Suicidality is associated with many challenges that I help people with including depression, panic disorder, post traumatic stress disorder, and substance use. In the U.S., roughly 4% of adults have had thoughts about suicide in the past year. Thinking about, attempting, and dying from suicide is even more prevalent among younger persons – about 7% of adults 18-25 years old have thought about suicide in the past year, and it is the 2nd most common cause of death for persons in that age group. When a person suicides, the impact can felt by family members, co-workers, and others in the community indefinitely. Losing a loved one to suicide is among the most painful experiences, and perpetuates cycles of trauma, depression, and prolonged grief reactions for survivors. Preventing suicide is arguably one of most important goals for mental health workers, and I take that challenge very seriously. In an effort to provide my clients with the best care possible, I have felt compelled to learn about suicide prevention and sought out training in approaches that go beyond checking the boxes. The most important message that I want to share is that there are evidence based strategies to help those who are at risk for suicide.
In fact, there are multiple specialized therapy approaches with strong research support to help people prevent suicide: Collaborative Assessment and Management of Suicidality (CAMS), Dialectic Behavior Therapy (DBT), Cognitive Therapy for Suicide Prevention (CTSP), and Brief Cognitive Behavior Therapy (BCBT) have all been found to reduce risk. Although researchers are still trying to determine which approaches are best for which clients, some general ideas have been proposed. CAMS appears well suited for clients in treatment with suicidal thinking, but minimal history of past attempts. On the other hand, for clients with longstanding challenges with emotional regulation and multiple suicide attempts, DBT is probably a better fit.
The approach I use most frequently in my practice is CAMS. It emphasizes a strong therapeutic relationship focusing on empathy, collaboration, honesty, and maintaining a focus on suicide prevention. Honesty stands out to me as one of the most important factors – the therapist is encouraged to be transparent about ethical and legal obligations surrounding suicidal risk. The goal is to prevent hospitalization or emergency services whenever possible. The client and therapist work together to complete a thorough assessment and develop a plan for safety. But CAMS goes beyond that. It’s more than just NOT committing suicide – it’s about understanding why that person is suffering and focusing on ways to address the painful situations that are driving the suicidality. CAMS prioritizes suicide prevention and temporarily displaces other therapies until the client has sufficiently stabilized. Once stabilized, therapy for other presenting challenges such as panic disorder, OCD, etc resumes. Of course, effective treatments for those conditions are important to prevent the reoccurrence of suicidality.
Other specialized counseling strategies that are not focused on suicide prevention per se may also be helpful. For example, the risk of suicide is higher among transgender persons due to their experiences of prejudice, discrimination, and victimization, so support within the context of gender focused therapy may reduce suicide risk for them. Because I do not possess sufficient training and experience to provide that type of counseling, I maintain awareness of others in my community who do and offer targeted referrals. The key is to recognize the various needs of each person and match the appropriate services that will be truly helpful.
Unfortunately, many people who are considering suicide do not seek professional help. If you or a loved one are thinking about suicide and not accessing care, you can receive support for free at Lifeline by calling 1-800-273-TALK (8255).
Authored by Jim Carter, Ph.D.