A Standard Protocol for the Clinical Management of Suicidal Thoughts and Behavior: Implications for the Suicide Prevention Narrative

Abstract

The last several decades have witnessed growing and converging evidence from randomized controlled trials (RCT’s) that an identifiable set of simple clinical management strategies are effective for those at risk for suicidal thinking and/or suicide attempts. The current article offers a brief review of clinical strategies supported by RCT’s targeting suicidality as “commonalities of treatments that work” and related recommendations for use in the delivery of care for suicidal individuals in generic fashion, regardless of any particular treatment, theoretical orientation, or intervention perspective. The article includes eight recommendations that can be easily adapted across the full range of clinical contexts, institutional settings, and delivery systems, recommendations that help frame a broader clinical narrative for suicide prevention. Recommendations cut across five identifiable domains or clinical strategies for the delivery of care: (1) informed consent discussion that identifies risks of opting out of care and emphasizes the importance of shared responsibility and a collaborative process, (2) an explanatory model that emphasizes the importance of individual self-management skills and targeting the causes of suicide rather than describing suicidality as a function of mental illness, (3) the importance of proactively identifying barriers to care and engaging in targeted problem-solving to facilitate treatment adherence, (4) a proactive and specific plan for management of future suicidal episodes, and (5) reinforcing the importance of taking steps to safeguard lethal means and facilitate safe storage of firearms.

Evidence-based care for suicidality as an ethical and professional imperative: How to decrease suicidal suffering and save lives.

“…suicide-focused clinical care at this point in time has become a professional and ethical obligation as per the aforementioned APA Ethics Code and expert guidance from leaders in the field of clinical suicidology (e.g., Rudd et al, 2022;Jobes, 2017;Jobes et al, 2008;Quinnett, 2021). To this end, the essential elements of an ethics-driven clinical risk management approach are now applied to suicidal risk.…”

“…This is particularly true within DBT, as team consultation is an essential component of the treatment. Nevertheless, consultation is also highly valued within CT-SP, BCBT, and CAMS because it is critical to sound clinical practice and helps support clinicians with stressful cases, which can help reduce professional burnout (Rudd et al, 2022).…”

“…Given the preceding discussion, it can be argued that the ultimate risk management strategy related to suicidal risk fundamentally centers on using evidence-based approaches with proven effectiveness for suicide-specific care. Beyond a clinical risk management strategy, using evidence-based, suicide-focused clinical care at this point in time has become a professional and ethical obligation as per the aforementioned APA Ethics Code and expert guidance from leaders in the field of clinical suicidology (e.g., Rudd et al, 2022; Jobes, 2017; Jobes et al, 2008; Quinnett, 2021). To this end, the essential elements of an ethics-driven clinical risk management approach are now applied to suicidal risk.…”

Recommendations for the use of the collaborative assessment and management of suicidality with sexual and gender minoritized adults.

“…Like all empirically supported suicide-specific care interventions with replicated randomized control trial support (Jobes, 2017; Rudd et al, 2022), CAMS incorporates a plan to help patients increase stability and safety between sessions as a way to manage suicide risk between health care contacts. The CAMS stabilization plan (CSP) is completed in the first session of CAMS at the start of Section C in which a suicide-specific treatment plan is collaboratively created and agreed upon.…”

The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial

“…In addition, a first pilot study showed promising results on Post Admission Cognitive Therapy (PACT) for suicidal patients in the inpatient setting (35). A recent review of common factors across suicide-focused care supported by RCTs has been published in this journal (36).…”