The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence‐Based Clinical Approach to Suicidal Risk

Abstract

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and clinician. This process is designed to enhance the therapeutic alliance and increase treatment motivation in the suicidal patient. Central to the CAMS approach is the use of the Suicide Status Form (SSF), which is a multipurpose clinical assessment, treatment planning, tracking, and outcome tool. The original development of CAMS was largely rooted in SSF-based quantitative and qualitative assessment of suicidal risk. As this line of research progressed, CAMS emerged as a problem-focused clinical intervention that is designed to target and treat suicidal "drivers" and ultimately eliminate suicidal coping. To date, CAMS (and the clinical use of the SSF) has been supported by six published correlational studies and one randomized clinical trial (RCT). Currently, two well-powered RCTs are under way, and various new CAMS-related projects are also being pursued. The clinical and empirical evolution of CAMS-how it was developed and what are the next steps for this clinical approach-are described here.

The collaborative assessment and management of suicide (CAMS): an important model for mental health services to consider

“…Each psychologist dedicates~2 hourly slots/week to working with suicidal people using the CAMS and so far the service has had~100 service users attend. Unpublished audit suggests promising results consistent with previous research evaluating the CAMS model (Jobes, 2012) (audit data currently submitted for publication). The vast majority of people resolve suicidality in a timely fashion, and there is very little need for hospitalisation.…”

“…It is also unusual for many clinicians to meet with suicidal people on a weekly or regular basis dedicated to resolving those issues driving their suicidality. The changes in practice required are eminently achievable and it is time well spent with rates of resolution of suicidality in the CAMS treated group being at 80% within 12 sessions (Jobes, 2012(Jobes, , 2016.…”

“…There are seven published correlational and open trial studies, and two published randomised controlled trials (RCTs) indicating positive and replicated results associated with reductions in psychological pain, stress, agitation, hopeless, self-hate, overall behavioural self-rated suicide risk, emergency department and primary care visits (see Jobes, 2012 for review) and promising RCT data pertaining to self-harm and suicide attempts (Andreasson et al 2016). A small (n = 32) feasibility RCT comparing CAMS with enhanced care as usual found, despite limited statistical power, a number of statistically significant findings including between group differences in suicidal ideation, overall symptom distress and optimism/hope (Comtois et al 2011).…”

Acute Suicidal Affective Disturbance (ASAD): A confirmatory factor analysis with 1442 psychiatric inpatients

“…For instance, if an individual has experienced an episode that meets criteria for ASAD in the past, due vigilance on the parts of treatment providers for future episodes, even in the absence of mood pathology, is warranteddthat is, if an individual has had an ASAD episode in the past, it alerts the clinician to the possibility of one recurring in the future. With regard to treatment, the assessment and clinical management of ASAD symptoms and episodes could also be incorporated into existing suicide-specific treatment frameworks, such as the Collaborative Assessment and Management of Suicidality (CAMS; Jobes, 2006Jobes, , 2012; see also Ellis et al, 2012;Ellis et al, 2015). Given that ASAD is a suicide-specific diagnosis, CAMS may be effective in reducing the duration and frequency of ASAD episodes.…”

The Role of Decision-Making in Suicidal Ideation

“…There are several new clinical interventions to enhance therapeutic alliance and decrease the risk of suicide behaviour [23,24]. However, there is a need of more awareness about the role of lack of inhibition, difficulty to actively suppress unwanted thoughts [25], lack of executive functions [18,26] in suicide attempters and more importantly in people who have suicide ideations.…”