Tag: collaborating in the management of suicidal patients

A Special Blog Post

by Midnight Demon, posted in blogging, suicide

This is my 500th blog post. I wanted it to be memorable. And it will be, I hope, to me anyways.

I thought I would talk about David Jobes. He is my idol in the field of suicidology. I talk a lot about his work on my blog because I want to spread the word that there are treatment plans and assessment scales available for those who are suicidal. It took twenty-five years for this to happen. It might not catch on like DBT (Dialectical Behavior Therapy) did for borderline personality disorder but I am hoping that through my blog, someone has at least an inkling about it.

His work is CAMS: the Collaborating Assessment and Managing of Suicide. It is a framework that allows the suicidal patient/client to work with the therapist in his or her treatment plan. By working together, therapist and client, it is hoped that suicidal thinking will decrease enough so a completed suicide is avoided. This does not mean that the suicidal thinking will go away completely. Nor does it totally prevent a suicide. During one of his talks, he spoke of a clinician in Texas that followed the CAMS and the assessment tool, SSF (suicide Status Form) to the letter with one of his suicidal clients. The client ended up killing himself. The clinician did everything that he could. But sometimes, there is still the risk.

The SSF is a seven page form that uses an initial, tracking, and outcome form to monitor and assess suicidality. It is based on the work of several clinicians. I won’t go into great detail about this because you can find out more in Dr. Jobes’s book, Managing Suicidal Risk. The link it to the Amazon website where you can purchase it. I would love to post the SSF one day but I would be violating copyrights, though in the book you can make copies of the form. I just can’t do it electronically, yet.

The wonderful thing about this form is that it is a self report about the client’s thinking about suicide and also has clinical information in the end so that both client and clinician fill it out to assess and document the suicide risk. It doesn’t take more than 10-15 minutes to fill it out (might take longer if the person has trouble understanding reading and writing English or has a disability that prevents that from happening, such as dyslexia). It is individualized for the client and that is a huge thing Jobes tries to do. It is not a fit all in one box, so to speak. It should broaden the thinking of the client and clinician to help bring together and work together to prevent the client from committing suicide. In the SSF, it talks about reasons for living and dying, assess psychological pain, hopelessness, the need to escape, and also asks the question, what would make you not kill yourself? I have used this form in my therapy sessions and that is the first question my therapist asks me when I am in the throws of a suicidal crisis, which happens more times than not for various reasons.
Mostly it has been my word that has kept me alive and I do hate myself for it at times. I have told my therapist that I would keep myself safe and I have, though sometimes, I overmedicate to do so.

Background information of Jobes is that he is a professor at the Catholic University of America and also has a private practice in the Washington, D.C. He has written in at least a half dozen books (some of which I own, if I could afford it I would own all) and countless research articles relating to his work and also to the field of suicidology. He not only write about his work but also about the legality and ethical matters of dealing with a suicidal client.

writing bug today

by Midnight Demon, posted in depression

I know this is my third blog of the day but I can’t help it. I have the writing itch and I can’t seem to stop it. I just can’t stop thinking about what I have been writing today about suicide and it has not really triggered me but I feel like I can’t stop it.

A fellow blogger wrote a comment about the frustrated needs in my last blog. I guess I wasn’t too clear about that. Frankly I am not too clear about it myself, only in the respect that I can see it myself and maybe that is not really clear. I will have to research it more as there are some top ones that always get people to think about suicide when their needs are frustrated or not met. I know succorance, validation, and affiliation are some of the top ones. I don’t know if this will make sense if you haven’t read my other blog, (my suicide career), it talks about frustrated needs as a precursor to suicidal thinking. It is the buildup of these unmet needs that might lead to suicide. Everyone has them, and most are met but for those that are mentally ill it can be challenging to have each of them met and feel satisfied with them. And all of this is related to the father of suicidology, Edwin Shneidman. He was a great guy that thought long and hard in the path of suicide prevention. He so wanted a psychometric assessment to evaluate suicidal thinking. Unfortunately, what he came up with was not always sound and easy to perform. Luckily, his successor, David Jobes, has been able to have a validated and empirically sound assessment called the suicide status form. Unfortunately, copyright laws prevent me from posting a new form. There is however one that has been filled out online if you search for it. I have used this form in my therapy and it has helped me. You can get it in his book Managing suicide Risk. I have made copies and have it in a word doc for easy copying.

I don’t know why I am thinking about this today. I have been up since three thirty this morning writing and writing and writing. Now my writing partner has come up with something else for me to write and somehow have it crossed linked to our blogs as tomorrow is National suicide prevention day. This is a wild idea. Hope it works out well for the both of us.

exciting article

by Midnight Demon, posted in depression, mental disorders, mental illness, mood disorders, psychache, psychosis, suicide, suicide attempt

Just read an interesting article about the Collaborating and Management of Suicidality (CAMS). I can’t believe this theory is 25 years old. It is gaining more acceptance as time goes on as more countries are using it as a treatment modality in suicidal people. It is a clinical intervention that is used as a collaboration between client and therapist in the treatment and care of a suicidal person. I find it one of the best out there and it is the best because it can be used across the disciplines in the mental health field.

I will be writing more about this. I write a lot about Jobes, the creator of CAMS and the SSF (suicide status form). He is the most brilliant person I have ever met. The fact that this is going to electronic way I think will be used across mediums and will be easier to deliver. Most clinicians have gone the electronic way but not all. This makes me want to go back to school and get my degree.

comparisons of psychological pain scales

by Midnight Demon, posted in Chronic pain, mental disorders, mental illness, mood disorders, psychache, suicide, suicide attempt

Suicide attempts are the leading reason why people go to see a mental health professional. What does it mean after an attempt and will the person get the help they need. There are many assessments on risks but few deal with the psychological pain that is attached to the attempt. In my research I have found three clinicians that have developed assessments to help deal with this issue. They are Dr. David Jobes from Catholic University of America, Dr. Israel Orbach in Israel, and Dr. Ronald Holden from Queen’s university in Canada.

Dr. David Jobes wrote and developed what is known as a suicide status form and believes that by collaborating with the client, you can decrease the suicidality (Jobes, 2006; Jobes & Drozd, 2004; Michel & Jobes, 2011). The form consists of three parts: initial, tracking, and outcome. The initial form has the initial evaluation of suicidality, followed by a treatment plan agreed upon by both client and clinician, and then clinical notes such as axis I diagnosis, mood status and session outcome (follow up appt, discharge, or hospitalization). The tracking and outcome are similar in nature. Tracking follows the suicidality. This is used until suicidality is resolved. I base his study on research articles and the two books he has written on the subject.

Dr. Ronald Holden was able to validate his scale of psychache that has helped to focus treatment on psychological pain. This is a 13 item scale rated on a Likert rating of 1-5. The total number of points is 65. The higher the psychache, the higher risk of suicide. The first 9 items deal with the psychological underpinning of what is causing suicidal thinking. The last 4 items deal with the likelihood that this person will act on it. His work I base on his research article.

Israel Orbach (Orbach, Mandrusiak, Gilboa-Schectman, & Sirota, 2003; Orbach, Mikulincer, Sirota, & Gilboa-Schectman, 2003) also has a mental pain scale but has 44 items and cannot be used, in this author’s opinion, in the clinical setting but does have some merit in the initial evaluation of psychological pain. The overall score is intricate and complex as it breaks down the 44 items into quartiles. The study was very small, less than 50 participants and was broken down into two parts. I base his study on his research article.

These combined formed my contention that psychological pain is a causal factor in suicidal thinking.

Suicide status form:
This is a collaborative effort between client and therapist in understanding the reason why a person is suicidal. These forms, initial, tracking, and outcome, provide a base for which to form a treatment plan for working on decreasing suicidality. It was built on the theories of multiple clinicians in the field of suicidality. These clinicians are Shneidman (Shneidman, 1993), who focused on psychological pain, Beck, who focused on cognitive treatment of depression, Baumeister (Baumeister, 1990), escape theory in suicide as escape from self, Linehan (Linehan, Goodstein, Lars Nielson, & Chiles, 1983), reasons for living when you want to die, and Jobes (Jobes, 1995), tracking suicidality.

Dr. Jobes has developed an assessment tool and mangement for suicidality. This management includes the suicide status form (SSF) and uniquely tailors the treatment around individual needs. This is based on the client’s direct input into their treatment. This collaboration takes away the therapist as expert and puts the client in charge of treatment. This also makes things more comfortable and meaningful. Dr. Jobes believes that by tracking the course of treatment, there may be better outcomes and those that are suicidal do not go by the way side, meaning get lost in the system or are ignored after their treatment ends. In his seminal work (Jobes, 1995), he found that nearly half of those that reported to be stressed and suicidal responded to treatment. The other half either dropped out of treatment, got hospitalized, or remained chronically suicidal. This propelled him to develop the SSF to keep track of the suicidal clients and their outcome.

OMMP: Orbach and Mikulinger Mental Pain Scale.
This scale is a 44 item assessment that measures mental pain on nine factors ranging from irreversibility, loss of control, narcissist wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. These factors are what contributes to mental pain as explained by the authors (see Orbach et al, 2003). Items are scored on a Likert scale of 1-5. In my opinion, given the complexity of this assessment, it cannot be used for clinical use but does hold a valuable research tool.

Holden scale.
Dr. Holden’s psychache scale is a thirteen question self-report of items based upon Shneidman’s book, Suicide as Psychache (1993). Psychache is defined as despair, anguish, hopelessness, and psychological pain one feels. Each items are ranked on a 1-5 point scale ranging from never to always agree, neither, or from strongly disagree to strongly agree (Holden, Mehta, Cunningham, & McLeod, 2001). Scores are from thirteen to sixty-five. This scale is easy to use and can be used clinically, with the permission of the author to reproduce it. What I like about this scale is that it is user friendly, scores can be added quickly, and the tracking of suicide can be seen. With higher results, suicide is more likely to occur. The lower the score, the lower the risk of suicide.

These three assessments are comparatively the same but are just called different things. The main point of suicide ideation is to find out what is driving the person to think about suicide and to try and prevent it from happening. Ideally these scales should be used in the first session and the Holden and/or SSF used thereafter.

Baumeister, R. (1990). Suicide as Escape From Self. Psychological Review, 97(1), 90-113.
Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A., & Drozd, J. F. (2004). The CAMS approach to working with suicidal patients. Journal of Contemporary Psychotherapy, 34(1), 73-85.
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.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.
Orbach, I., Mandrusiak, M., Gilboa-Schectman, E., & Sirota, P. (2003). Mental Pain and Its Relationship to Suicidality and Life Meaning. Suicide and Life-Threatening Behavior, 33(3), 231-241.
Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schectman, E. (2003). Mental Pain: A Multidimensional Operationalization and Definition. Suicide and Life-Threatening Behavior, 33(3), 219-230.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.

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