Collaborative management and assessment of suicidality (CAMS)

Written by Grow Therapy , Grow Therapy

Clinically reviewed by Grow Therapy Clinical Review Team

When a person’s life is at stake, a general approach to psychotherapy might not be enough. Fortunately, there are treatments designed specifically for addressing thoughts of self-harm and suicide, as well as suicidal risk. In the Collaborative Management and Assessment of Suicidality (CAMS) framework, therapist and client work with tools — such as the Suicide Status Form (SSF) — to uncover root causes and ultimately rediscover reasons for living.

What are the origins of CAMS?

The CAMS framework was developed by a therapist named David A. Jobes based on his suicidality and clinical psychology research at the Catholic University of America. Prior to that, Jobes had studied suicide prevention as a graduate student at American University. 

In 2014 Jobes and his colleagues founded CAMS-Care, a company that describes itself as “the only authorized trainer of the CAMS approach.” Throughout his decades-long career, Jobes has worked as a private practice therapist, as the President of the American Association of Suicidology, as a consultant for the Centers for Disease Control and Prevention, and a Board Member of the American Foundation for Suicide Prevention, among many other roles.

During the past decade in particular, Jobes and the Suicide Prevention Lab team have focused on proving the efficacy of CAMS. In his bio page for the Catholic University of America, Jobes wrote, “We are presently engaged in funded randomized controlled trials (RCTs) to investigate the effectiveness of CAMS with patients in the US and abroad.”

When is CAMS used?

Therapists typically employ CAMS with outpatient and inpatient clients who have had persistent suicidal thoughts, suicidal ideation, thoughts of self-harm or attempts at self-harm, and/or suicide. 

Sometimes therapists determine this status only by talking to the client. In other cases, the decision to use CAMS is a response to a concerning score on a risk assessment form such as the Suicide Status Form (SSF). In a 2016 clinical trial and research paper, of which Jobes, D.A. is a co-author, the team described how it draws on “central suicide markers” previously developed by other researchers:

  1. Psychological pain
  2. Stress
  3. Agitation
  4. Hopelessness
  5. Self-hate

While describing their symptoms, patients rate each of these metrics on a scale from 1 to 5, with 5 being most severe. Using the results of this risk assessment, the mental health practitioner decides whether CAMS is warranted and, if so, what the stabilization plan should be.

There are other scales and therapeutic frameworks clinicians often consider while deciding when to use CAMS. In the trial mentioned earlier, researchers utilized the Beck Scale for Suicide Ideation – Current (BSSI-C) as part of their criteria for participation. 

Here are several other scales clinicians may reference when they are trained in the Collaborative Management and Assessment of Suicidality:

How does CAMS work?

CAMS is broken up into three phases: the beginning, middle, and end.

Beginning

During the first session, the client uses four pages of the Suicide Status Form (SSF) — and sometimes other scales — to rate their emotional pain and reasons for living versus dying. The therapist asks the client questions and then uses those answers to make a suicide-focused treatment plan called a Stabilization Plan. This may include keeping the client away from things they could use to harm themselves, strategies for coping with suicidal thoughts, bringing a psychiatrist into the fold, or outlining emergency contact plans.

Middle

During the “interim sessions” (the sessions in between the first and final session), two pages of the SSF are used as the therapist and client address the “drivers of suicidality. Along with his co-researchers, Jobes identified two types of suicidal drivers: direct and indirect. 

  • Direct drivers – Broad types of thoughts, emotions, and behaviors that correlate with specific suicidal ideation and thoughts.
  • Indirect drivers – Life circumstances and events that cause or fuel the direct drivers. Common factors are unemployment, trauma, and abuse.

During the interim sessions, the therapist may integrate other types of therapy, including dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), and mindfulness. The stabilization plan is reviewed, and each session ends with an update to the treatment plan, ensuring the interventions are working as needed. This phase usually continues until the therapist observes significant, consistent improvement over three or more sessions.

End

In the final phase, also called the Outcome/Disposition Phase, the final two pages of the SSF are used. Together, the therapist and client agree that the client is able to manage their suicidal thoughts and feelings. Ideally, the client will no longer be reporting suicidal thoughts. Next steps vary depending on the specific case.

CAMS differs from other types of therapy in that its primary focus is on the risk of suicide. CAMS also features something similar to homework — the SSF forms — but this is completed in-session, not after, and the client and therapist work on these forms together. 

How long does CAMS take?

The length of CAMS depends on the frequency of sessions, severity of symptoms, clinical judgment, and patient resources. If a patient has relatively manageable symptoms, a strong support network, and the financial means to meet with an effective therapist multiple times per week, the course of treatment could conclude in about a month. In cases where the patient is severely suicidal, socially isolated, and financially limited, it could take many months for a therapist or facility team to feel comfortable entering the Outcome/Disposition Phase.

Typical sessions are weekly, lasting between 50 and 60 minutes. Interim sessions dedicate around five minutes to updating the SSF assessment. According to the CAMS-care website, CAMS can resolve a client’s suicidal ideation in six to eight sessions.

Is CAMS effective?

CAMS is an evidence-based approach that has proven effective for treating suicidality in adults and adolescents. Research has shown that CAMS leads to a reduction in the frequency and intensity of suicidal ideation. In addition, it can lead to decreased depression symptoms, increased hopefulness, and even help treat related mental disorders like borderline personality disorder (BPD).

Below is a breakdown of the studies that have been instrumental in demonstrating efficacy. Notable researchers have assisted Jobes, namely Chloe E. Chessen, Katherine Anne Comtois, and Stephen S. O’Connor (sometimes cited as O’Connor, S).

How to find a collaborative management and assessment of suicidality (CAMS) therapist

If you think collaborative management and assessment of suicidality (CAMS) might be right for you, it’s important to speak with a licensed and experienced clinician. There are many types of mental health care providers who are trained in CAMS,  including licensed marriage and family therapists (LMFTs), licensed clinical social workers (LCSWs), psychologists, psychiatrists, psychiatric nurses, licensed professional counselors (LPCs), licensed mental health counselors (LMHCs), and more.

On top of finding a therapist who is trained in CAMS, you want to make sure they meet your other needs. For example, if you struggle with symptoms of borderline personality disorder, you’ll want to find a CAMS therapist who also uses dialectical behavioral therapy (DBT) in their practice.

In addition, finding a therapist who accepts your insurance can make therapy much more affordable. You can find a therapist who accepts your insurance and specializes in CAMS by using Grow Therapy. After filtering for your location, insurance, and needs, you can then select “Collaborative Management and Assessment of Suicidality (CAMS)” from the “Treatment methods” drop-down.

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Dialectical behavior therapy (DBT)

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This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.