Working with Suicidal Clients Using the Collaborative Assessment and Management of Suicidality (CAMS)

Article excerpt

The Collaborative Assessment and Management of Suicidality (CAMS) was developed to modify clinician behaviors in how they initially identify, engage, assess, conceptualize, treatment plan, and manage suicidal outpatients. This approach integrates a range of theoretical orientations into a structured clinical format emphasizing the importance of the counselor and client working together to elucidate and understand the "functional" role of suicidal thoughts and behaviors from the client's perspective. Based on clinical research in various outpatient settings, CAMS provides mental health counselors with a novel clinical approach that is tailored to a suicidal client's idiosyncratic needs thereby insuring the effective clinical assessment, treatment, and tracking of high risk suicidal clients.

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It has been eight years since the United States Surgeon General David Satcher, sounded the alarm about the profound impact of suicide in his Call To Action to Prevent Suicide (U.S. Public Health Service, 1999) imploring the public health, mental health, and medical communities to seriously address the issue of suicide. Since this time there have been various efforts towards developing community-based prevention strategies but remarkably few efforts have specifically focused on the development of effective clinical assessments and treatments of suicidal individuals. Despite the increased awareness of suicide as a major public health problem, gaps remain in training programs for health professionals who often come into contact with suicidal patients in need of these specialized assessment techniques and treatment approaches. Studies indicate that many health professionals are neither adequately trained to provide proper assessment, treatment, and management of suicidal patients, nor do they know how to refer clients properly for specialized assessment and treatment (U.S. Public Health Service, 2001; Bongar, 1991). For many years, suicidality has been the most commonly encountered clinical emergency for mental health professionals (Schein, 1976) and mental health counselors continue to be critically positioned on the front lines for clinically assessing, referring, and treating suicidal individuals (Barrio, 2007).

While a number of suicide risk instruments exist, survey research indicates that the majority of mental health counselors prefer to rely on a clinical interview to assess suicide risk (King, Kovan, London, & Bongar, 1999). In terms of clinical treatments for suicidal risk, there has been a remarkably limited empirical literature for treating suicidal states. Indeed, most of the extant literature over the past decades has been theory-based or anecdotal with limited empirical support (Jobes, 1995; 2000). In more recent years, however, a growing number of researchers have developed and empirically investigated more suicide-specific clinical approaches (e.g., Brown et al., 2005; Henriques, Beck, & Brown, 2003; Linehan, 1993; Rudd, Joiner, Jobes, & King, 1999; Rudd, Joiner, & Rajab, 2001). As part of this trend, the Collaborative Assessment and Management of Suicidality (CAMS) was developed to modify clinician behaviors in how they initially identify, engage, assess, conceptualize, treatment plan, and manage suicidal outpatients. In our view, this novel clinical approach can be used in a variety of mental health settings, including outpatient clinics, community mental health centers, private practice, employee assistance programs, prisons/jails, and even inpatient units (Jobes, 2006).

At the heart of the CAMS approach is an emphasis on a strong therapeutic alliance where counselor and client work closely together to develop a shared understanding of the client's suicidal phenomenology. An interactive assessment process is used to build a clinical partnership; risk assessment information gleaned from this process is then used to directly shape a suicide-specific treatment plan. …

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