To Hospitalize or Not to Hospitalize, the Question Most Therapists Struggle with in Helping Clients with Suicidality

In this interview, Dave discusses his career in researching suicide and how Marsha Lineman encouraged him to go beyond his assessment work to create an intervention for therapists working with clients who are suicidal. He discusses how many therapists struggle to know how to effectively assess suicide risk and intervene in a manner that can build the therapeutic relationship as well as keep clients safe. He explains that due to lack of training, knowledge of evidence-based interventions, and fear, therapists often jump to hospitalizing their clients, when it may not be necessary, and he challenges the overall utility and effectiveness of hospitalization altogether. Dave discusses his clinical tool and intervention, the Suicide Status Form (SSF-4) and his Collaborative Assessment and Management of Suicidality (CAMS), which have been found to decrease suicidal risk in patients through randomized controlled trials. He explains that therapists can effectively treat suicidality through collaboration, being clear and transparent on the limits of confidentiality and what may lead to a hospitalization. His intervention helps reduce access to lethal means as well as the value of identifying and treating patient-defined "drivers" for suicide, which research shows leads to decreasing hopelessness while increasing hope. The topics of suicidal ideation vs. suicidal intent are discussed and how ideation in itself is sometimes a form of coping. He speaks to the most feared situations where the therapist is not sure if the client can be sufficiently stable for outpatient care, and he addresses cases in which clients who take their life despite all clinical best efforts. Dave encourages therapists to become more competent in suicide assessment and treatment, because even though clinicians may screen for suicide when accepting patients, it is inevitable that they will have clients who are suicidal. He argues that suicide risk being "not something I work with,” is a problematic stance as it reflects an unwillingness to work with the one fatality of mental health. David A. Jobes, Ph.D., ABPP, is a Professor of Psychology, Director of the Suicide Prevention Laboratory, and Associate Director of Clinical Training at The Catholic University of America. Dave is also an Adjunct Professor of Psychiatry, School of Medicine, at Uniformed Services University. He has published six books and numerous peer-reviewed journal articles. Dave is a past President of the American Association of Suicidology (AAS) and he is the recipient of various awards for his scientific work including the 1995 AAS “Shneidman Award” (early career contribution to suicidology), the 2012 AAS “Dublin Award” (for career contributions in suicidology), and the 2016 AAS “Linehan Award” (for suicide treatment research). He has been a consultant to the Centers for Disease Control and Prevention, the Institute of Medicine of the National Academy of Sciences, the National Institute of Mental Health, the Federal Bureau of Investigation, the Department of Defense, Veterans Affairs, and he now serves as a “Highly Qualified Expert” to the U.S. Army’s Intelligence and Security Command. Dave is a Board Member of the American Foundation for Suicide Prevention (AFSP) and serves on AFSP’s Scientific Council and the Public Policy Council. He is a Fellow of the American Psychological Association and is Board certified in clinical psychology (American Board of Professional Psychology). Dave maintains a private clinical and consulting practice in Washington DC; clinicians can get trained in the CAMS evidence-based treatment at https://cams-care.com/.