For those wondering, here is what a future blog post of CAMS is about. I will be writing more about this and the SSF in greater detail.
Copyright 2014, Midnight Demon p 10-11. All rights reserved. Collerone, G
David Jobes is my idol. I really love his works and he is a great suicidologist. He really gets what it means to be suicidal and better than that, he wants to help suicidal people. Most clinicians do not want to deal with suicidality with a ten foot pole. They are afraid of the risks involved, from liability to malpractice to ethical concerns. Dr. Jobes has written about all of this and with a passion created a clinical framework to deal with this population. The framework is called CAMS (Collaborating Assessment, and Managing of Suicide). It is a philosophical yet empirical theory that has helped thousands of suicidal people get out of their suicidal thinking and on with their lives. CAMS was developed specifically to modify clinician behaviors in how they initially identify, engage, assess, conceptualize, treatment plan, and manage suicidal outpatients. It is a brilliant concept that is much needed in outpatient therapy as inpatient treatments have gone by the way side and insurance companies have dictated more on treatment than clinical matters. The heart of CAMS is the emphasis on a strong therapeutic alliance where counselor and client work closely together to develop a shared understanding of what brings the client to think about suicide. CAMS is similar to the Aeschi model, where the clinician is open to hearing the clients story of why they are suicidal. It is a patient oriented model rather than a physician oriented model.
These CAMS model has an assessment tool called the Suicide Status Form (SSF) and it is used to assess, treatment plan, and track suicidal patients. The cool thing about this assessment is that it multi-faceted and is not restricted to one mode of therapy or type of clinician. It can be used across all disciplines and types of therapists (DBT, CBT, psychodynamic, etc.) As long as there is a willingness to adhere to the principles of putting the client first, that is the first step in the right direction.
The SSF is a seven page assessment tool that is used to initiate, track and follow the outcome of suicidality. It was created so people who are suicidal are not lost to follow up. More can be said about this in Jobes’s book, Managing Suicide Risk.
I have used the SSF in my therapy. But I have to confess that my therapist and I never followed through completely with it. We would use the initial and the tracking forms but never quite got to the outcome phase of the assessment. Because I felt like it was my idea, and she wasn’t into changing her style of treatment, it was difficult to follow through. But that is okay because I am still here regardless. We mostly use the SSF to assess my psychological pain, reasons for living/dying, and the level of my suicidality.
I will repeatedly talk about the works of Jobes, Shneidman, and the Aeschi model throughout this book. It is because I think there is not enough awareness of this in the world of psychiatry, psychotherapy and psychology. And there is even less in the training of therapists and future psychiatrists. It really is a shame that not enough awareness of suicide is mentioned in the course of graduate college training and it is often left up to the students to figure it all out on their own, if at all. Usually it isn’t until a suicide or attempted suicide happens that people have hindsight and that isn’t always 20/20.
“Do I” is a song by Luke Bryan, one of my favorite male artists. Every time I hear the song, I wonder if my therapist and I are still a good fit. I think we are as we have been together for so long, but I often wonder if I am too much for her to bear or that I am a burden to her.
I went to Starbucks for the first time in four weeks. All my baristas were gone from the Davis location. I was so bummed not to see familiar faces. I hope they were off that day or just on vacation. I will be super bummed if I have to deal with new people. I will go there tomorrow and see how they make a clover coffee. I won’t order their reserve, just the Pike. I seem to like that better than their regular iced coffee, probably because it is made fresh.
I am still feeling good. Today on Mental Health chat on Twitter, the discussion was bipolar disorder. I have been diagnosed with bipolar as I have had some hypomanic episodes. I have never been full blown manic. I had one episode while I was in the hospital. I was really jocular and upbeat. I was also really racy and despite taking Ativan regularly, it still didn’t alter my mood. This lasted until I took some pain meds and then I crashed, hard over this past weekend. It was fun while it lasted and I wish I still felt that great. I felt like nothing could touch me. Suicide was furthest from my mind and I felt like I was on top of the world, even though I was in a psych hospital. It was very strange. I was expecting to go down, but I wasn’t expecting to be “that” down. I was really tired and just needed to rest but I was too restless to actually sleep. I took a prn to calm down some and finally was able to get some rest. Everyone was telling me I looked tired and down. With my anticipated discharge on Monday, I was thinking that it was not going to happen. I really didn’t want to leave the hospital feeling the way I did this weekend. It was such a major depressive episode that I didn’t want to chance leaving the hospital and then acting on my thoughts. So I had to practically beg to stay one more day. My case manager asked me why I wanted to die. I told her to end the pain and the indignity that I was feeling with my disability. I really just wanted to say “are you fucking kidding me”? This hospitalization, I experienced everything I do when I am home. I crapped my pants, leaked urine, was suicidal more than a few times, and was overall, severely depressed. The hypomania was a godsend. I just wish it lasted longer than it did. But it never does and the longer it lasts, the worse my depression is. I think I had a total of 12 hours of it. Not long enough to do any financial damage or anything, but enough to let me know I was alive again, that something inside me wants to keep going no matter what the suicidal thoughts might be.
My writing partner has suggested that I write a book about coping as a suicide attempt survivor. I have been giving it some serious thought and I think I can write it. I don’t know if I am going to write it in blog form or book form yet. Depends on how much I can actually write. But a large part of what works for me is already out there but people don’t utilize it. For example, I gave the crisis response plan (see this blog about it) to one of the patients because it was less confusing than what the hospital was giving out about distress tolerance. The hospital uses DBT type of works, which is fine for some people but may not fit for everyone. And, who the fuck is going to look at a piece of paper when they are in crisis mode?? I know I am not. I have been there too many times. But I have found that the crisis response plan has been helpful to me since David Jobes uses it in his work with suicidal patients.
One of the mental health counselors was interested in my book and the SSF, Suicide Status Form (see my comparisons of psychological pain scales for more information). I wish I could publish it on my blog but it is not available in electronic form and I would be violating copyrights. I use this in my therapy when I am suicidal. It helps because it gives my therapists some way of knowing which areas are causing me to want to die. I think it would be wonderful to use in an inpatient stay but I don’t get to make those types of decisions. Anyway, this MHC and I were talking about it and it was so good to talk about clinical stuff with someone again rather than just stuff about me. It was like being back in academia again where exchanging ideas is so important for learning. I just wish my treatment team was on board with my ideas for my treatment than just saying that I have to stay away from suicide stuff. I told them that I can’t. It is apart of me like breathing. I am always thinking about what is best for me and I am always searching for an answer to end the suicidal thoughts. Just telling me to stop is not going to work. I read clinical stuff as well as blogs because I want to keep abreast of the latest research. Even though I am no longer a member of the AAS, I still keep up with the suicide research. I wish I could afford their membership but I am on such a fixed budget that I can’t. I also would love to have the archives of suicide research journal but again, I can’t afford membership. It totally sucks. I was hoping that the sales of my book would provide me with additional income but it hasn’t taken off the way that I wanted it to. I have not reached my goal of selling 100 books, though I am half way there. While I was in the hospital, I sold two books. Not my personal copies, just through Amazon. I did bring one with me to give away but I never did. I still have it. My book signing has not gone well. It brought extra income just to buy food and the essentials. The struggles of the writer. I just have to find the right audience to get my book sold.
I am planning on getting my book reviewed by the AAS (American Association of Suicidology). It will be sent out next week along with a book for my editor. I have been meaning to send it out but things always seemed to get in the way. I wasn’t planning on being in the hospital for so long. I really thought I was going to stay a few days and that would be it but they had other plans when I told them I was going to kill myself when I got out. Hospitals tend to frown upon that. I put them in a “bind”. Sorry, but that was how I was feeling. I really was in bad shape and all that I was feeling felt normal to me. Looking back, I see that I wasn’t as rational as I thought I was. I guess that small overdose was the wake up call for my outpatient treaters to put me in the hospital.
It is really hot today and the humidity is killing me, making me really irritable. I only left my room for the usual items: coffee, food, and bathroom. I did manage to go to the bank to make a withdrawal. I am going to ask my Brother in law for some cash because I need my meds. And this month I am short. It’s my own fault because I thought I wouldn’t need groceries. I can never keep it to the minimum of what I need.
Sallie Mae keeps calling me every three hours now. I am going to answer the next time they call and make them look like a fool. If they ask what can I pay them, I will say $10/month. Screw them. I can barely buy groceries and they want $132+ dollars a month? Fuck them.
I talked to my therapist even though I fired her. I wasn’t in a talking mood. She did the SSF to see where I was. I was so out of it I don’t remembered what I answered. Doesn’t matter now. My sister is home so I can’t kill myself even if I really wanted to. There is no way I am killing myself with the potential of my little niece finding me. So I am stuck here, again. And I am not happy about it.
The only good news to report is that my pain levels have shifted downward. I am not in as much pain as I was. I hope this stays this way for the next week because I am out of my pain meds, again. I don’t know what possessed me to have my doc reduce my number of pills. Course, there was a time when I was hardly taking them. I would have pain flares at least twice a month. Now it’s like almost every week. I know it is just to adjust to the temperature. I get that but why does it have to be so painful?
I started a letter, in a word doc, that I thought I would post as a blog. It was for my therapist and her foolish ways about me wanting to live. Anyways, it got a little more personal than I would like and never published it. I might read it to her tomorrow or might password it so she can open it but she isn’t too tech savvy so I am not sure it is worth doing. I might get more aggravated than helped.
Issues around my body came about today. I told her I was ugly and there is no fixing that. She was trying to tell me otherwise but it was falling on deaf ears. I can tell I really want to talk about this because I keep checking the internet and twitter for the past 1/2 hour. So I will just leave it as I am ugly and my therapist is fired because she thinks otherwise.