Question 1

What are the most important questions to ask as part of an assessment in adult patients with strong suicidal ideation, but no specific plan? I am a nurse practitioner working in a physical medicine/physiatry clinic and screen all pts I see using PHQ9 & GAD7 tools

David Jobes · Accepted Answer

I would strongly encourage you to NOT use the PHQ or GAD7 as they are not optimal. Instead, I recommend the ASQ, which has excellent psychometrics for screening suicide risk in youth and adults. See attached articles.

Question 2

Hi, I work with adolescents with special needs (MID & ASD). How can suicide risk assessment be done for this population? Any screening tools to recommend? Thank you.

David Jobes · Accepted Answer

I recommend using the ASQ, which was normed on youth populations. See attached. The Zero Suicide Institute offers trainings in Assessing and Manging Suicide Risk here: https://psychwire.com/zsi/courses

Question 3

Can suicidal ideation disappear after it started or does it has to be continuously assessed?

David Jobes · Accepted Answer

Our experience using CAMS shows us that treating patient-defined “drivers” of suicide can decrease and even eliminate suicidal ideation. SI does sometimes come back, so being sensitive to that prospect is a prudent thing to do. As the proven best clinical treatment for SI, I would strongly recommend using CAMS (see attached meta-analysis of 9 CAMS trials).

Question 4

A client described their decision to suicide (years from now) as coming from a place of thoughtful, value-based deliberation. As their therapist, I felt conflicted between my urge to prevent suicide and to respect their wishes. Any suggestions?

David Jobes · Accepted Answer

Be candid about your state mental health act and your duty to intervene when there is “clear and imminent danger,” then proceed accordingly. I am just candid that I cannot be a part of or support their suicide, so it would be better for them to not be in treatment if they do not want a mental health provider to be compelled to stop them as per state law.

Question 5

How can we actually TREAT suicidal thoughts and behaviours?

David Jobes · Accepted Answer

By using CAMS we can effectively identify, target, and treat the problems that the patient says makes them suicidal (which we call drivers in CAMS). The clinical trial research of CAMS shows that this approach is effective based on five published randomized controlled trials, 9 published correlational clinical trials, and two independent meta-analyses. There are several other suicide-focused clinical interventions that effectively treat suicide risk, including DBT, CT-SP, BCBT, Attempted Suicide Short Intervention Program, Mentalization-Based Therapy, Attachment-Based Family Therapy.

Question 6

What is your best advice for giving someone a sense of hope? Thank you for your answer 🙂

David Jobes · Accepted Answer

If patients who are suicidal are seeing a mental health provider, there is always a flicker of wanting to hope deep inside. I have blogged on this topic at the following link: https://cams-care.com/resources/blog/hope/

Question 7

How do we help the situation where suicidal patients feel like they are a burden and mental health staff do feel fearful of managing suicidality?

David Jobes · Accepted Answer

I would recommend using CAMS and potentially treating the “driver” of perceived burdensomeness. We know from a study conducted in GA of training in different models that CAMS-care training significantly increases practitioner confidence and is better than other suicide-related trainings (see attached).

Question 8

Why do many people with suicidal ideation reject mental health care?

David Jobes · Accepted Answer

Many reasons, including the fear of being hospitalized. In my view, there is too much invalidation and coercion in modal responses to suicide. Too often, people who are suicidal reject us because they want to be treated differently with a patient-centered and compassionate approach instead of what Marsha Linehan called a culture of shame and blame.

Question 9

Hi David, can you give a brief explanation of what CAMS is and where to go for training? Thanks

David Jobes · Accepted Answer

CAMS is a suicide-focused therapeutic framework that identifies, targets, and treats patient-defined “drivers” of suicide which are the problems that make them consider suicide. Authorized training of CAMS is available from CAMS-care: https://cams-care.com/

Question 10

I'm interested in the relationship between rumination and suicide - is there one and would targeting rumination help?

David Jobes · Accepted Answer

Rumination is a big problem with suicidal risk, it reflects a loss of frontal lobe control over the limbic system. We have studied this phenomena (see attached article). Interventions that help increase frontal lobe activity or control is the best recommendation (e.g., mindfulness or even a low dose neuroleptic).

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