approach, and incoming interns and temporary or part-time counselors are trained in the proper use of CAMS. They are also provided with a copy of Dr. Jobes’ book.

Nadine says, “CAMS provides a common language and framework for talking about suicide with students. The Student Affairs division and student leaders understand that students are getting help if that student mentions CAMS. The off-site 24-hour auxiliary counselors have been trained to ask if someone has a “Stabilization Plan” if that student talks about working with a CAPS counselor.” Through the use of CAMS the need to initiate the Baker Act is significantly reduced, and the process is well documented with the entire Suicide Status Form CAMS package.  The Rollins Wellness Center has avoided hospitalization for all but the most severe cases, and almost all who have been hospitalized have done so voluntarily.

If you would like to learn more about implementing CAMS in your College or University Counseling Center, please contact Dr. Kevin Crowley at kevin.crowley@cams-care.com

Hidden Lessons from Black Suicide Science

Given the preponderance of suicidogenic risks and vulnerability for Black adults and youth, one might predict higher rates of suicide death in the Black community. However, suicide and factors that contribute to suicide “resilience” are understudied among Black Americans. Dr. Walker will discuss patterns of suicide death, highlight relevant research from the Culture, Risk, and Resilience Lab, and propose important steps in addressing suicide as a serious but preventable public health concern.

About Dr. Rheeda Walker

Dr. Rheeda Walker is an award-winning Professor of Psychology, a fellow in the American Psychological Association, and a leading scholar who has published more than 60 scientific papers on African American mental health, suicide risk, and emotional resilience. She is also a licensed clinical psychologist who prepares doctoral students for independent careers.

Dr. Walker’s impact has expanded beyond academia and she has quickly become a fan favorite with the release of her first book, The Unapologetic Guide to Black Mental Health. Delving into the heart of the Black experience, Dr. Walker debunks myths about mental health, builds the case for psychological fortitude, and delivers practical advice for use in everyday life. Her charismatic vision and practical approach to life’s challenges have led to numerous appearances on Good Morning America, The Breakfast Club, and NPR, among others. She is often quoted in major publications like the Washington Post, the Los Angeles Times, the Huffington Post, GQ Magazine, and the Houston Chronicle.

Dr. Walker’s eclectic mix of experiences positions her well to achieve her ultimate goal of bringing culturally-informed, psychological fortitude to both professional and lay audiences.

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 an evidence-based treatment, CAMS, recognized by the Joint Commission, the Surgeon General, Zero Suicide, and the CDC. 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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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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Cultural Perspectives on Suicide: How Different Societies Approach Prevention

Posted on by STOLBER Digital

Cultural Perspectives on Suicide

When it comes to suicide prevention, cultural awareness is extremely important. Every culture has their own views of suicide, stemming from their histories and belief systems. Therefore, not everyone addresses suicide prevention efforts in the same ways. Here is a look at how various cultures from around the world have historically viewed suicide and how some of them approach prevention.

Eastern Views and Approaches to Suicide


Historically, countries in Eastern cultures have had a more positive view of suicide than those in Western cultures. For example, in some Asian countries, suicide used to be viewed as a noble or honorable act. China is one example of an Eastern country that has shifted its view on suicide over time. Suicide was seen as honorable when it was done for social or political causes. It was even viewed highly when Confucianism was the main philosophy throughout the country. China saw their worst rates of suicide in the 1990s. [1] However, the rates dramatically declined in the decades to follow. There may be several factors at play. One possibility is fast economic growth. Another factor could be surveillance-based monitoring of students on college campuses. [2] China has also been working to reduce air pollution, as some studies have shown a connection between air pollution and suicide rates. [3] 

Japan is another Eastern country that has shifted its perceptions of suicide. Its general attitude toward suicide has been described as “tolerant.” [4] Similar to China, Japanese cultures have historically viewed suicide as honorable or “morally responsible” when it’s performed as a ritual. Also similar to China, Japan experienced a spike in suicide rates in the 1990s when they experienced an economic crisis. However, unlike China, Japan’s rates have not recovered to the extent that China has seen. Japan has, though, been working toward getting its rates down. In 2006, the government initiated a national suicide prevention strategy that helped reduce suicide rates by 35% by the year 2022. [5] This strategy along with other prevention efforts have helped the topic of suicide to be less of a taboo in Japanese culture. Instead, it is starting to be seen as a legitimate health concern.

 

Western Views and Approaches to Suicide


Western cultures have historically had a much more negative view of suicide compared to Eastern cultures. In these cultures, suicide is often seen as shameful and cowardly. It is also considered illegal in some places. In fact, the term “commit suicide” comes from when suicide was a crime and those who survived suicide could be imprisoned. [6] Much of the stigma surrounding suicide stemmed from Judeo-Christian beliefs and teachings that have been prominent in Western cultures. These teachings considered suicide immoral and punishable. While these religious overtones may no longer be as prominent, the stigma has lingered. This has caused many to struggle in silence, feeling ashamed and hesitant to get help. 

Historically, Western cultures have had a more clinical approach to suicide. They focus on identifying and treating mental illness that may be associated with it. This differs from other cultures. In more recent years, however, the topic of mental health has been more openly talked about. Wider prevention strategies started being put into place. For example, the 2024 National Strategy for Suicide Prevention was developed in the U.S. as a 10-year, whole-of-society approach to preventing suicide. Rather than only focusing on the clinical aspect, this strategy addressed health equity and community-based prevention methods.

 

African Views and Approaches to Suicide


Cultures in African countries also have their own unique perspectives when it comes to how they view and handle the topic of suicide. The cultures and belief systems throughout Africa vary greatly depending on the region. Many cultures view suicide as a taboo topic. This is often due to fear and unknowns surrounding mental health and illness in these cultures. Belief systems play into this, as well, with some cultures viewing suicide as the result of evil spirits or inherited curses. In some countries, such as Ghana and Uganda, suicide is punishable by law and can have severe consequences for the person’s family and community. [7]

Historically, there was an assumption that countries in Africa had low suicide rates. However, this was likely due to a lack of reporting and studies on suicide deaths in African countries. It has since been found that suicide is a public health concern. [8] Due to the vast diversity of culture and lack of data, suicide prevention strategies for African regions have been difficult to implement and research. However, many African cultures highly value community-based efforts. Traditional healers are important in many countries. One example is in South Africa. They have played a crucial role in helping people at risk of suicide. [9] 

 

Indigenous Views and Approaches to Suicide 

 

Indigenous cultures have struggled with significantly higher rates of suicide than non-Indigenous cultures, specifically in North America. [10] There are many factors that play a role in this, including generational trauma, loss of cultural identity, and issues related to poverty. Many Indigenous communities see suicide as a symptom of their broader collective trauma. However, many of these cultures have had stigmatized views of suicide for generations, making it difficult to approach the subject and receive help.

Because community is at the heart of Indigenous culture, Indigenous-specific approaches to suicide prevention often prioritize community-based and culturally grounded practices. This might include performing ceremonies, storytelling, connecting with the land, and finding ways to celebrate and honor their culture. [11] Elders also play a central role in supporting youth and restoring these generational and cultural ties. Rather than focusing on the individual, Indigenous strategies aim to heal the collective spirit and restore harmony within the entire community.

Suicide occurs in all countries and cultures. However, there are different ways to approach it. These methods should specifically resonate with the people who are affected. Learning about cultural differences helps us understand and stay aware that some forms of prevention may be more appropriate than others. The overarching theme, though, appears to be the need for community and meaning. Even though this may be found and approached in different ways, everyone needs to know that they matter to others and that their life has significance. 

Sources:

[1] https://www.sciencedirect.com/science/article/pii/S2352827323000071 

[2] https://www.healthdisgroup.us/articles/APM-5-125.php 

[3] https://news.ucsb.edu/2024/021373/clearing-air-reduces-suicide-rates 

[4] https://www.suicidecleanup.com/culture-and-suicidal-behavior/  

[5] https://www.who.int/news-room/feature-stories/detail/suicide-prevention-in-japan–a-public-health-priority 

[6] https://learning.nspcc.org.uk/news/why-language-matters/rethinking-language-suicide

[7] https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.549404/full  

[8] https://www.sciencedirect.com/science/article/abs/pii/S1876201823004355  

[9] https://www.madinamerica.com/2018/05/traditional-south-african-healers-use-social-bonds-connection-suicide-prevention/

[10] https://pmc.ncbi.nlm.nih.gov/articles/PMC3483901/ 

[11] https://pmc.ncbi.nlm.nih.gov/articles/PMC9588522/ 

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.