Category: suicide attempt

Zero Suicide

by Midnight Demon, posted in psychache, suicidality, suicide, suicide attempt

Zero Suicide

For most of the day, I have been reading on Twitter, “Zero Suicide”. While I believe in decreasing the suicide rate, I don’t ever think there will be zero suicide in any population, in any country of the world. In the words of the father of suicidology, Edwin Shneidman, he stated before his death, “well how many suicides do you want, and I say I don’t want any, but I want there to be the freedom to do it. So there is a morality. I study suicide but I am not pro-suicide. I am for suicide prevention”. That to me, sums up the notion there can never be zero suicide. To think that one day there can be, is just foolish. Now to prevent suicide, that is another ball game. I believe that there should be every effort to prevent a suicide from happening. But to do that, you will have to do quite a few things. Suicide must be talked about like cancer is talked about. Cancer was once considered taboo. People thought if you talked about it, you could get it. So it is with suicide, that talking about it will lead to someone taking their life. This is a myth. The next is that if you are suicidal, you will be forever. As Shneidman has explained, suicide is a time limited event. It doesn’t last forever. You might, like me, have lingering thoughts of suicide or once your mental pain has decreased, you no longer think about taking your life.

It just angers me when people talk about “zero suicides”. I get the sentiments but I just think it is foolish without serious interventions and preventions out there. Increasing hotlines or having your family doc talk openly about it. All that is needed is usually an open ear. Increasing services rather than taking them away. Decrease wait times for call back services or for psychiatric crisis teams. If there were more people who actually had help that was available to them rather than waiting months for an appointment, there definitely will be less suicides, possibly. This has to be more than words on a sheet of paper. I once heard of a case in the UK that a woman was waiting desperately for a callback from their crisis team, for days. She was begging them for hospitalization. They denied it or there wasn’t a bed available so she ended up killing herself. Her daughter was left to deal with the aftermath. I know things like this happen in the US as well. My friend’s daughter was once in the ER for days before there was a bed available at a psych hospital/unit.

I just think that if more mental health professionals dealt with suicidal people rather than pawn them off to hospitals, there might be less suicides. I am not saying that is the answer to every case, but if outpatient services are afraid of suicide, how is the client supposed to trust them?

Twitter Rant 01.10.2015

by Midnight Demon, posted in Bipolar Disorder, depression, mental illness, mood disorders, suicidality, suicide, suicide attempt

People seem to think that my writing of suicide is what leads me to think about suicide. It’s quite the opposite. It helps me to think of ways to control my suicidality and work against the dark feelings by expressing myself in a clinical way. By me thinking of this as clinical, it helps me compartmentalize the feelings so they aren’t so powerful that I do impulsive things. But then I am fighting the stigma that talking about suicide, leads to suicide and that is hurtful. By my writing about coping with suicide I not only free myself of the thoughts, but I may also help someone in the process. That is my goal when I share my papers about Edwin Shneidman and David Jobes. Their work about psychache and CAMS (collaborating, assessment, and management of suicidality) really help me focus on not killing myself. If we talk about suicide like we do cancer survival, maybe we might decrease the suicide rate. if suicide wasn’t a taboo topic anymore, there might be some healing and actually lead to more discussion and openness.

notes from Suicide as Escape from Self

by Midnight Demon, posted in suicide attempt

Notes from Baumeister Suicide as Escape from Self. Psychological Review.1990.Vol 97.p 90-113

**please note this is my take on his theory in parentheses. Other than that this is all Baumeister’s thoughts in this article**

The central argument is that suicide is often an escape from self that is from meaningful awareness of certain symbolic interpretations or implications about the self.
However, concluding simply that depression causes suicide and leaving it at that may be inadequate for several reasons. It is abundantly clear that most depressed people do not attempt suicide and that not all suicide attempters are clinically depressed.
Baumeister argues that an unsuccessful attempt at suicide may achieve the goal of escape almost as well as a completed suicide, at least in the short run, and in the suicidally deconstructed state, the short run is all that seems to matter.
There are six main steps in the escape theory. First a severe experience that current outcomes (or circumstances) fall far below standards is produced either by unrealistically high expectations or by recent problems or setbacks, or by both. Second, internal attributions are made so that these disappointing outcomes are blamed on the self and decrease negative implications about the self. Third., an aversive state of high self awareness comes from comparing the self with relevant standards (in connection with self blame for recent disappointments) the individual is thus acutely aware of self as inadequate, incompetent, unattractive, or guilty. Fourth, negative affect arises from the unfavorable comparison of self with standards. Fifth, the person responds to this unhappy state by trying to escape from meaningful though into a relative numb state of cognitive deconstruction. This escape is not fully successful, however, and so the individual desires increasingly strong means of terminating the aversive thoughts and feelings (i.e., suicidal thinking). Sixth, the consequences of the deconstructed mental state include a reduction of inhibitions which may contribute to an increased willingness to attempt suicide (i.e., decreased appetite, lost of interest in pleasurable activities, decrease in weight, etc). Suicide thus emerges as an escalation of the person’s wish to escape from meaningful awareness of current life problems and their implications about the self (i.e., the person thinks that life is too much and the only way out of this is to seek oblivion by killing oneself).
Suicide may arise either because stands are unrealistically high or because event are unusually bad (or both).
The result is that is it not just recent events but the self that is perceived as falling short of expectations.
According to escape theory, the main appeal of suicide is that it offers oblivion. Suicide becomes appealing when the troubling thoughts, feelings and implications are neither adequately shut out by cognitive deconstruction nor removed by consoling high level interpretations.
Deconstruction tends to eliminate all emotions whereas any return to meaningful or integrative thought will recall the negative affect thus positive affect will be least apparent.
Cantor was lead to characterize suicidal people as having strong need for affiliation, succorance, and nurturance. (These same needs are a part of Shneidman’s (1996) idea that blocked needs results in suicide attempt. Shneidman also believes that psychache, perturbation, and press all converge to bring about suicidal thinking. With the absence of these needs, suicide is likely to occur). Thus the suicidal person is not a true introvert or loner but rather someone whose strong desires and expectations for intimacy are being disappointed.
Suicide rates are lowest on Friday and highest on Mondays which is consistent with the idea that people are often hopeful as the weekend approaches but may kill themselves in response to painful disappoint (I.e., things do not resolve by Monday.)

It is perhaps not surprising that low self-esteem (or even loss of esteem) should be found among suicidal people.
Neuringer’s (1974) findings support the view that suicide arises from a combination of unusually high standards (evidenced by ratings of others) and negative attributions about the self.
Truly suicidal persons are more self aware than people imagine them to be.
Depression has been associated with a tendency to become highly self-aware after failure and it too has been associated with suicidal tendencies. However, depression is not a cause of suicide as there are many people who live unhappy lives but do not think of taking their life (Shneidman 1996).
On the basis of the indirect evidence, one may tentatively conclude that people who would normally tend to be self-aware are indeed more prone to attempt suicide but direct evidence of a self focused state before suicide is limited.
Escape theory emphasizes that aversive awareness that oneself falls short of personal and social standards. It is reasonably clear that presuicidal individuals do regard themselves as falling short in that way but the evidence currently available is not adequate to say that they often think about these personal failures and inadequacies.
Meiges and Weisz (1971) found that reminiscing about past suicide attempts generated negative affect although control subjects show similar negative reactions to the task.
Guilt can be considered one major form of anxiety. Several studies have associated high levels of guilt with suicidal tendencies.
Hendin (1982) observed that many suicidal alcoholics felt guilty about letting people down, and concluded that guilt “is central to the desire to end their lives” (p139).
Suicidal guilt has been interpreted psychodynamically as a wish for punishment. It is plausible, though, that guilt does motivate desires to escape from self-awareness.
Feeling lonely or feeling like a failure are the most common feelings reported by suicidal people preceding the suicide attempt, but these are not necessarily emotions. Sadness is commonly observed as well. In addition, many people say that the period preceding the suicide attempt was filled with worry (possibly worry about failing to succeed and feeling intense guilt).
Anger is reported to have been the main effect preceding suicide in about one third of the cases in several samples.
Neuringer and Harris (1974) reported that suicidal people found it more difficult than various control groups to think about the future.
These findings fit with Baumeister’s argument that suicidal individual’s past is associated with aversive affect, which leads to the attempt to focus narrowly on the present, which in turn prevents thinking about the future (this is a central element of suicidal thinking. Most suicidal individuals will not think they have anything to live for (in the future) and will use suicidal as their way to end the pain. The “what’s the use” comes into play. No perceived future will always lead to suicidal thinking which leads to hopelessness).
Although depression has frequently been linked to suicide, analyses show that hopelessness is more predictive of suicide than depression. In fact, controlling for hopelessness eliminates the predictive relation between depression and suicide which is consistent with the causal pathway proposed in escape theory.
According to learned helplessness theory and related views, past failures often lead the person to expect future failures. According to escape theory, the inability to anticipate a “happy” future causes a reluctance to contemplate any future. The cognitive narrowing involved in the deconstructive shift is an attempt to avoid thinking that past failures and misfortunes entail future misery.
Shneidman (1981) coined the term “tunnel vision” or constriction to refer to the narrow concrete focus of the psychological state preceding a suicide attempt, often reflected in the banal and barren content of suicide notes.
The hopelessness data cited suggest that suicidal people lack realistic long-term goals. (I disagree. I always wanted to be a doctor but the only things that have prevented this from happening is my mental illness and the lack of financial resources for my education).
It is not that a rigid personality predisposes one to suicide rather rigidity is part of an effort to cope with a life crisis (Shneidman, 1981).
Suicide is one way of stopping thoughts. Cognitive control is another, more desirable and adaptive means of achieving the same goal.
Consequences of Deconstruction
• Disinhibition
• Passivity
• Absence of emotion
• Irrational thought
88% of suicidal subjects described the suicide attempt in terms that clearly reflected mere impulses (e.g., lack of adequate planning, saying attempt “was just on impulse”)…this fits with the escape theory, impulsiveness only reflects the disinhibition produced by the presuicidal, deconstructed state rather than being a stable personality trait.
It seems more plausible to suggest that such gambles occur when people lose their normal inhibitions against life-threatening risks.
According to escape theory, the effect is indeed available but the person is striving to keep it out of awareness. (lack of emotion is common with melancholy that has anhedonia)
This weakness may arise from the fact that many suicidal people were keeping much of their negative affect at bay by avoiding meaningful thought (or avoiding situations that caused them to reveal their true feelings when they are thinking about ending their life. This also is why some people will wonder why someone who looked and acted “normal and happy” are surprised to find that the person has attempted to end his life).
A successful escape would therefore require more drastic measures, such as taking one’s own life.
Cognitive functioning of suicidal people seem to fit a pattern of absence of emotion.
The correlation between suicidal tendencies and a wish to be someone else provides further support for the view of suicide as an attempt to escape from one’s own real identity. (I have found this to be try on many occasions in which I longed to be anywhere or be anyone other than my true identity. My identity as a male is not congruent with my biology and I long to escape to become a male gender, hence suicidal tendencies always increase when my gender identity is threatened with the use of improper pronouns)
Abundant evidence fits the view that suicide results from a combination of high standards or expectations and recent failures or setbacks.
A variety of evidence supports the view that negative affect leads to suicide, although much of this evidence is indirect (i.e., suicides arises from life situations that generally produce negative affect).
Depression may strengthen several links to the causal chain leading to suicide although it is not indispensable to the caudal process.
The cry for help may oppose, coexist with, or even fit together with the desire to escape into suicide.
Presuicidal state is defined as lack of future perspective, the concreteness, the high focus, and high standards of expectation of self.
Escape theory’s contention is that the ability of the self to meet important standards is a cause of suicide.
Durkheim’s (1897/1963) hypothesis of social integration has generally been regarded as a reasonable and accurate although incomplete, contribution to the theory of suicide. The notion of social integration is reflected in two steps in the escape theory. First, loss of social integration may constitute one of the stresses and setbacks that form the precipitating circumstances. Second, if one assumes anxiety and depression arise in response to actual or threatened exclusion from important social groups, than Durkheim’s contribution is especially relevant to escape theory’s hypothesis of negative affect. In short Durkheim’s social integration hypothesis first well into the escape theory.
An earlier version of escape theory in which suicide was treated as a way of solving life problems. Hence the term from Quinnett, “suicide is a permanent solution to a temporary problem”.
Suicidal people do not actually decide to kill themselves on the basis of rationalistic calculation. (in other words, they are mostly irrational when contemplating suicide).
The positive appeal of suicide according to escape theory is chiefly that of oblivion. Unlike aggression theories, which posit catharsis or other aggressive pleasure as the principle satisfaction in suicidal acts, the escape theory emphasizes the appeal of losing consciousness.
Pokorny and Kaplan (1976) found that suicidal people were distinguished by their inability to defend against or deal with aversive negative feelings about the self, connected with events that seemingly demanded substantial restructuring of one’s life (major life changes does not bode well with suicidal people).
Normal inhibitions are disengaged and whatever thinking the person does maybe filled with irrationality and distortion, in this condition, suicidal behavior may appeal as an engrossing immediate activity that effectively removes one’s mind from the troubling thoughts and meanings while promising relief through oblivion. The irrationality and disinhibition make the person less and less prudent in evaluating techniques that will accomplish the overriding ends of stopping emotion, stopping meaningful thought about the implications of recent events or stopping meaningful self-awareness. Suicidal action accomplishes all these needs.
Attempts versus Completed Suicide:
Whether the attempt is successful may deprend on other irrelevant factors, including luck, competence with lethal means, and the strength of a competing wish to live. Escape theory is thus primarily concerned with the causes of suicide attempts, rather than their relative degree of success, except in so far as the outcome is affected by the strength of suicidal motivation.
In many cases a suicide attempt may effectively stop one’s life and remove one from aversive circumstances at least temporarily (this is where the suicide attempt is cathartic. It means that the suicide attempt was able to stop the bad feelings and thus help make the person live again and doesn’t attempt again, for a while).
When preparing for suicide one can finally cease to worry about the future. For one has effectively decided that there will be no future. The past, too, has ceased to matter, for it is nearly ended and will no longer cause grief, worry or anxiety. And the imminence of death may help focus the mind on the immediate present.
Altogether, then, attempting to kill oneself may help the person to escape awareness of problematic life circumstances and inadequacies of self. The wish to die may arise from just such desires for escape. Even an unsuccessful attempt may provide an effective and powerful escape.

CAMS/SSF Collaborating, Assessment, Managing Suicidality/Suicide Status Form Blog

by Midnight Demon, posted in mood disorders, suicide, suicide attempt

The CAMS/SSF Blog by G. Collerone all rights reserved, copyright 2015

Despite the increase in awareness of suicide as a major psychological health problem, gaps remain in training programs for mental health professional, or even health care professionals who often come into contact with suicidal patients in need of these specialized assessment techniques and treatment approaches.

CAMS (Collaborating, Assessment, and Managing of Suicidality) was developed to modify clinician behaviors in how they initially identify, engage, assess, conceptualize, treatment plan, and manage suicidal outpatients. 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 a client’s suicidal phenomenology.

CAMS is designed to specifically target suicidal ideation and behavior as the central clinical problem, independent of diagnosis. Within CAMS, there is a basic belief that suicidal thoughts and behavior represent a fundamental effort to cope or problem solve, in pursuit of meeting legitimate needs (e.g., needs for control, communication of pain, or an end to suffering).

Ironically, the counselor’s capacity to understand and appreciate the viability and attraction of suicide as a means of coping provides the essential ingredient for forming a strong therapeutic alliance where more adaptive methods of coping can be evaluated, explored, and tested.

Philosophically speaking, CAMS emphasizes an intentional move away from the directive “counselor as expert” approach that can lead to adversarial power struggles about hospitalization and the routine and unfortunate use of coercive “safety contracts” (Jobes 2000, 2006)

Suicide Status Form, the CAMS assessment tool, uses Likert and qualitative open ended items related to the client’s psychological pain, stress, agitation, hopelessness, self-hate, and overall suicide risk. Throughout the assessment process, the client’s perspective is treated as the assessment gold standard. We suggest the regular use of brief symptom assessments collected at every clinical contact is analogous to medical personal routinely taking a patient’s vital signs to monitor overall physiological functioning and health.

This blog will discuss in detail the underpinnings of the CAMS model as well as its assessment tool, the Suicide Status Form (SSF). This blog uses multiple references that will be posted at the end of the post.

The reason I am writing this Blog is not only to disseminate the information of David Jobes’s work, but also to bring something that is easy to administer in a timely fashion, provided the client is English speaking, literate, and cooperative. The beauty of this assessment tool is that it can be used as part of the client’s medical record. There doesn’t have to be additional paperwork with the SSF as it already has the documentation required. Granted, I am not a clinician, so guidelines may be different but I think most places and practices has to have the axis’s and GAF score. I could be wrong about this but do what is best for your practice and clinic.

Another reason I am writing about this important work is that it saved my life and countless others. I believe in this so much that it is all I talk about when someone mentions suicide prevention. That is how strongly I believe in this brilliant seminal work. I think that if every clinician had this at their disposal, less suicides would happen. And isn’t that the goal that should be achieved?

CAMS, the Collaborating, Assessment, and Managing of Suicidality, came about from the need of one clinician-researcher to keep track of suicidal patients, to monitor their progress, to assess, manage, and collaborate with suicidal clients. The framework and research was done over a period of twenty-five years. The need to have something better than “no suicide contracts” and long assessment forms had to happen. There had to be an evidence based treatment and assessment tool out there as the days of long hospitalizations for depression were over. Many clients who were deeply suicidal were only kept for one to three days, tops. Soon as they were admitted, talk of discharge were discussed, much to the chagrin of the outpatient clinician. What was going to help the clients see another way out of their pain and misery?

In his book, Managing Suicidal Risk, Jobes realized four assumptions of why clinicians were reluctant to use suicide assessment instruments:
• Over reliance on clinical interviewing
• Wide spread perceptions that suicide risk assessments are clinically intrusive or simply too long
• Most existing instruments are atheoretical. Clinicians do not know the meaning of an obtained risk score
• Common perception that these instruments fail to fundamentally capture essential but elusive aspects of suicidality.
The end result was coming up with a framework and assessment tool that was evidence based, easy to administer and code, assess overall suicide risk, and have a treatment plan in place that both clinician and client agreed on. Behind the name of “managing suicide risk”, there is a double meaning of clinical work with suicidal clients is best performed by collaborating, managing the issue with the client, and in turn such an approach makes the whole challenge of working with suicidal risk much more manageable for the clinician. CAMS can be quickly learned and readily used with new cases, or with ongoing cases, wherever suicide risk is present. It is not meant to be a stand alone treatment but rather serves as a practical method that can be added to a standard treatment approach, a tool already existing in any mental health professional’s toolbelt.

The SSF (Suicide Status Form) is the tool that is used with CAMS and is made up of seven different pages that are divided into three phases of clinical care

• Index Assessment/treatment planning (pg 1-3)
• Clinical tracking (pg 4-5)
• Clinical outcome (Pg 6-7)

Thus, there are three distinct phases of the SSF that I will attempt to discuss in detail that are used within the process of using CAMS with any suicidal client. (I.e., there are distinct phases that include a beginning, a middle and an end.)

The first phase of CAMS require the first three pages that assess the suicide client. It uses four distinct sections. The first section (A) are Likert ratings. The first three Likert assessment construct (pain, perturbation, press) are based on the work of Edwin Shneidman (1988) and these make up the “cubic model of suicide”. The 4th item is hopefulness bases on Beck’s work. The 5th item, self hate, is based on Baumeister work of escape theory of suicide. He links intolerable perceptions of self to a need for suicide escape (see this blog post for more information on his work).

Psychological pain or as Shneidman has named it, psychache, is a profound and seemingly unbearable suffering that exists in the mind’s eye of the suicidal person. The psychological threshold has been exceeded and suicide occurs. Not everyone’s tolerance of psychache is the same. It is unique to each suicidal client.

Press (stress) is what Shneidman borrows from Murray (1938). For our purposes, the term refers to largely external (sometimes internal) pressures, stressors, or demands that impinge upon, touch, or psychologically affect an individual. External things such as relational conflicts, job loss, or events that occur in life that create significant distress. Alternatively, however, internal stressors such as command hallucinations can be similarly distressful. Presses are intimately linked to overwhelming feelings: the perception that I am overpowered by psychological demands. For the sake of clarity, further descriptions of press will be referred to as stress.

Perturbation, the second ‘P’, is a unique and crucial construct that is distinct and different from psychological pain. Shneidman defines perturbation as the state of being emotionally upset, disturbed, and disquieted. In his thinking, perturbation includes both cognitive constriction (narrow-minded or one way thinking) and need for self-harm or ill-advised action. It can be described as the “need to do something” to change the unbearable situation.

The “cubic model of suicide” conceptualizes suicidal behaviors that occurs from the synergy of these three constructs (psychache, perturbation, and press (stress); also known as the three P’s) They are rated on a Likert scale of 1-5. It is believed that should a score of 5-5-5 occurs, suicide is imminent and is therefore lethal.

This Cubic Model of Suicide is the hub of the SSF. It provides a three dimensional window into the client’s suicidal mind that meaningfully eclipses any one dimensional linear way of thinking about suicide risk assessment.

The next item on the SSF in Section A is hopelessness. No single construct has been more highly correlated with completed suicide than hopelessness. Jobes felt it imperative to include hopelessness as a key SSF construct. It provides an organizing focus for treatment. The therapist must be “hope vendors”. This notion strikes him as being uniformly true and central to successful treatment in general and particularly when working with suicidal people.

The next item in Section A is self-regard (self-hate). Baumeister conceptualized suicide as an escape from self. In his view, suicidal people are fundamentally driven to psychologically escape as a way to get rid of themselves. According to Baumeister’s theory, one’s negative view of self can become so unbearable (i.e., one’s self-loathing and self-hate is so extreme) that suicide becomes a compelling means to escape intolerable perception of self. Simply put, there is an intense psychological need for escape. It is perhaps self-evident that people who love themselves are fundamentally comfortable with who they are and most likely are not inclined to take their lives. Thus the beauty of Baumeister’s conceptual approach is that it captures two essential components of suicide struggle, the need for escape and the core importance of the self.

The behavioral assessment of suicide risk is the final component of the SSF. This construct, the Likert question of overall risk of suicide, does not cite any theorist. In this regard, the 6th item simply asks the client if they will or will not kill him or herself. The question is asked to the obvious implications for life and death and determines the medicolegal challenge to whether there is “clear and imminent” risk for suicide behavior. Suicidal states are much more shades of gray rather than crystal clear. They are hardly ever “clear”. And imminent is further convoluted as it could mean this second, later today, or sometime next week. While these definitions are elusive, these terms are important for the safety of the client and have significant implications for the potential liability of the clinician should a complete suicide occurs. Therefore, it made sense to include this risk as a final Likert construct on the SSF.

Next section: Qualitative SSF Assessments

This is a novel idea because most psychological assessment tools are either qualitative or quantitative. The SSF includes both to provide a much fuller picture of virtually any suicidal state. The three different qualitative assessments are 1) the Likert prompts, 2) Reasons For Living vs. Reasons For Dying (RFL/RFD), and 3) the one thing response.

The Likert prompts provides the clinician information about the client’s suicidal mind in his/her own words. For more information about the coding of these responses, see pages 18-19 of the book. But for the most part, in my opinion, these responses are straight forward to what the client is dealing with in this crisis and what is driving them to think suicide is the answer.

The SSF RSF/RFD was built upon the important work of Marsha Linehan (1983). She developed the reasons for living inventory. Linehan had the novel idea of studying suicide risk assessment in an entirely different way. With dozens of studies dedicated to risks factors and why people might want to die, Linehan argued that an equally compelling assessment notion was the value of examining why any person might want to live. The absence of RFL could be inversely correlated to increased suicide risk. In an opposite fashion, Jobes built the reasons for dying inventory in the same assessment (Jobes and Mann, 2000). These assessments provide a tool that parallels no other risk assessment in the literature that tells a picture of the client’s suicidal mind, in my opinion.

The one thing response gathers information directly from clients about the one thing that would make them no longer suicidal. This provides the clinician with potentially more clinical information that leads directly to a treatment intervention. For example, if the client state that being in less pain would make them no longer suicidal, the clinician can work with the client to decrease that pain.

Section B has the SSF empirically-based risk variables on the second page of the initial form. These risk factors have been well researched risked factors that are the best variables for suicide risk.

Section C is the wonderful piece of the SSF. It is the section where both the client and clinician come up with a treatment plan, together! In this section, treatment goals, length of treatment, crisis response plans, and specific interventions are discussed. For the Crisis response plan example, please check out this blog post. It emphasizes what the client will do should he/she become intensely distressed, impulsive, and suicidal. These measures are clearly planned in anticipation of potential crises. This becomes a contract where the client then signs in agreement.

The tracking form (pg 4-5) omits sections b and c. It assesses similar to the initial form. It was created so that the suicidal feelings are “tracked” and monitored. This is to be used until the suicidal thinking has resolved for three sessions. The outcome form (pg 6-7) describes the overall experience of the crisis and provides feedback to the clinician. It also assesses the Likert ratings to be sure the suicidality has been sufficiently dealt with. If the client should become suicidal at anytime before the outcome is used, then a new initial form should be evaluated again.

All three forms then have sections that provide post session evaluations. There is a space for clinical notes as well as the mental status of the client. It also has information regarding the outcome of the appointment and when the next scheduled appointment is. That is the beauty of this assessment tool. No extra paperwork!

here is the DSM IVR Form

Update 23/November/2016 Dr. Jobes has a 2nd Edition of the Managing Suicide Risk that is available through eBooks. It has the DSM V form of the SSF. I am unable to load it at this time, as I do not have his permission to load it on my blog. If I am able to find an electronic version of it, I will place it here instead of the DSM IV version. Thank you for reading.

Jobes, D. A., Moore, M. M., & O’Connor, S. S. (2007). Working with Suicidal Clients Using the Collaborative Assessment and Management of Suicidality (CAMS). Journal of Mental Health Counseling, 29(4/October), 283-300.

Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.

Jobes, D. A. (2012). The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence-Based Clinical Approach to Suicide Risk. Suicide and Life Threatening Behavior, 42(6), 640-653.

Murray, H. A. (1938). Explorations in Personality. New York: Oxford University Press.

Linehan, M., Goodstein, J., Lars Nielson, S., & Chiles, J. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51(2), 276-286.

Jobes, D. A., & Mann, R. E. (1999). Reasons for Living versus Reasons for Dying: Examining the internal debate of suicide. Suicide and Life-Threatening Behavior, 29(2), 97-104.

Jobes, D. A. (2009). The CAMS Approach to Suicide Risk: Philosophy and Clinical Procedures. Suicidologi, 14(1).

Baumeister, R. (1990). Suicide as Escape From Self. Psychological Review, 97(1), 90-113.

Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.

Shneidman, E. S. (1996). Suicide as psychache. In J. T. Maltsberger & M. J. Goldblatt (Eds.), Essential papers on suicide (pp. 633-638). New York, NY: New York University Press.

Oordt, M. S., Jobes, D. A., Fonseca, V. P., & Schmidt, S. M. (2009). Training Mental Health Professionals to Assess and Manage Suicidal Behavior: Can Provider Condience and Practice Behaviors be Altered? Suicide and Life-Threatening Behavior, 39(1), 21-32.

copyright 2015, Collerone, G