Who You Treat: Adults

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.

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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How CAMS Empowers Families to Support Suicidal Loved Ones

Posted on by STOLBER Digital

Youth mental health remains a growing concern in the U.S. According to the Centers for Disease Control and Prevention (CDC), suicide is the second-leading cause of death for teens and young adults between the ages of 10–34 in the U.S. [1] Additionally, 36.7% of young adults ages 18–25 have mental health needs that are not being treated. [2] 

It is common for family members, especially caregivers, to feel overwhelmed. They may wonder what to do when a loved one talks about suicide. CAMS (Collaborative Assessment and Management of Suicidality) is an evidence-based treatment for suicide that allows family members to be a part of the process. It puts emphasis on the “collaborative” aspect. Rather than teaching and handing off the tools to the at-risk person to manage themselves, CAMS strives to involve parents and caregivers. The Stabilization Support Plan is one way that CAMS does this. This plan provides guidance to family members to help support their child’s treatment moving forward. This helps create a bigger system of support for the person who is struggling.  

The Role that Family Plays

Family members and caregivers play crucial roles in helping support their child’s mental health. Adolescence is often a time of instability and change—from changes in friendships to increased demands at school and other activities. Children and teens who are close with their family members have positive, built-in relationships with people they can rely on for help and support through the ups and downs. Here are a few specific ways that family members can help each other when it comes to mental health and suicide prevention. 

Offering emotional support

In a healthy dynamic, family members can provide emotional support to one another. They provide safe spaces for each other to open up and share about their struggles. Families often have deep bonds from shared experiences, good and bad. They know each other’s history, struggles, and triumphs. They are often the first place that people go to with those struggles and triumphs. Having people available to lean on during these times can be extremely helpful.  

Detecting early warning signs of suicide

Family members may be more in-tune and aware of certain warning signs, sensing when things seem “off.” They can easily detect abnormal behavior since they’re familiar with what normal behavior looks like. They are often able to be on alert for signs of distress. Being able to identify warning signs and abnormal behaviors in someone is a key first step to suicide prevention.

Being involved with treatment

When it comes to treatment, family members and caregivers are able to be more easily and seamlessly involved than those on the outside. Parents and caregivers can help their child stay healthy. They can manage logistics like scheduling and driving to appointments. They can also encourage their child to follow treatment plans. 

Family: A Protective Factor 

When talking about suicide, risk factors and protective factors are important to discuss. Risk factors are things that make suicide more likely. Protective factors are things that make suicide less likely. Some people are naturally more at risk than others depending on their background and living situation. According to the Suicide Prevention Resource Center, social isolation can be a big risk factor. Connectedness to other individuals, community, and family is a protective factor. [3] Therefore, it’s important for families to be present and know how to help their child or adolescent through their struggles.

Ways CAMS Supports Family Involvement

Unlike many other types of treatment methods, CAMS puts a large emphasis on collaboration when it comes to working with and supporting the at-risk individual. CAMS is set up to help family members be involved and take an active role in their loved one’s treatment, especially when dealing with parents and children. One way is through CAMS-4Teens®. CAMS-4Teens is a specific method of using the CAMS Framework® to treat children, teens, and young adults who are struggling with thoughts of suicide. Parents and caregivers are engaged in this process, as well. They are given expectations and information up front about the treatment. They are updated regularly as the treatment goes on. They join sessions to learn about their child’s “suicidal drivers.” They also discuss stabilization and support plans, among other topics.

Allowing parents to have a more active role in their child’s treatment allows for open communication and helps reduce the stigma about mental health and suicide. Parents and caregivers can learn about what leads to thoughts of suicide. They can also understand the CAMS therapy approach. This knowledge helps them better understand their child’s mind. 

Benefits of CAMS for Families

CAMS not only benefits the person at risk, but it can help families as a whole grow closer and move forward together in confidence. Here are a few of the specific areas in which families can benefit when working with CAMS.  

Insight into the issues

Many young people, especially teenagers, struggle with issues related to friendships, insecurity, and comparing themselves to their peers. In CAMS, the patient is always listened to first. This helps the therapist see the person’s suicidal thoughts from their point of view. This makes it easier to share these thoughts with family members who can then gain a better understanding.  

Greater sense of control and direction

CAMS allows parents and caregivers the opportunity to get a glimpse into what is going on

and what their role is in helping their child. This is helpful for the children but also helpful for the parents. It gives them a greater understanding and knowledge about what tools and techniques their child is learning to deal with their difficult thoughts and feelings. 

Strengthening trust and relationships

When mental health is openly talked about, trust is more easily built. Family members of any age can benefit from these open conversations around mental health and struggles. When parents and caregivers see how serious the issue is, it helps their child. They also learn what is being done to help. This way, the child can trust that their parents care about what is happening. 

Increased confidence in dealing with a crisis

A common fear that many parents and caregivers have is that they will make a situation worse by saying or doing the wrong thing, particularly in a moment of crisis. CAMS works with parents to put a plan in place for dealing with emergencies. That way, if a crisis happens, parents and caregivers will know how to respond appropriately.

Warning Signs to Watch For

It’s always important to stay aware of the warning signs of suicide, especially because they may look different for people of different ages. Here are some warning signs to watch for from the Substance Abuse and Mental Health Services Administration (SAMHSA): [4]

Warning signs in adults:

  • Talking about or making a plan for suicide
  • Behaving recklessly or acting agitated
  • Talking about feeling trapped or like a burden
  • Increased use of alcohol or drugs
  • Withdrawing or isolating from others
  • Changes in sleep (increased or decreased)
  • Showing signs of rage 
  • Displaying extreme mood swings

Warning signs in youth and children:

  • Expressing hopelessness about the future
  • Displaying severe or overwhelming emotional distress
  • Withdrawing or isolating from others
  • Changes in sleep (increased or decreased)
  • Sudden anger or hostility that seems out of character
  • Increased irritability 

Supporting a loved one who is struggling with suicidal ideation can feel overwhelming and even scary, especially those who feel ill equipped. CAMS aims to help families by offering them a lifeline and including them on the healing journey. CAMS helps parents and caregivers by encouraging open talks about struggles. It focuses on what matters most to the person at risk. This way, they gain the tools and confidence to support their loved one on the path to recovery.  

Curious to learn more about CAMS-4Teens? See more information in this article here: Proven CAMS-4Teens Strategies to Treat Adolescent Suicide. For those interested in or pursuing CAMS-Trained™ designation, check out our on-demand video CAMS-4Teens: Working with Parents. This 3-hour video training covers how therapists can work with parents to support the use of CAMS treatment with their child using the Stabilization Support Plan. 

For more help and tips on supporting a loved one, see this guide from the Center for Suicide Research and Prevention with resources.

Remember, if you or someone you know is in crisis, reach out to the 988 Suicide & Crisis Lifeline via call, text, or online chat.

 

Sources:

[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf
[2] https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national.pdf
[3] https://sprc.org/risk-and-protective-factors/
[4] https://www.samhsa.gov/mental-health/suicidal-behavior/warning-signs

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

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

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

Edwin Boudreaux, PhD

About Edwin Boudreaux Ph.D.

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

 

David A. Jobes, PhD

About David A. Jobes Ph.D. ABPP

David Jobes, PhD, ABPP, is the founder of CAMS-care, LLC. He began his career in 1987 in the Counseling Center of the Catholic University of America, where he developed a suicide risk assessment tool for college students that evolved into CAMS. Dr. Jobes is now a Professor of Psychology and Associate Director of Clinical Training at Catholic; he has trained thousands of mental health professionals in the United States and abroad in evidence-based assessment and treatment of suicide risk and the use of CAMS.

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